From: [w--li--h] at [ix.netcom.com] (William House )
Newsgroups: alt.law-enforcement,alt.drugs,alt.drugs.culture,alt.drugs.hard,alt.drugs.pot,rec.drugs.cannabis,rec.drugs.misc,rec.drugs.psychedelic,talk.politics.drugs,talk.politics.libertarian,talk.politics.misc,soc.culture.african.american
Subject: p2 The Nadelmann Study : Costs, Consequences, and Alternatives to Prohibition.
Date: 26 Oct 1995 14:37:57 GMT

   Perhaps the most difficult costs to evaluate are those that relate
to the widespread defiance of the drug prohibition laws; the effects
of labeling as criminals the tens of millions of people who use drugs
illicitly, subjecting them to the same risks of criminal sanction, and
obliging many of those same people to enter into relationships with
drug dealers (who may be criminals in many more senses of the word) in
order to purchase their drugs; the cynicism that such laws generate
toward other laws and the law in general; and the sense of hostility
and suspicion that many otherwise law-abiding individuals feel toward
law enforcement officials. It was costs such as these that strongly
influenced many of Prohibition's more conservative opponents.

   Among the most dangerous consequences of the drug laws are the
harms that stem from the unregulated nature of illicit drug production
and sale (37).  Many marijuana smokers are worse off for having smoked
cannabis that was grown with dangerous fertilizers, sprayed with
paraquat, or mixed with more dangerous substances. Consumers of heroin
and the various synthetic substances sold on the street face even more
severe consequences, including fatal overdoses and poisonings from
unexpectedly potent or impure drug supplies. In short, nothing
resembling an underground Food and Drug Administration has arisen to
impose quality control on the illegal drug market and provide users
with accurate information on the drugs they consume. More often than
not, the quality of a drug addict's life depends greatly on his or her
access to reliable supplies. Drug enforcement operation that succeed
in temporarily disrupting supply networks are thus a double-edged
sword: they encourage some addicts to seek admission into drug
treatment programs, but they oblige others to seek out new and hence
less reliable suppliers, with the result that more, not fewer, drug-
related emergencies and deaths occur.

   Today, about 25% of all acquired immunodeficiency syndrome (AIDS)
cases in the United States and Europe, as well as the large majority
of human immunodeficiency virus (HIV)-infected heterosexuals,
children, and infants, are believed to have contracted the dreaded
disease directly or indirectly >from illegal intravenous (IV) drug use
(38). In the New York metropolitan area, the prevalence of a
seropositive test for HIV among illicit IV drug users is over 50%
(39). Reports have emerged of drug dealers beginning to provide clean
syringes together with their illegal drugs (40). In England, recent
increases in the number of HIV-infected drug users have led to renewed
support among drug treatment clinicians for providing IV heroin
addicts with free supplies of injectable methadone and heroin; this
reversal of the strong since the early 1970s for oral methadone
maintenance has been spearheaded by Philip Connell, chairman of the
Home Office Advisory Committee on the Misuse of Drugs (41). But even
as governments in England, Scotland, Sweden, Switzerland, Australia,
the Netherlands, and elsewhere actively attempt to limit the spread of
AIDS by and among drug users by removing restrictions on the sale of
syringes and instituting free syringe exchange programs (42), state
and municipal governments in the United States have resisted following
suit, arguing, despite mounting evidence to the contrary (43), that to
do so would "encourage" or "condone" the use of illegal drugs (44).
Only in late 1988 did needle exchange programs begin emerging in U.S.
cities, typically at the initiative of nongovernmental organizations.
By mid-1989, programs were under way or close to being implemented in
New York City; Tacoma, Washington; Boulder, Colorado; and Portland,
Oregon (45).  At the same time, drug treatment programs remain
notoriously underfunded, turning away tens of thousands of addicts
seeking help even as increasing billions of dollars are spent to
arrest, prosecute, and imprison illegal drug sellers and users.

