This decision was one of the most difficult which the Commission faced. The great harm which misuse of short-acting barbiturates now causes weighed very heavily with us. At the same time, recognizing the negative implications of applying stringent Schedule II controls over widely used therapeutic agents, such as the barbiturates, as com pared with the less medically used amphetamines, coupled with our preference for voluntary private action whenever that can effectively serve in place of formal governmental intervention, argued for an initially less restrictive alternative. After long and hard delibera tion, the Commission does not recommend that any of the bar biturate drugs, including the short-acting barbiturates, be placed in Schedule II of the Federal Controlled Substances Act at this time. Instead, the Commission recommends that the AMA im mediately design and furnish to physicians guidelines on the prescribing of barbiturates and actively encourage state medical societies and individual practitioners to respect these guidelines.

If, after a reasonable period of time, such guidelines prove ineffec tive ye then ti the responsible federal agencies should consider increasing control over the prescribing of these drugs. The Commission cautions, however, that aux prospective controls should be enforced cautiously so as not to hinder legitimate therapeutic uses. The public should be informed about the relative ineffectiveness of such controls on the illicit production of barbiturates and on the street use of those substances

Non-Barbiturate Sedatives

For the most part, the social cost of the non-barbiturate sedatives is significantly lower than that of the other CNS depressants. How ever. there is one important exception — methaqualone — which is not even classified as a controlled substance and, therefore, is subject only to a minimal level of control. The risk potential of methaqualone is roughly equivalent to that of the short-acting barbiturates. Moreover, recent evidence indicates that illicit use of this too easily obtained substance is i increasingly conimon among adolescents and has as become a significant problem in a number of locations (Pascarelli. 1973).

Since, unlike the barbiturates, methaqualone does not have large. scale medical uses, the Commission recommends that it be placed in Schedule II, along with the amphetamines.

The ot her barbiturate rate substitutes are al ready included in Schedules

III a mid IV of the ( Controlled led Substances laws. None of them poses a problem of i irresponsible use at thratee present time, and the Commission advises no change in the control of tlrateeir availability.

Minor Tranquilizers

One class of depressants. the so-called minor tranquilizers is con trolled only minimnally through restrictions which apply to all pre scription drugs. The Bureau of Narcotics and I)angerous Drugs though, Imas recently completed administrative action to include two of these substances—chloriazepoxide (Librium) and diazepam (Val ium) — in Schedule IV. Since this decision is now under court review, the Commission will masot express an opinion as to the proper outcome of that case.

We will masote. however. our findings with respect to these drugs. At present. they are the most widely prescribed psychoactive substances in the world, utilized for a wide spectrum of legitimate iithedlical purposes and generating a combined total of $200 million in retail sales each year I)espite the fact that these drugs are sometimes found on the streets and that approximately 6% of the adults and % of tIthe youth have uised them for self-defined purposes (Abelson, et. al.. 1973) . their important medical uses and low dependence liability

point away from overly rigid control.

At the same time, the Commission feels the use of thuese drugs de serves policy-making attention, because of their prevalence in circum- stantial drug use. One of our major concerns about this particular kind of drug-taking behavior is the possibility that it may become a condi tioned response to personal anxieties. If the discouragement policy is to be taken seriously, the medical system must cease to encourage any automatic ic association in the public mind between a pill and peace of mind. Neither the public nor the medical profession should treat any effective psychoactive substance as harmless or routine.

While we defer to the juudiciary on whether chloriazepoxide and diazepam should 1 be controlled led lundler the Federal Controlled Sub stances Act, we do think that thratee review of their status was timely and necessary. Accordingly, the Commission recommends that the appropriate federal agencies conduct studies on all other ethical hypno-sedative drugs not presently covered by the Controlled Substances Act to determine whether or not further controls are required.

The availability dlecision with regard to the hallucinogenic drugs, such as LSD,. I)MT and DET, involves a delicate balancing of con cerns. On the one hand, these drugs have a low dependence liability, and their widespread tuse wouuldl not involve a social cost as heavy as

that associated with use of the CNS depressants or stimulants. On the other hand, while hallucinogens, with a few minor exceptions, have no recognized medical utility, 5% of the adult population and 5% of the youth have run the already identified psychological risks inherent in the hallumeinogen experience (Abelson, et al., 1973) ; and much more remains to be learned abouit the effects of these substances.

