Date: Thu, 11 May 1995 08:51:00 -0700 From: Eric Sterling (ESTERLING@IGC.APC.ORG) To: firstname.lastname@example.org Subject: Re: Atlanta Mayor's Drug Education OPENING A DISCUSSION ABOUT EFFECTIVE ANTI-DRUG STRATEGIES May 15, 1995 by Eric E. Sterling President, The Criminal Justice Policy Foundation There is a movement, gathered here in Atlanta, Georgia, that argues that the means to fight the drug problem cannot be discussed. This movement is based on a false fundamentalism: society's fight against drugs can be carried out either by means of prohibition (namely the status quo) or it must surrender to what it calls legalization. The arguments of those who advocate legalization are too dangerous even to be heard. Thus the Atlanta Resolution's first point is to reject all proposals to legalize illicit drugs. This is simplistic thinking at its worst. Ninety-five percent of The Atlanta Resolution is plain common sense, but that is not what the Atlanta conference has gathered to discuss. The conference agenda describes the catastrophe that would result from legalization, but no person who advocates any version of legalization has been invited to present their view or to answer questions. The conference characterizations of drug legalization are as fair and as realistic as using Star Wars movies to describe the outcome of the NASA manned space flight program. Implicit in the conference agenda is that our current strategy is simply dandy. But the American people don t think our current strategy is dandy at all. A nationwide survey in February 1995 by Peter Hart Research Associates for Drug Strategies, Inc. found that 50% of the American people gave the Federal government a grade of F or D for dealing with the problems of drug use and addiction, and 59% gave those grades for the problem of drug-related crime. Only 10% would give the Federal government a grade of A or B for dealing with drug use, and only 11% for drug-related crime. Only 6% of Americans thought that drug abuse was less of a problem today than 5 years ago. A strategy must set forth goals and means. The 1995 National Drug Control Strategy (the Strategy) promulgated by President Clinton sets forth clear and worthwhile goals that are a distinct improvement from previous strategies (Table 1-1). The means proposed, however, are largely the same ones -- prohibition, and its enforcement -- which have failed. The National Drug Control Strategy is, in a sense, schizophrenic -- it reads as though it were drafted by a committee of Dr. Jekyll and Mr. Hyde. It reflects an internal conflict between realistic goals and priorities, and the exaggeration characteristic of politicized discussions of the drug problem. The Strategy writes about various drug problems oblivious to the causes of the problems and reasonable methods to correct those problems. Prohibition has failed to reduce crime or addiction. There is no prohibition-based strategy that will substantially address those problems. A drug-free society is unrealistic. Our strategy of punishing drug addicts is akin to expelling from school students with learning disabilities. To claim to be taking the profits out of $50 billion of a year's drug trafficking through the yearly forfeiture of $1 billion in property is absurd. Even sales taxes would be more effective in taking the profits out. Certainly much more extensive taxation is required but it is only possible when prohibition is repealed. We must change our strategy, but we must do so cautiously. A regulatory, management approach to the myriad drug problems is called for. It should be tailored to specific issues and adopted incrementally. There will be addicts and crime no matter what we do. An example of regulatory complexity is the regulation of alcohol, one legal drug. There are probably 10,000 different alcohol laws reflecting multiple goals from revenue collection to reducing consumption. For this one drug, the regulation of the sale, advertising, taxation, and places of distribution and consumption vary in every jurisdiction depending whether it is beer, wine or whiskey. Alcohol regulation has evolved since 1933. In some ways it has improved, and in others it has gotten worse. Developing a comprehensive regulatory scheme for dozens of classes of drugs can t be accomplished overnight. There is much necessary market and regulatory research. National Drug Control Strategy -- A Strategy Founded on Deceptions and Failures A strategy for action should identify the most important problems and recognize the limits of what the strategy can effect -- it must be honest. The first problem identified in the White House's National Drug Control Strategy -- February 1995: The crime-drug cycle continues. Second, More teenagers are smoking pot. The third problem is described as: Less of them [America's teenagers] think cocaine use is dangerous. What does the Strategy say about the crime-drug cycle? It simply sets forth the number and percentage of drug-related murders for the past eight years which ranged between 751 (3.9%) in 1986 and 1403 (7.4%) in 1989, down to 1287 (5.2%) in 1993, and states that there has been a marked increase youth homicide reported by Dr. Alfred Blumstein. The Strategy provides no analysis of the problem. It fails to