.. alleviate the symptoms of glaucoma; to improve appetite dangerously reduced from AIDS. They use it as an effective medicine, yet they are technically regarded as criminals, and every year many are jailed. Although more than 75 per cent of Americans believe that marijuana should be available legally for medical purposes, the Federal Government refuses to legalize access or even to sponsor research. 2.
Drugs are here to stay. The time has come to abandon the concept of a “drug-free society.” We need to focus on learning to live with drugs in such a way that they do the least possible harm. So far as I can ascertain, the societies that have proved most successful in minimizing drug-related harm aren’t those that have sought to banish drugs, but those that have figured out how to control and manage drug use through community discipline, including the establishment of powerful social norms. That is precisely the challenge now confronting American society regarding alcohol: How do we live with a very powerful and dangerous drug–more powerful and dangerous than many illicit drugs–that, we have learned, cannot be effectively prohibited? Virtually all Americans have used some psychoactive substance, whether caffeine or nicotine or marijuana. In many cases, the use of cocaine and heroin represents a form of self- medication against physical and emotional pain among people who do not have access to psychotherapy or Prozac.
The market in illicit drugs is as great as it is in the inner cities because palliatives for pain and depression are harder to come by and because there are fewer economic opportunities that can compete with the profits of violating prohibition. 3. Prohibition is no way to run a drug policy. We learned that with alcohol during the first third of this century and we’re probably wise enough as a society not to try to repeat the mistake with nicotine. Prohibitions for kids make sense.
It’s reasonable to prohibit drug-related misbehavior that endangers others, such as driving under the influence of alcohol and other drugs, or smoking in enclosed spaces. But whatever its benefits in deterring some Americans from becoming drug abusers, America’s indiscriminate drug prohibition is responsible for too much crime, disease, and death to qualify as sensible policy. 4. There is a wide range of choice in drug-policy options between the free-market approach favored by Milton Friedman and Thomas Szasz, and the zero-tolerance approach of William Bennett. These options fall under the concept of harm reduction.
That concept holds that drug policies need to focus on REDUCING CRIME, whether engendered by drugs or by the prohibition of drugs. And it holds that disease and death can be diminished even among people who can’t, or won’t, stop taking drugs. This pragmatic approach is followed in the Netherlands, Switzerland, Australia, and parts of Germany, Austria, Britain, and a growing number of other countries. American drug warriors like to denigrate the Dutch, but the fact remains that Dutch drug policy has been dramatically more successful than U.S. drug policy.
The average age of heroin addicts in the Netherlands has been increasing for almost a decade; HIV rates among addicts are dramatically lower than in the United States; police don’t waste resources on non-disruptive drug users but, rather, focus on major dealers or petty dealers who create public nuisances. The decriminalized cannabis markets are regulated in a quasi-legal fashion far more effective and inexpensive than the U.S. equivalent. The Swiss have embarked on a national experiment of prescribing heroin to addicts. The two-year-old plan, begun in Zurich, is designed to determine whether they can reduce drug- and prohibition-related crime, disease, and death by making pharmaceutical heroin legally available to addicts at regulated clinics. The results of the experiment have been sufficiently encouraging that it is being extended to over a dozen Swiss cities. Similar experiments are being initiated by the Dutch and Australians.
There are no good scientific or ethical reasons not to try a heroin-prescription experiment in the United States. Our Federal Government puts politics over science by ignoring extensive scientific evidence that sterile syringes can reduce the spread of AIDS. Connecticut permitted needle sales in drugstores in 1992, and the policy resulted in a 40 per cent decrease in needle sharing among injecting drug users, at no cost to taxpayers. We see similar foolishness when it comes to methadone. Methadone is to street heroin more or less what nicotine chewing- gum and skin patches are to cigarettes.
Hundreds of studies, as well as a National Academy of Sciences report last year, have concluded that methadone is more effective than any other treatment in reducing heroin-related crime, disease, and death. In Australia and much of Europe, addicts who want to reduce or quit their heroin use can obtain a prescription for methadone from a GP and fill the prescription at a local pharmacy. In the United States, by contrast, methadone is available only at highly regulated and expensive clinics. A warning of the prohibitionists is that there’s no going back once we reverse course and legalize drugs. But what the reforms in Europe and Australia demonstrate is that our choices are not all or nothing.
