Rethinking the Drug Problem

A growing number of academic, legal, criminal justice, and political sources agree that the nation's "war on drugs," has failed to achieve its objectives and has become excessively costly to American taxpayers. While the federal government has a lengthy history of criminalizing drug problems, the contemporary drug war has its roots in the early 1980's when conservative politicians began campaigning for stronger legal controls and criminal penalties to stem the tide of a "growing drug menace."Although President Nixon was first to point to a growing drug problem, President Reagan initiated the contemporary drug war on October 2, 1982. Reagan was able to consistently persuade Congress to allocate large sums of federal dollars to support his drug war. Consequently, the drug enforcement budget rose nearly tenfold from $1.2 billion in 1981 to nearly $11 billion in 1991. During this period, Congress also repealed many existing procedural protections accorded to the accused, markedly increased criminal penalties for drug offenses, and gave law enforcement agencies windfall resources through sharing proceeds of asset forfeiture. Despite these unprecedented measures and the intervention and coordination of federal agencies, including the CIA, FBI, DEA, U.S. Customs, the Coast Guard, the Navy, NASA, as well as fiscal support to a wide range of local law enforcement agencies, the flow of illegal drugs continued with relative impunity.While it is clear that the shift toward retributive and incapacitative strategies brought the criminal justice system more squarely onto center stage, it also had the effect of discrediting other drug control strategies, such as prevention, education, and drug treatment programs which were often characterized by conservatives as failed liberal solutions. Consequently, federal funding for the drug war was primarily aimed at interdiction and law enforcement efforts, with smaller amounts earmarked for treatment.In 1985, thirty-one percent of the national drug control funding was devoted to treatment, prevention, and supporting research and 36 percent was given to domestic law enforcement. Ten years later treatment and prevention funding had grown only to 35 percent while domestic law enforcement received 53 percent of the $13.3 billion total drug control funding. These figures are ironic as the RAND Corporation reports that treatment is the least expensive approach to reducing drug use. Their 1994 study found that $34 million spent on treatment reduced cocaine use to where $348 million spent on domestic law enforcement and $360 million spent on interdiction would be needed to accomplish the same level of reduction.Nevertheless, President Bush, following the Reagan drug control strategy, declared cocaine to be the "scourge of this Hemisphere" and pursued an escalation of the drug war. In a national television address Bush announced the dispatch of military equipment to Columbia to assist the war against the Medellin and Cali drug cartels. Hence, the militarization of the drug war, guided by the President's Office of National Drug Policy, set the tone for the Bush administration's approach to the drug problem.By the mid-1980's the news media (including the New York Times) joined the march to the conservative drumbeat, reporting "hundreds" of crack babies being born, daily drive-by shootings involving innocent victims, and characterizing the drug problem as an "epidemic" of crack cocaine use among "out of control" urban residents. This fueled the adoption of draconian drug penalties giving disproportionate and lengthy prison sentences to users of crack cocaine while those convicted of drug offenses involving powder cocaine were given significantly lighter penalties.Crack is nearly identical to powder at the chemical level, but given the perception that it is the drug of choice among urban black residents it has sparked one of the most pointed and glaring examples of racial injustice among criminal defendants.The vast majority of federal crack defendants are black; whites are more frequently convicted of powder cocaine offenses -- carrying lesser penalties. The U.S. Sentencing Guidelines require a mandatory 5-year prison sentence for selling 5 grams of crack, although it takes a sale of 500 grams of powder to result in the same penalty! At year-end 1997, nearly 60 percent of all federal prisoners were serving a sentence for drug offenses, up from 26 percent in 1982, and 17 percent in 1972. Consequently, black males and females now comprise almost 41 percent of the federal prisoner population, in spite of making up only 12 percent of the U.S. population. When the percentage of black males aged 18 to 38 is used as the base rather than the entire U.S. black population, racial disparity in the use of incarceration becomes even more glaring. One of the most costly results of the drug war is illustrated by the growth of the nation's prison population. The Bureau of Justice Statistics reports that state and federal prison populations nearly doubled during the 1980's. By mid-year 1997, an estimated 1,725,800 persons were in the nation's jails and prisons, with over 23 percent of state prisoners serving sentences for drug offenses. Furthermore, more than one-half of the nation's state prisoners have serious drug problems, although less than 10 percent participate in intensive drug treatment programs.The crime control model has not only failed to adequately address the drug problem, it has become a social control mechanism targeting large numbers of young black males who are incarcerated for lengthy periods of