explain the crime- drug cycle and how to break it. Mostly, the crime-drug cycle exists because drugs are prohibited. Prohibition inevitably requires violence. All businesses are subject to conflict among market- participants. Such conflict is resolved nonviolently for legal businesses by means of the courts or other nonviolent dispute resolution programs. Prohibited businesses are forced to resolve conflict illegally -- either through violence or through adjudication by organized crime figures who rely upon violence for enforcement. Prohibition markets are especially attractive robbery targets because of the inevitably high volumes of cash and over-priced contraband. Unlike legitimate businesses that can take checks or credit cards, illegal drug markets take only cash. Legitimate business can hire licensed security guards. Prohibition businesses only hire for protection those who demonstrate they are prepared to kill. Legalizers share the nation's goal of ending the crime-drug cycle. Second, certainly teenage marijuana use is a problem. But more teenagers start a lifetime of addiction to cigarettes every year than use marijuana one time, and the smoking prevalence is increasing. More teenagers got drunk in the past two weeks than used marijuana once in the past year, and the alcohol consumption prevalence is up. The Strategy presents strong evidence that teenage use of liquor is a more serious problem in violence and suicide than teenage marijuana use. Teen drunkenness is also a major factor in teen pregnancy, sexually transmitted disease, school failure, and crime. Dr. Lloyd Johnston pointed out over a decade ago that teen tobacco use is one of the best predictors of teen hard drug use, but aside from a couple of paragraphs in the 150-page Strategy, alcohol and tobacco are ignored. Teen smoking and drunkenness are not political hot-buttons. There is no multi- billion Federal, State and local tax-funded establishment to address those problems. The sponsors of the Partnership for a Drug Free America earn millions of dollars annually from the promotion of tobacco and alcohol. And the tobacco and alcohol industries are among the biggest of corporate contributors to political campaign committees of both political parties. They fight every effort to increase the taxes on alcohol and tobacco and to limit the advertising of these drugs. Public health and safety is not on their agenda. Our political leadership is craven in failing to challenge these industries. Most legalizers share the nation's goal of reducing teenage drug, alcohol and tobacco use. Typically, the Strategy is given to exaggeration. Saying fewer teenagers think cocaine is dangerous, the Strategy implies that children are largely misled about the dangers of drugs. In fact, 89.3% of last year's high school seniors believed that they would be at great risk if they took cocaine regularly. Or the Strategy says, "Drug using adults from every social strata are clogging court dockets, crowding emergency rooms..." Clogged court dockets, a top national emergency...or some trial lawyers nightmare? The serious problems are often nowhere near as widespread as implied by the Strategy. In 1991, there were 93.5 million emergency room visits according to the 1993 Statistical Abstract, and less than 500,000 of them were drug-related, hardly crowding emergency rooms. Emergency room episodes involving drugs have tripled since 1985 -- when the war on drugs was kicked into high gear under President Reagan. This data is actually more evidence that our prohibition-based strategy is failing to protect the public. Outside the realm of exaggeration, hype and political posturing, in the real world of 1995, the three most pressing problems from drugs in America are the violence in the drug trade, the spread of AIDS, and the immense and growing power of the criminal underworld. This has been the case for at least a decade: * Drug trade violence was identified as the cause of 40% of the homicides in New York City in the late-1980s. More importantly, the drug trade is responsible for the proliferation of guns among American youth. Since 1985 the white juvenile homicide rate grew by 80%, and the black juvenile homicide rate more than doubled, growing 120%. According to Dr. Alfred Blumstein, this is directly linked to the prohibition-created crack cocaine trade. * In 1993, AIDS became the biggest killer of Americans between the ages of 25 and 44. In 1992, there were 24,000 new AIDS cases where the infection involved the injection of drugs. By 1992, roughly 40% of all new AIDS cases involved injection of drugs. On average, each AIDS case costs the taxpayers $100,000. Unless checked, dirty needle - related AIDS will soon cost $24 billion per year. * Large, international criminal organizations -- funded with drug profits -- are steadily growing more powerful. They are subverting democratic governments on every continent around the world. In the 1990 election, the drug cartels assassinated four candidates for President in Colombia. Last year, the leading candidate for President of Mexico was assassinated in a crime linked to political protection of the drug traffickers. These criminal organizations have acquired enormous economic power rivaling that of the