   Other costs of current drug prohibition policies include the
restrictions on using the illicit drugs for legitimate medical
purposes (46).  Marijuana has proven useful in alleviating pain in
some victims of multiple sclerosis, is particularly effective in
reducing the nausea that accompanies chemotherapy, and may well prove
effective in the treatment of glaucoma (47-49); in September 1988, the
administrative law judge of the Drug Enforcement Administration
accordingly recommended that marijuana be made legally available for
such purposes (49), although the agency head has yet to approve the
change. Heroin has proven highly effective in helping patients to deal
with severe pain; some researcher have found it more effective than
morphine and other opiates in treating pain in some patients (50). It
is legally prescribed for such purposes in Britain (50) and Canada
(51). The same may be true of cocaine, which continues to be used by
some doctors in the United States to treat pain despite recently
imposed bans (52).  The psychedelic drugs, such as LDS (d-lysergic
acid diethylamide), peyote, and MDMA (known as Ecstasy) have shown
promise in aiding psychotherapy and in reducing tension, depression,
pain, and fear of death in the terminally ill(53); they also have
demonstrated some potential, as yet unconfirmed, to aid in the
treatment of alcoholism (47, 53). Current drug laws and policies,
however, greatly hamper the efforts of researchers to investigate
these and other potential medical uses of illegal drugs; they make it
virtually impossible for any of the illegal drugs, particularly those
in Schedule I, to be legally provided to those who would benefit from
them; and they contribute strongly to the widely acknowledged
undertreatment of pain by the medical profession in the United States
(54).

   Among the strongest arguments in favor of legalization are the
moral ones.  On the one hand, the standard refrain regarding the
immorality of drug use crumbles in the face of most Americans'
tolerance for alcohol and tobacco use.  Only the Mormons and a few
other like-minded sects, who regard as immoral any intake of
substances to alter one's state of consciousness or otherwise cause
pleasure, are consistent in this respect; they eschew not just the
illicit drugs, but also alcohol, tobacco, caffeinated coffee and tea,
and even chocolate. "Moral" condemnation by the majority of Americans
of some substances and not others is little more than a transient
prejudice in favor of some drugs and against others.

   On the other hand, drug enforcement involves its own immoralities.
Because drug law violations do not create victims with an interest in
notifying the police, drug enforcement agents must rely heavily on
undercover operations, electronic surveillance, and information
provided by informants. In 1986, almost half of the 754 court-
authorized orders for wiretaps in the United States involved drug
trafficking investigations (55). These techniques are certainly
indispensable to effective law enforcement, but they are also
among the least desirable of the tools available to police. The same
is true of drug testing. It may be useful and even necessary for
determining liability in accidents, but it also threatens and
undermines the right of privacy to which many Americans believe they
are morally and constitutionally entitled. There are good reasons for
requiring that such measures be used sparingly.

   Equally disturbing are the increasingly vocal calls for people to
inform not just on drug dealers but on neighbors, friends, and even
family members who use illicit drugs. Intolerance of illicit drug use
and users is heralded not merely as an indispensable ingredient in the
war against drugs but as a mark of good citizenship. Certainly every
society requires citizens to assist in the enforcement of criminal
laws. But societies, particularly democratic and pluralistic ones,
also rely strongly on an ethic of tolerance toward those who are
different but do no harm to others. Overzealous enforcement of the
drug laws risks undermining that ethic and propagating in its place
a society of informants. Indeed, enforcement of drug laws makes a
mockery of an essential principle of a free society, that those who do
no harm to others should not be harmed by others, and particularly not
by the state.  Most of the nearly 40 million Americans who illegally
consume drugs each year do no direct harm to anyone else; indeed, most
do relatively little harm even to themselves. Directing criminal and
other sanctions at them, and rationalizing the justice of such
sanctions, may well represent the greatest societal cost of our
current drug prohibition system.