their reproductive lives with little or no hope of establishing a normal social and economic connection upon return to their respective communities. The drug war has also produced a number of other dysfunctional outcomes. Among these outcomes have been the corruption of some law enforcement agents and members of the legal community, creation of devastating public health problems, such as the spread of HIV through sharing dirty needles, the victimization of countless children and family members of drug users who became secondary victims of the drug war, and the further division of racial groups in American Society. A New Direction It is becoming increasingly clear that the public health, harm reduction, and legalization models have much to offer in reducing drug-related harms. The public health model, used heavily during the 1960's and 1970's, views drug addiction as a medical problem which should be addressed with treatment resources as well as prevention and public education. While there were critics of this approach, particularly of the use of civil commitment statutes to provide involuntary treatment to addicts, it nevertheless provided a much clearer distinction between punishment and treatment than we have today. Under this model, drug addiction and drug dependency are addressed outside of the criminal justice system. This allows for a much broader range of intervention strategies, such as methadone maintenance, drug crisis centers, and community intervention and outreach programs.The public health model also allows for a comparative analysis of the impacts and associated harms of abuse of legal substances such as tobacco, alcohol, and prescription and OTC drugs, whereas the crime control model emphasizes the social and moral harms solely of illegal drugs.Each year during the 1990's, nearly 500,000 deaths are attributed to cigarette smoking. Another few hundred thousand lives are lost to alcohol-related morbidity and trauma (e.g., car crashes). Further, the nation has approximately 10 to 12 million alcohol abusers who present substantial social and medical costs to the nation. It is estimated that the cost of alcohol abuse for 1990 was $136.3 billion! Each year alcohol abuse and tobacco use account for a significantly greater death rate than all illegal drugs combined. The addictive properties of nicotine have been deemed by a number of researchers to be stronger than that of heroin, yet public policy remains directed toward the harms and control of illegal substancesSome European countries approach drug dependency as a medical problem. What is often termed the "English System" is essentially the medicalization of narcotics addiction. Fifteen years ago England experimented with the distribution of heroin. The government licensed qualified physicians working in treatment centers to prescribe heroin, morphine, and methadone to addicts in need of treatment. Treatment approaches varied across treatment centers, as well as across addicts based upon their individual needs and background. A similar program has operated in Switzerland for approximately two years. Among the benefits of the medical approach is the administration of standardized doses, thus preventing overdoses within the addict population, and the availability of sterilized needles to IV-drug users. While the number of addicts in England increased from about 500 in 1965 to over 3,000 in 1972, and currently there are approximately 12,000 addicts in Great Briton, much of the increase was attributed to the in-migration of drug addicts from other European countries seeking access to treatment. In spite of these increases, the rate of narcotic addiction in England remains less than one-third of that of the U.S. Generally, drug addicts in the Great Briton are not considered to be a major threat and are most frequently treated with compassion and understanding, primarily because there is little relationship between drug use and predatory criminal behavior in England. A similar approach was recently started in the Netherlands. Under the Dutch program, heroin is being given to untreatable addicts in several cities. These are addicts for whom methadone was ineffective. Initially, heroin will be dispensed to about 750 heroin addicts who have to report three times a day to a site located outside of their familiar drug scene. Later, a larger group of addicts are to be brought into the program. This effort is set within a tightly structured research design including two treatment groups and one control group. This approach accompanies the already widespread use of methadone maintenance programs, and the legal use of marijuana in selected "coffee houses." While there are some indications that the U.S. is slowly moving closer to a public health approach, the proposed use of greater treatment resources remains tightly linked to the crime control model. For example, while President Clinton's 1996 FY National Drug Control budget allocated nearly $4.5 billion for drug treatment, prevention, and related research, it reflected only 33 percent of the total NDC funding. These funds also do not address the medical, social, psychological, and economic needs of the nearly 5.5 million drug abusers on the street.Harm reduction offers another option. The harm reduction model approaches the drug problem less from an attempt to reduce drug use and more from an attempt to reduce or eliminate the harms associated with substance use and abuse. Among the harm reduction strategies used throughout Europe are needle exchange programs, drug and alcohol detox centers, government regulated "shooting galleries," decriminalization