Without belaboring the issue, the Commission believes that the same considerations which argue against institutionalization of availability of marihuana apply more strongly to the hallucinogens. Only within the last decade have these drugs been ursed on any significant scale in American society, and their use tends to be age-specific and transitory. Data presented in Chapter Two suggest that the incidence of experi mentation may have already peaked, indicating the same transience which may characterize the marihuana phenomenon.

Finally, the combination of scientific uncertainty about the effects of these drugs, together with the inability of present availability models to structuire the use experience, dictate caution. If a non-medical avail ability model were chosen for these drugs, it would have to differ sub stantially from the present alcohol scheme. An appropriate third-party expert would be needed to determine whether the potential consumer could handle the experience and to structure it for him. As we sug gested in our first Report, possible regulatory mechanisms for channel ling the availability of psychoactive druigs for self-defined purposes have not vet received adequate study. Until this area is given detailed

psychoactive

and thorough scrutiny, institutionalization of any more substances would not be in the public interest.

Marihuana

As promised in our first Report, the Commission has reviewed all of its findings and recommendations during this past year. We reaffirm our conclusions and recommendations.⁵ The risk potential of marihuana is quite low compared to the potent psychoactive stub stances. amud evenrate its widespread consumption does not involve the socual cost now associated with most of the. stimulants and depressants (Jones. 1973: Tinklenberg, 1971) . Nonuetheless. thue Commission re iratemains persuaded that availability of this drug should not be institu— tionalized at this time.

The Commission's 1972 National Survey data suggest that the inci dence and prevalence of marihuana use may indeed be peaking. Un certainty about long-term effects of heavy use continues. Lastly, it is painfully clear from the debate over our recommendations that the

5 The recommendations Cf our first Report. Marihuana A Signal of Misunder= standing are set out at the end of this Report.

absence of a criminal penalty for private use is presently equated in too many minds with approval, regardless of a continued prohibition on availability. The Commission regrets that marihuana's symbolism remains so powerful, obstructing the emergence of a rational policy.

Alcohol

Society at present pays a heavy price for the widespread availability of alcohol. The social costs of long-term, heavy use are much higher than any other drug "problem" -we have.

The Commission does not believe that it is realistic to reconsider pro hibition of availability for self-defined purposes. This country's earlier experiment with such controls amply demonstrated that they are inef- fective and extremely costly. Impracticality of strict control, however, does not argue for a system of controls so lax and haphazard that heavy use is in no way discouraged and in some cases even encouraged. With out reviving Prohibit.ion, society can demonstrate to users that alcohol is not an ordinary commodity but, rather, is a powerful psychoactive drug.

The Commission recommends that the National Institute on Alcohol Abuse and Alcoholism devote susbtantial effort to the development of better non-prohibitory means of controlling the availability of alcohol. In particular, society should alter avail ability controls to minimize the social costs of alcohol use.

Throughout most of the history of this country's regulation of psy choactive druigs, certain cycles have been evident. First, restricting lawful production and distribution of a particular drug is emphasized. When this has been achieved, the government has either ignored the situation for a time on' turned its attention directly to the user. Law enforcement agencies, particuasharly federal agencies, have steadily tried to disrtupt illegal manufacture and distribution, but until very re— cently theiu' efforts, both in size amid in result, played a small part in drug policy. International drug regulation has shown the same pattern:

the Simigle Convention on Nau'cotic Drugs and the proposed Conven tion on Psychotropic Drugs deal with the restriction of licit production and manufacture. Under the aegis of the United Nations Commission omi Narcotic Drugs, there have been arrangements for exchange of information on illegal trafficking and occasions of bilateral and multi lateral cooperation: but international treaties have had no major or continuing impact on illegal trafficking.