Alternatives to Drug Prohibition Policies

   Repealing the drug prohibition laws clearly promises tremendous
advantages.  Between reduced government expenditures on enforcing drug
laws and new tax revenues from legal drug production and sales, public
treasuries would enjoy a net benefit of at least $10 billion per year
and possibly much more; thus billions in new revenues would be
available, and ideally targeted, for funding much-needed drug
treatment programs as well as the types of social and educational
programs that often prove most effective in creating incentives not to
abuse drugs. The quality of urban life would rise significantly.
Homicide rates would decline. So would robbery and burglary rates.
Organized criminal groups, particularly the up-and-coming ones that
have yet to diversify into nondrug areas, would be dealt a devastating
setback.  The police, prosecutors, and courts would focus their
resources on combating the types of crimes that people cannot walk
away from. More ghetto residents would turn their backs on criminal
careers and seek out legitimate opportunities instead. And the health
and quality of life of many drug users and even drug abusers would
improve significantly. Internationally, U.S.  foreign policymakers
would get on with more important and realistic objectives, and foreign
governments would reclaim the authority they have lost to the drug
traffickers.

   All the benefits of legalization would be for naught, however, if
millions more people were to become drug abusers. Our experience with
alcohol and tobacco provides ample warnings. Today, alcohol is
consumed by 140 million Americans and tobacco by 50 million. All of
the health costs associated with abuse of the illicit drugs pale in
comparison with those resulting from tobacco and alcohol abuse. In
1986, for instance, alcohol was identified as a contributing factor in
10% of the work-related injuries, 40% of suicide attempts, and about
40% of the approximately 46,000 annual traffic deaths in 1983. An
estimated 18 million Americans are reported to be either alcoholics
or alcohol abusers. The total cost of alcohol abuse to American
society is estimated at over $100 billion annually (56). Estimates of
the number of deaths linked directly and indirectly to alcohol use
vary from a low of 50,000 to a high of 200,000 per year (57). The
health costs of tobacco use are different but of similar magnitude. In
the United States alone, an estimated 320,000 people die prematurely
each year as a consequence of their consumption of tobacco. By
comparison, the Nation Council on Alcoholism reported that only 3,562
people were known to have died in 1985 from the use of all illegal
drugs combined (58). Even if we assume that thousands more deaths
were related in one way or another to illicit drug use but not
reported as such, we still are left with the conclusion that all of
the health costs of marijuana, cocaine, and heroin combined amount to
only a small fraction of those caused by either of the two licit
substances. At the very least, this contrast emphasized the need for a
comprehensive approach to psychoactive substances involving much
greater efforts to discourage tobacco and alcohol abuse.

   The impact of legalization of the nature and level of consumption
of those drugs that are currently illegal is impossible to predict
with any accuracy.  On the one hand, legalization implies greater
availability, lower prices, and the elimination (particularly for
adults) of the deterrent power of the criminal sanction - all of which
would suggest higher levels of use. Indeed, some fear that the extent
of drug abuse and its attendant costs would rise to those currently
associated with alcohol and tobacco (59). On the other hand, there are
many reasons to doubt that a well-designed and implemented policy
of controlled drug legalization would yield such costly consequences.

   The logic of legalization depends in part upon two assumptions:
that most illegal drugs are not as dangerous as is commonly believed;
and that those types of drugs and methods of consumption that are most
risky are unlikely to prove appealing precisely because they are so
obviously dangerous.  Consider marijuana. Among the roughly 60 million
Americans who have smoked marijuana, not one has died from a marijuana
overdose (49), a striking contrast with alcohol, which is involved in
approximately 10,000 overdose deaths annually, half in combination
with other drugs (57).  Although there are good health reasons for
people not to smoke marijuana daily, and for children, pregnant women,
and some others not to smoke at all, there still appears to be little
evidence that occasional marijuana consumption does much harm at all.
Certainly, it is not healthy to inhale marijuana smoke into one's
lungs; indeed, the National Institute on Drug Abuse (NIDA) has
declared that "marijuana smoke contains more cancer-causing agents
than is found in tobacco smoke." (60). On the other hand, the number
of "joints" smoked by all but a very small percentage of marijuana
smokers is a tiny fraction of the 20 cigarettes a day smoked by the
average cigarette smoker; indeed the average may be closer to one or
two joints per week than one or two per day. Note that the NIDA
defines a "heavy" marijuana smoker as one who consumes at least two
joints "daily." A heavy tobacco smoker, by contrast, smokes about 40
cigarettes per day.