of recreational drugs, and the medical supply of narcotic drugs. In Great Briton, more than 250 agencies and pharmacies distribute safe needles to IV drug users. In contrast, there are only about 75 needle exchanges in the U.S. and all are operated with the use of private funds. Given that the overwhelming proportion of new HIV cases are the result of using infected needles and syringes, overcoming moral objections to supplying addicts with the means to continue their drug use can substantially reduce the transmission of serious social and medical problems. Harm reduction attempts to address not only the direct effects of substance use, but also the harms connected to a drug-using lifestyle. The most controversial of all the new directions in drug control is the legalization of previously illegal drugs. Marijuana appears to be the most plausible drug for legalization. It is important to note that virtually all advocates of legalization view the issue as a shift from criminalization to regulation -- similar to that of alcohol, tobacco, and some prescription drugs. The legalization of a vice does not necessarily imply endorsement of the activity. However, when state governments assumed control of gambling, off-track betting, and in the case of Nevada, prostitution, they have inadvertently promoted or condoned the activity and have contributed to related social problems. Thus, the legalization of marijuana would need to be connected to a larger moral purpose to be of social value. Societal goals such as a reduction in crime and violence, greater public health awareness and safety through standardized products would appear to be of sufficient social value. Furthermore, the removal of subcultural artifacts and lifestyle surroundings, which often accompany purchase and use patterns, may in fact make marijuana use less attractive to some participants. That is, "set and setting" have always been important factors in determining a drug "high" among drug using populations, so the neturalization of the patterns of excitement in breaking the law and associating with other law breakers may serve to reduce use among some groups. From a practical perspective it makes little sense to criminally prosecute hundreds of thousands of American citizens for possession of small amounts of marijuana. At the very least, the national drug policy should support the use of civil sanctions rather than criminal penalties.Approximately sixty-six million Americans have smoked marijuana and about 10 million continue to do so on a regular basis. In addition, twenty-two million have used cocaine, 150 million have used tobacco with over 50 million people are doing so daily. Recently, California and Arizona voters authorized the medical use of marijuana with a doctor's recommendation. Yet the Office of the National Drug Control Policy has strongly denounced these measures and adamantly opposes any form of legalization. Opponents of legalization point to the physical harms thought to be related to regular heavy use of marijuana. A number of studies were conducted during the 1970's and 1980's which have indicated that marijuana smoke contains substantially more known carcinogens than tobacco smoke, has effects on short-term memory and coordination, and like cocaine, heroin, alcohol, and nicotine triggers the release of dopamine in a small midbrain region known as the nucleus accumbens. However, most of these studies based their results upon levels of marijuana use comparable to tobacco smokers who consume more than 20 cigarettes daily. Another factor not widely discussed is that legalized marijuana products would almost certainly have the many of the undesirable contaminants removed and safety concerns would be brought more squarely to the forefront. Generally, the arguments in favor of legalization include claims that legalization would undermine the interests of organized crime and foreign drug markets, reduce drug prices so that users would not have to resort to prostitution and street crime to support their habits, reduce governmental corruption, reduce costs of operating the criminal justice system, and allow drug revenues to be directed toward prevention and education efforts. The arguments against include claims that marijuana use combines the pitfalls of both tobacco and alcohol, that it has become more potent over the years, thus contributing to a much greater level of drug harm, that it would be a "gateway" drug to more addictive drugs such as cocaine and heroin, that it would inspire heavy use, resulting in lost productivity and developmental impacts, and that it would move the average user age downward to include a much greater number of children and adolescents. Whether or not the U.S. (or some states) adopt legalization policies will swing not on the rationality of the arguments presented, but on the level of ideological support for either choice. Given the continuation of draconian drug policies and the government's concerted attempt to portray the drug problem as a moral issue there is little likelihood that legalization will be considered in the near future. However, discourse on this topic can bring about greater public awareness and perhaps more willingness to reduce drug-related harms. Perhaps an enlightened society will no longer tolerate the structural racism and marginalization of alternative lifestyles associated with current drug enforcement policies. It is time to bring a greater number and the representation of more diverse groups of citizens into the formation of national drug policy.

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