largest corporations on the Fortune 500. Only one drug trafficking cartel, based in Medellin, Colombia, has been put of out business, but dozens of others around the world are growing, and increasingly collaborating. The Strategy claims success because the number of casual users of cocaine has gone down. However, the consumption of cocaine in the U.S. has actually remained stable since 1985. The profits from supplying that cocaine (as well as heroin and marijuana) is the greatest transfer of wealth to criminals in the history of the world. Americans have been given a Strategy that denies the reality of prohibition economics, that ignores the law of supply and demand, and that is blind to the relation between cause and effect. What is needed is a more effective national drug strategy that is no longer bound by the counterproductive paradigm of prohibition. This paper outlines a strategy to fight violence and reduce AIDS that could be more effective. It is based not on polls, but on what is humane and realistic. It is based on what can be accomplished, not on political slogans such as attaining a drug-free America. 1. Remember that drug laws and drug policy should help people, not hurt them People who have drug problems should not be demonized, they need help. People with drug problems are usually in some kind of physical or psychological pain. Addicts should not be treated like lepers in the Old Testament who were stoned by their neighbors or banished. People who don t have drug problems, and who aren't hurting anyone, should be left alone. Everyone who wants to quit using drugs should be able to get appropriate treatment. Addicted single parents need residential treatment that won t break up families. Pregnant addicts need treatment, not imprisonment -- but most treatment programs won t accept pregnant addicts. HIV positive addicts should be the top priority for treatment, yet many programs won t take HIV positive people. All drug addicted prisoners should get treatment, but no one should be prosecuted or imprisoned simply to get treatment. Relief of physical pain is one of the oldest medical traditions and a basic human value. Our policy should be compassionate toward those who are in pain from disease or from its treatment. Marijuana has well documented medical uses. Even the Chief Administrative Law Judge at the Drug Enforcement Administration, Francis L. Young, after hearing evidence gathered from around the nation over a four- month period, agreed that marijuana has medical uses. Those Americans who can benefit from using marijuana medically should get it legally from their doctors. This is a perfectly respectable position, and it was endorsed by the National Association of Attorneys General on June 25, 1983. Heroin relieves pain for some people who obtain no relief from other drugs -- those people should get heroin legally. In the late 1980s, without weakening the severe penalties for the unauthorized use of heroin, the conservative Canadian government joined the United Kingdom in legalizing heroin for medical use only. The medical uses of marijuana and heroin do not mean these drugs are good. Nor does it mean these drugs are better than other drugs. Simply, these drugs are useful for some people. The people who can benefit from these drugs should not be denied them. Some persons, justifiably concerned about the abuse of these drugs by drug addicts and by children, oppose even the very carefully controlled medical use of these drugs because medical use of marijuana or medical use of heroin supposedly sends the wrong message. First, drug abusers aren't listening for this message. Cocaine, Valium , Dilaudid , and most controlled substances have uses in medicine, but many addicts who abuse those drugs don t care, even if they are actually aware of such uses. Drug abusers don t rationalize their drug use as medical. Secondly, there isn't a single positive value we want our children to learn that is not being undermined by a host of wrong messages. For every virtue -- honesty, thrift, industry, studiousness, cleanliness, chastity, charity, responsibility, civic-mindedness, moderation, non-violence, or sobriety and abstinence from drugs -- movies, television, advertising and popular music are sending messages that directly conflict with positive values. Every teenager everyday has to deal with, and we hope disregard, seductive messages that conflict with virtue. Exaggerating the dangers to children of the wrong message when it comes to subtleties of medical practice is unwarranted and irrational. It is the job of drug abuse prevention programs to teach children the important differences between drugs prescribed by doctors and street drugs. People who are dying or going blind should not be forced to endure more suffering because drug abuse prevention programs might sometimes be ineffective in helping children draw the necessary distinctions between the legitimate and the inappropriate uses of drugs. The Controlled Substances Act makes cocaine, THC, methadone and other synthetic opiates perfectly legal -- when their use is prescribed for by a physician in the proper circumstances. Debating how systems of control can be improved does not undermine the drug abuse prevention effort. To say that the American public should not openly debate other forms of drug legalization because children might get the wrong message, is like saying the public should not debate gun control, militia groups or the Second Amendment because children might get the wrong message. It is fundamental to the health of democratic governments that public policies be debated. 