   Nor is marijuana strongly identified as a dependence-causing
substance. A 1982 survey of marijuana use by young adults (18 to 25
years) found that 64% had tried marijuana at least once, that 42% had
used it at least ten times, and that 27% had smoked in the last month.
It also found that 21% had passed through a period during which they
smoked "daily" (defined as 20 or more days per month) but that only
one-third of those currently smoked daily and only one-fifth (or about
4% of all young adults) could be described as heavy daily users
(averaging two or more joints per day) (61). This suggests in part
that daily marijuana use is typically a phase through which people
pass, after which their use becomes more moderate. By contrast, almost
20% of high school seniors smoke cigarettes daily.

   The dangers associated with cocaine heroin, the hallucinogens, and
other illicit substances are greater than those posed by marijuana but
not nearly so great as many people seem to think. Consider the case of
cocaine.  In 1986, NIDA reported that over 20 million Americans had
tried cocaine, that 12.2 million had consumed it at least once during
1985, and that nearly 5.8 million had used it within the past month.
Among 18- to 25-year-olds, 8.2 million had tried cocaine; 5.3 million
had used it within the past year; 2.5 million had used it within the
past month; and 250,000 had used it on the average weekly (20). One
could extrapolate from these figures that a quarter of a million young
Americans are potential problem uses. But one could also conclude that
only 3% of those 18- to 25-year-olds who had ever tried the drug fell
into that category, and that only 10% of those who had used cocaine
monthly were at risk. (The NIDA survey did not, it should be noted,
include persons residing in military or student dormitories, prison
inmates, or the homeless.)

   All of this is not to say that cocaine is not a potentially
dangerous drug, especially when it is injected, smoked in the form of
"crack," or consumed in tandem with other powerful substances.
Clearly, many tens of thousands of Americans have suffered severely
from their abuse of cocaine and a tiny fraction have died. But there
is also overwhelming evidence that most users of cocaine do not get
into trouble with the drug. So much of the media attention has focused
on the relatively small percentage of cocaine users who have become
addicted that the popular perception of how most people use cocaine
has become badly distorted, In one survey of high school seniors'
drug use, the researchers questioned those who had used cocaine
recently whether they had ever tried to stop using cocaine and found
that they could not stop. Only 3.8% responded affirmatively, in
contrast to the almost 7% of marijuana smokers who said they had tried
to stop and found they could not, and the 18% of cigarette smokers who
answered similarly (62). Although a survey of crack users and cocaine
injectors surely would reveal a higher proportion of addicts, evidence
such as this suggests that only a small percentage of people who snort
cocaine end up having a problem with it. In this respect, most people
differ from captive monkeys, who have demonstrated in tests that they
will starve themselves to death if provided with unlimited cocaine
(63).

   With respect to the hallucinogens such as LSD and psilocybic
mushrooms, their potential for addiction is virtually nil. The dangers
arise primarily >from using them irresponsibly on individual occasions
(53). Although many of those who have used hallucinogens have
experienced "bad trips," far more have reported positive experiences
and very few have suffered any long-term harm (53). As for the great
assortment of stimulants, depressants, and tranquilizers produced
illegally or diverted from licit channels, each evidences varying
capacities to create addiction, harm the user, or be used safely.

   Until recently, no drugs were regarded with as much horror as the
opiates, and in particular heroin. As with most drugs, it can be
eaten, snorted, smoked, or injected. The custom among most Americans,
unfortunately, is the last of these options, although the growing fear
of AIDS appears to be causing a shift among younger addicts toward
intranasal ingestion (64). There is no question that heroin is
potentially highly addictive, perhaps as addictive as nicotine. But
despite the popular association of heroin use with the most down-and-
out inhabitants of urban ghettos, heroin causes relatively little
physical harm to the human body. Consumed on an occasional or regular
basis under sanitary conditions, its worst side effect, apart from the
fact of being addicted, is constipation (65). That is one reason why
many doctors in early 20th-century America saw opiate addiction as
preferable to alcoholism and prescribed the former as treatment for
the latter where abstinence did not seem a realistic option (66, 67).