Virtually all the steps described above represent modest and relatively low-risk initiatives to reduce drug and prohibition-related harms WITHIN OUR CURRENT PROHIBITION REGIME. At the same time, these steps are helpful in thinking through the consequences of more far-reaching drug-policy reform. You don’t need to go for formal legalization to embark on numerous reforms that would yield great dividends. But these run into opiaphobia. The blame is widespread.
Cowardly Presidents, unwilling to assume leadership for reform. A Congress so concerned with appearing tough on crime that it is unwilling to analyze alternative approaches. A drug czar who debases public debate by equating legalization with genocide. A drug enforcement/treatment complex so hooked on government dollars that the anti-drug crusade has become a vested interest. But perhaps the worst offender is the U.S.
Drug Enforcement Administration–not so much the agents who risk their lives trying to apprehend major drug traffickers as the ideologically driven bureaucrats who intimidate and persecute doctors for prescribing pain medication in medically appropriate (but legally suspicious) doses, who hobble methadone programs with their overregulation, who acknowledge that law enforcement alone cannot solve the drug problem but then proceed to undermine innovative public-health initiatives. I am often baffled by the resistance of conservatives to drug-policy reform, but encouraged by the willingness of many to reassess their views once they have heard the evidence. Conservatives who oppose the expansion of federal power cannot look approvingly on the growth of the federal drug-enforcement bureaucracy and federal efforts to coerce states into adopting federally formulated drug policies. Those who focus on the victimization of Americans by predatory criminals can hardly support our massive diversion of law-enforcement resources to apprehending and imprisoning nonviolent vice merchants and consumers. Those concerned with overregulation can hardly countenance our current handling of methadone, our refusal to allow over-the-counter sale of sterile syringes, our prohibition of medical marijuana.
And conservatives who turn to the Bible for guidance on current affairs can find little justification there for our war on drugs and the people who use and sell them. 3. KURT SCHMOKE Mayor Kurt Schmoke of Baltimore may be the only sitting politician who advocates, if not outright legalization, reforms in that direction. But even if he is lonely, he is not hopeless on the question of democratic political enlightenment. Mr.
Schmoke was first elected mayor in 1987. He is a graduate of Yale University and a Rhodes Scholar. Serious problems require serious minds. That may help explain why William F. Buckley Jr.
was one of the first public figures to acknowledge that the war on drugs is a failure. I don’t know how Mr. Buckley’s early apostasy about the war on drugs was greeted by his conservative colleagues–although it’s not hard to guess–but I remember the reaction in 1988 to my own call for a national debate on that war. A leading congressional liberal called me the most dangerous man in America. A national magazine referred to me as “a nice young man who had a bright future.” Many of my political supporters encouraged me to drop the subject and stick to potholes. Potholes are important, but, as Mr.
Buckley argued to the New York Bar Association, dropping the subject of the war on drugs means dropping any hope of solving some of America’s most difficult social problems. The war on drugs isn’t a solution in search of a problem. It’s a problem in search of a solution. How big a problem? Very big. As Mr. Buckley points out, “More people die every year as a result of the war on drugs than die from what we call, generically, overdosing.” He is similarly correct in noting that blanket prohibition is a major source of crime: it inflates the price of drugs, inviting new criminals to enter the trade; reduces the number of police officers available to investigate violent crime; fosters adulterated, even poisonous, drugs; and contributes significantly to the transmission of HIV.
These are not problems that are merely tangential to the war on drugs. These are problems caused, or made substantially worse, by the war on drugs. That is why I have long advocated that the war on drugs be fought as a public-health war. This is sometimes called medicalization, or regulated distribution. Under this alternative to the war on drugs, the government would set up a regulatory regime to pull addicts into the public-health system. The government, not criminal traffickers, would control the price, distribution, and purity of addictive substances–which it already does with prescription drugs.
This would take most of the profit out of drug trafficking, and it is profits that drive the crime. Addicts would be treated–and if necessary maintained– under medical auspices. Children would find it harder, not easier, to get their hands on drugs. And law enforcement would be able to concentrate on the highest echelons of drug-trafficking enterprises. I do not specifically endorse the idea of a federal drugstore, particularly if that means selling drugs to people who are not already physically or psychologically addicted. On the other hand, I do support a national commission to study ALL possible alternatives (including legalization) to our failed strategy of blanket prohibition.