2. Adopt a public health approach toward all drugs and drug users This requires a comprehensive approach toward all drugs, not simply now illegal drugs. What we should be concerned about is the drug abuse problem -- not just the illegal drug problem. Illegal drug use does not exist in legal or >social isolation. Treatment professionals recognize cross-addiction and polydrug abuse. Prevention professionals recognize a gateway relationship between legal drugs and use of illegal drugs. Tighten the regulations surrounding alcohol and tobacco -- for adults and for children -- and this will help reduce the use and abuse of other drugs as well. In order to delay the onset of teen alcohol and tobacco use, which delays the onset of other drug use, we must reduce the promotion and availability of tobacco and alcohol to children. To respond to our drug problem we must expand honest anti-drug education. Honest comprehensive prevention programs work. Cigarettes kill more than 400,000 Americans in a year and are as addictive as heroin or cocaine, according to the U.S. Surgeon General. Yet forty-four million addicted cigarette smokers have quit in the past thirty years. This is the result of a tremendous, successful public health campaign. This campaign succeeded without jailing or urine-testing cigarette smokers, without prosecuting tobacco sellers, without prohibition, and in spite of the annual expenditure of billions of dollars to promote tobacco-use. Most policy makers reject the idea of prohibiting cigarettes because it would be a disaster of corruption and crime, and wholly inconsistent with American values. Cigarettes, alcohol, or marijuana can be gateways toward use of harder drugs. Therefore prevention programs need to focus on all drugs. We must continue to evaluate drug abuse prevention programs. Mathea Falco in The Making of a Drug-Free America (1992) pointed out that most programs have not been evaluated. Research Triangle Institute reviewed 18 studies in September 1994 and found D.A.R.E., America's most common drug abuse prevention program, was substantially less effective in reducing drug use among the children who took the program than certain other approaches. If we are serious about prevention, we must be willing to abandon programs that don t work well, even if they are politically popular. Quality medical care and drug abuse treatment must be easily available for those who need it. Heroin addicts, crack addicts, the mentally ill, the homeless, the uninsured, and everyone at risk of catching or spreading contagious disease are the highest treatment priority. This will help halt the transmission of disease, and reduce the use of illegal drugs as pain killers for untreated disease. To stop the spread of blood borne disease among injecting drug addicts, clean needles should be exchanged for used ones. This is the recommendation of the National Commission on HIV and AIDS, and top government scientists who have studied the issue. Distribution of hypodermic syringes is a crime in eleven states which should be repealed. Until 1965 (Griswold v. Connecticut), distribution of condoms to any person was a crime in some states. Thirty-years ago sale of condoms in supermarkets and convenience stores was unthinkable. Now, for the widely accepted public health purpose of fighting sexually transmitted disease, condoms are widely distributed to the sexually active as one component of a public health program. When we think about drugs and disease in less judgmental terms, public health distribution of hypodermic syringes to drug injectors will no longer be shocking. Under appropriate controls and supervision, drugs must be made available to addicts to reduce harms. Smoking tobacco is the most dangerous means for ingesting nicotine. If Nicorette gum were cheaper and more freely available many more smokers and snuff dippers would be likely to quit. Cigarettes, after all, are only crude, disposable nicotine ingestion devices -- of the most dangerous kind. Nicotine is addicting but is not as dangerous as the tars, particulates and gases in cigarette smoke. Heroin is addicting but is not as dangerous as HIV, hepatitis, and the adulterants added by criminals who distribute street drugs. Heroin addicts who can t or won t quit should not be banished to the underworld, nor put at risk of death from criminally contaminated drug supplies. They ought to be able to get clean, affordable opiates under medical and pharmaceutical supervision if it will prevent them from spreading disease or committing crimes. Incidentally, Dr. Alfred Blumstein, former president of the American Society of Criminology, whose work on the crime-drug cycle is cited in the Strategy, endorses this approach to certifiable addicts. (Of course, the use of heroin by addicts must not violate the principle of user accountability discussed below.) In considering why some people use and abuse drugs, we must address the causes and contributing factors. One major cause is family violence and sexual abuse. Another co-factor with drug abuse is teenage pregnancy. Public health and family-strengthening programs to address those problems are key parts of an anti-drug strategy. To further prevent addiction and overdoses, patients and doctors need to know more about prescription drugs and their risks and interactions. 