In addition, the enforcement of availability controls, like the level of social response in general, has oscillated with the degree of public concern nut a given point in time. Control agencies have tenuded to oper ate at two speeds, crisis and complacency. making long-term stu'ategies difficult to achieve or predict. Enforcement has also followed l)ublic semastiment in determinimug what drug to control most rateuctively. Agencies have gone through periods of emphasis ouu heroin, marihuana, heroin again, amphetamines, hallucinogens, marihuana again, and now heroin a third time, with cocaine and barbiturates thrown in for good measure.
The current period of intense control, however, is different from earlier ones in two important ways. First, it has involved virtually all of the psychoactive drugs (except alcohol) in rapid progression: hal lucinogen use by college youth simultaneously with marihuana use by virtually all segments of the population ; street amphetamine use, including intraveuasous use: heroin use: and barbiturate use among youth. Cocaine consumption may also be increasing, although that drug has rarely been the subject of serious concern since the early 1920's 6 (Woods amid Downs, 1973).
The cui'rent response also differs in the emphasis placed on enforce ment of availability proscriptions In earlier periods of elevated public concern, policy makers almost invariably responded to the problem of supply by tightening controls on lawful distribution and increasing the penalties for illegal trafficking. Law enforcement agencies may have received funds for' a few additional investigative personnel. but apparently controls were assumed to be self-effectuating.
Now, the Government has begun to inerrease the vigor' of law en forcement rather than concentrating entirely on the rigor of the laws. Enforcement resources have multiplied several-fold. In five years, Fed eral expenditures for law enforcement have gone from a total of $20.5 million to over $225 million. The Bureau of Narcotics amid I)angerous Drugs alone has more thrun quadrupled its budget since 1969. (See Table IV—2)
Agencies have also developed new strategies of enforcement and re cruited high—calibre personnel. Projects are underway to enhance cooperation between state and federal control agencies and between agencies in this country and in other's.
The Commission commends this muew approach, It will test. for the flm'st time. the efficacy of availability controls in reducing use because for' the first time enforcement agencies have resources adequate to their assigned tasks. At the same tinie. we ar'e concerned that expectations for' the current effom't are too high. The assuiml)tioiass that underlie the present al)l)roaclas need chosen' examination.

One brief coca rue crisis apparently occuirred in Chicago, after World War II. but the principal worry then was that cocaine use was leading to the use of
heroin.
Table IV-2,—FEDERAL EXPENDITURES FOR DRUG LAW ENFORCEMENT

(In millions of dollars)
Fiscal year
Agency
1969 1970 1971 1972 1973



Justice:
LEAA - 0 0,6 2.2 16.6 30.3
BNDD . . 16.8 25.8 41.3 59.7 71.2
Other 0.3 1.3 3.5 0.3 4.8
Treasury:
IRS 0 0 0 7.6 18.9
Customs - 3.1 12.4 30.2 46.6 54.3
State 0.3 1.3 i 1.0 1.6
Aid - 0 0 4.4 20.7 42.7
Agriculture - 0 0 0 2.1 1.8
DOT 0 0 0.5 0.5
Law enforcement, total 20.5 41.4 81.6 155.3 226.1


1 Less ihan $100,000.

Official spokesmen ofteni sax- now that control of suipply is tIre key to tIme problem of ruse. a conclusion they seem to reach from the observa— tion that if drugs are riot available they cannot be usedi. Like most tautologies this one is not really helpful It assumes that the desired restriction of availability can be completely achieved that. increasing enforcement fft reduces supply proportionally rateurud that, at sonase point law enforcement can eliminate tIme illicit supply altogether

To support these assumptions, rising statistics of drug arrest and drug seizures are ofteir cited. In 1971, for example there were an esti— mated 500, 000 arrests for violations of state and federal drug laws, approxirnately a 400% increase since 1967 (Federal Bureau of Investi gation ii, 1972). Seizures, naturally, increased too. In 1971, federal agen— cies removed from tIre illicit. market over 1,500 pounds of heroin, triple tIme amount of tIre year before ( Bureau of Narcotics aund Dangerous Drugs. 1972) .

These figures are dramatic, bunt they do riot. really tell what is hap- pening. Increased numbers of arrests may simply mean more violators, rather than more effective enforcement Similarly, the quarutities of drugs seized may reflect only the size of the illegal market. It is pos sible, in fact, that law enforcement efforts are not even keeping up with the illicit trade. TIme. vohuimne of illegal drugs sold arid used may be increasing even faster than time number of arrests and seizures. Drug availability on time illicit market, according to most law enforcement officials, has riot appreciably declined.