This commission would be similar to the 1929 Wickersham Commission, which President Hoover set up to study how to enforce alcohol prohibition more strictly. Although Hoover tried to conceal the results, the commission concluded that alcohol prohibition was, in the words of Walter Lippmann, a “helpless failure.” I believe that an objective and nonpartisan inquiry would come to the same conclusion about the war on drugs. I also support Mr. Buckley’s idea of applying a “utilitarian” calculus to the war on drugs. Congress is quite enthusiastic about weighing the costs and benefits of health care, welfare, community development, and other domestic programs.
It should apply a similar analysis to the war on drugs, a war that is now costing the Federal Government $14 billion a year. In weighing the costs and benefits, Congress would not have to start from scratch. There have been many studies and experiments, including our needle-exchange program in Baltimore. This program costs $160,000 a year. The cost to the state of Maryland of taking care of just one adult AIDS patient infected through the sharing of a syringe is $102,000 to $120,000.
In other words, if just two addicts are protected from HIV through the city’s needle exchange, the program will have paid for itself. But a cost-benefit analysis for the war on drugs would do more than offer a guide to the sensible allocation of federal dollars. It would also make advocating changes in the war on drugs less politically risky for elected officials. Unfortunately, that risk has kept most political leaders in lockstep support of the war on drugs. I understand their reluctance to call for an end to blanket prohibition, especially since individual mayors and governors cannot, by themselves, end the war on drugs or its devastating effects on their communities. However, I also believe that the political risks of debating and criticizing the war on drugs have been overstated.
I have been elected twice since 1988. In my most recent election, last year, my opponent specifically attacked my call for a new strategy in the war on drugs. She advocated “zero tolerance,” which is more of a slogan than a policy, and said she would sign the Atlanta resolution, which supports the status quo. In spite of her distortions of my record on drug policy, I won re-election by a 20-point margin, the widest margin in my political career. Although I strongly believe that changes in national drug policy must be national in scope, I have nevertheless tried to demonstrate that some reforms can be made on the local level.
For example, in 1993 I formed a Mayor’s Working Group on Drug Policy Reform, and I have since implemented most of its major recommendations. These recommendations included providing for more community policing; encouraging Baltimore’s teaching hospitals to make addiction treatment a larger part of their curriculum; and, most important, developing the needle-exchange program mentioned above. Needle exchange was my top legislative priority in 1994. We could not begin the program without a change in the state’s drug- paraphernalia laws. In the previous two years, lawmakers had been reluctant to go along, in part out of fear that they would be accused of condoning drug use. But in 1994, we were able to convince the legislature that needle exchange would not increase drug use but instead would save lives, and perhaps even reduce crime.
The most politically effective argument in selling needle exchange was that it would slow the spread of AIDS. That is because 70 per cent of new AIDS cases in Baltimore are related to intravenous drug use, and AIDS is now the number-one killer of both young men and young women in Baltimore. (This crisis is not unique to Baltimore, and the problem is especially horrendous for African-Americans. A recent report entitled HEALTH EMERGENCY: THE SPREAD OF DRUG-RELATED AIDS AMONG AFRICAN-AMERICANS AND LATINOS, shows that 73,000 African-Americans have drug-related AIDS or have died from it. Among people who inject drugs, African- Americans are almost 5 times as likely as whites to be diagnosed with AIDS.
And for African-Americans, the risk of getting AIDS is 7 times greater than the risk of dying from an overdose.) I’m proud that Baltimore now has the largest government-run needle exchange program in the country. That program is being thoroughly evaluated by the Johns Hopkins School of Public Health and Hygiene. I expect that evaluation to show that needle exchange is saving lives, a claim that the war on drugs has not been able to make for more than eighty years. Mario Cuomo once made an observation that both liberals and conservatives should feel comfortable endorsing. He said that policymakers must distinguish between ideas that sound good and good ideas that are sound. The current war on drugs is an idea that sounds good, but it is not a good idea that is sound.
After hundreds of billions of dollars spent trying to stop the supply and demand of drugs, after the break-up of thousands of families because of the arrest of a nonviolent drug offender, after eight decades of failure, how much longer will the war on drugs continue? I once told a television reporter that the war on drugs was our domestic Vietnam. Conservatives and liberals disagree about the justice of that war. But we generally agree that the strategy for fighting it didn’t work, and as a result the war lasted too long and cost too many lives. The same is true of the war on drugs. It’s time to bring this enervating war to an end.
It’s time for peace.