3. Insist Upon Drug and Alcohol User Accountability and Responsibility People who hurt or endanger others must be held responsible for their actions. Drug or alcohol use is not an excuse for criminal or negligent conduct. Protection of public safety (e.g. safety on the streets, of travelers, medical patients, etc.): In critical safety situations we should require performance tests to detect actual impairment by drugs (legal and illegal), alcohol, exhaustion, etc. Following any kind of accident, it is perfectly appropriate to immediately test the blood of pilots, engineers, drivers, surgeons, etc. for evidence of use of alcohol and drugs -- legal and illegal. This would be appropriate not only for airplane, rail, maritime or motor vehicle accidents, but also for medical accidents such as administering medications improperly or making mistakes in surgery. Past use of intoxicants identified by urine or hair tests is irrelevant to public safety and drug user accountability. We must encourage increased professional responsibility and peer supervision of professions like medicine, airline piloting, etc. to police against on-the-job recklessness such as alcohol or drug use. Suspected misconduct that threatens public safety must be investigated and prosecuted where criminal recklessness has occurred. Criminal conduct: Drug or alcohol use is not an excuse for criminal conduct such as robbery, theft, forgery, etc. All drug addicted offenders and prisoners should get treatment. But in the absence of actual harm or substantial risk of endangering others, Americans should not be prosecuted or imprisoned as a means to get treatment. Convicted predatory criminals such as robbers, rapists, assaulters, and burglars should be drug and alcohol-abstinent while on probation and parole. This requires frequent and extensive surprise drug and alcohol testing, and a system of consistent sanctions for violations. Drug and alcohol user licenses: Drug and alcohol use are privileges, and should be subject to licenses which can be revoked for misuse. Some states adopted alcohol use licenses after national prohibition was repealed. Persons who use drugs or alcohol might be required to get special liability insurance coverage. It should not be presumed that persons over 21 are responsible alcohol or drug users. 4. Insist upon vendor accountability and responsibility Just like users, vendors of drugs and alcohol need to be held responsible for their actions. Violence, corruption, product adulteration, tax evasion, and antitrust violations by drug, alcohol and tobacco sellers are crimes and should be investigated and punished. Adulteration and mislabeling of drugs and alcohol should also be subject to product liability civil law remedies. Vendors must comply with reasonable regulations and inspections, pay taxes, and resolve marketplace conflicts through the law, not violence. These provisions are much more easily investigated and enforced in a regulated environment than under prohibition. Convicted criminals can t be licensed to legally sell alcohol now -- they shouldn't be allowed to sell other drugs after the repeal of prohibition. The prohibition against sales to minors of tobacco, alcohol and other drugs must be enforced. Sales to those who have been denied or deprived of their privilege to use alcohol or drugs should be prohibited. Like alcohol dram- shop laws, over-the-counter sales of drugs to those who are already intoxicated should not be permitted. Promotion of alcohol, tobacco and drug use should be severely limited. Advertising that either targets kids or is placed in media in which kids have legitimate interest in (e.g. professional and amateur athletics, popular music, motion pictures, etc.) should be disallowed. 5. Maximize the reach of law and respect for the law Drug and alcohol buyers should be discouraged from patronizing criminals. For example, growing one's own marijuana is today a felony, and growers risk the forfeiture of their homes or land. Every marijuana user today (between 9 and 20 million persons) either becomes a felon or has to patronize criminals. Shouldn't home cultivation for personal use be encouraged, even under prohibition? We should be reducing the commercial opportunities of criminals, not expanding them. Even under prohibition, decriminalizing home marijuana cultivation would sharply reduce the tens of billions of dollars in annual profits now funding organized crime. Almost no police officers or revenue agents are killed or injured enforcing the liquor laws. Marijuana, the most widely consumed illegal drug, should be taxed and sold to adults with warning messages -- but with prohibition of the promotion we suffer from with tobacco and alcohol. Very few law enforcement officers will be killed or injured enforcing a managed, regulated drug trade.