   It is both insightful and important to think about the illicit
drugs as we do about alcohol and tobacco. Like tobacco, some illicit
substances are highly addictive but can be consumed on a regular basis
for decades without demonstrable harm. Like alcohol, many of the
substances can be, an are, used by most most consumers in moderation,
with little in the way of harmful effects; but like alcohol they also
lend themselves to abuse by a minority of users who become addicted or
otherwise harm themselves or others as a consequence. And like both
the legal substances, the psychoactive effects of each of the illegal
drugs vary greatly from one person to another.  To be sure, the
pharmacology of the substance is important, as is its purity and
the manner in which it is consumed. But much also depends upon not
just the physiology and psychology of the consumer but his
expectations regarding the drug, his social milieu, and the broader
cultural environment, what Harvard University psychiatrist Norman
Zinberg called the "set and setting" of the drug (68). It is factors
such as these that might change dramatically, albeit in indeterminate
ways, were the illicit drugs made legally available.

   It is thus impossible to predict whether or not legalization would
lead to much greater levels of drug abuse. The lessons that can be
drawn from other societies are mixed. China's experience with the
British opium pushers of the 19th century, when millions reportedly
became addicted to the drug, offers one worst-case scenario. The
devastation of many native American tribes by alcohol presents
another. On the other hand, the decriminalization of marijuana by 11
states in the Unites States during the mid-1970's does not appear to
have led to increases in marijuana consumption (69). In the
Netherlands, which went even further in decriminalizing cannabis
during the 1970s, consumption has actually declined significantly; in
1976, 3% of 15- and 16-year-olds and 10% of 17- and 18-year-olds used
cannabis occasionally; by 1985 the percentage had declined to 2 and 6%
respectively (70). The policy has succeeded, as the government
intended, "in making drug use boring." Finally, late 19th-century
America is an example of a society in which there were almost no drug
laws of even drug regulation but levels of drug use were about what
they are today (71). Drug abuse was regarded as a relatively serious
problem, but the criminal justice system was not regarded as part of
the solution (72).

   There are however, strong reasons to believe that none of the
currently illicit substances would become as popular as alcohol or
tobacco even if they were legalized. Alcohol has long been the
principal intoxicant in most societies, including many in which other
substances have legally available.  Presumably, its diverse properties
account for its popularity: it quenches thirst, goes well with food,
often pleases the palate, promotes appetite as well as sociability,
and so on. The widespread use of tobacco probably stems not just from
its powerful addictive qualities but from the fact that its
psychoactive effects are sufficiently subtle that cigarettes can
be integrated with most other human activities. None of the illicit
substances now popular in the United States share either of these
qualities to the same extent, nor is it likely that they would acquire
them if they were legalized. Moreover, none of the illicit substances
can compete with alcohol's special place in American culture and
history, one that it retained even during Prohibition.

   Much of the damage caused by illegal drugs today stems from their
consumption in particularly potent and dangerous ways. There is good
reason to doubt that many Americans would inject cocaine or heroin
into their veins even if given the chance to do so legally. And just
as the dramatic growth in the heroin-consuming population during the
1960s leveled off for reasons apparently having little to do with law
enforcement, so we can expect, if it has not already occurred, a
leveling off in the number of people who smoke crack.

   Perhaps the most reassuring reason for believing that repeal of the
drug prohibition laws will not lead to tremendous increases in drug
abuse levels is the fact that we have learned something from our past
experiences with alcohol and tobacco abuse. We now know, for instance,
that consumption taxes are an effective method for limiting
consumption rates and related costs (73).  Substantial evidence also
suggests that restriction and bans on advertising, as well as
promotion of negative advertising, can make a difference (74). The
same seems to be true of other government measures, including
restrictions on time and place of sale (75), bans on vending machines,
prohibition of consumption in public places, packaging requirements,
mandated adjustments in insurance policies, crackdowns on driving
while under the influence (76), and laws holding bartenders and hosts
responsible for the drinking of customers and guests. There is even
some evidence that some education programs about the dangers of
cigarette smoking have deterred many children from beginning to smoke
(77). At the same time, we also have come to recognize the great harms
that can result when drug control policies are undermined by powerful
lobbies such as those that now block efforts to lessen the harms
caused by abuse of alcohol and tobacco.