January 22, 2014

Dear Visitor:

The following is the first chapter of my fourteen chapter book, presented here as a sampler, for you to consider.  The other 13 chapters show how vitally a fundamental change in our failed drug policy is needed, both on grounds of humanity and of the practical importance of keeping drugs out of the hands of adolescents, the age at which the vast majority of our nation’s adult addicts began their use.  The idea presented, a scalable state by state program, ought in time to serve as a model for America and the rest of the world.

KILL THE DRUG TRADE

Ending the war on drugs in a System of Toleration, Counseling and Controls

             A System to Prevent Access by Minors, Reduce Addiction and Crime, and End the Harms of Prison Terms for Drug Users

 

Chapter 1: A dynamic idea with power and impact

 

If at first, the idea is not absurd, then there is no hope for it.

Albert Einstein

It takes considerable knowledge just to realize the extent of your own ignorance.

Thomas Sowell

 

Over the past half century, the barely audible voices of protest at the beginning of the war on drugs have grown to a high-volume chorus of opposition impossible to ignore.  Some of the best minds in the world, representative of all points along the political spectrum, are voicing agreement with the conclusion of the 2011 Report of the Global Commission on Drug Policy[i] that the so-called war on drugs has not only failed, but continues to inflict devastating consequences on the lives of individuals and the health and safety of our communities. This report was joined in 2016 by the Lancet Commissions with their report titled “Public health and international drug policy.”[ii] Whereas the earlier report is the work of world leaders consisting of both conservatives and progressives, the Lancet report is the work of leading international scientists. Both reach the same conclusion–drug prohibition has got to go.

Most of us know something about the havoc delivered courtesy of the pursuit of drug prohibition. We’ll detail it in chapters that follow.  Allow me here to briefly identify the more prominent harms. They include: the corruption of officials all the way from the upper levels of government right down through the ranks to the cops on the street: corruption which has ensnared judges, prosecutors, prison guards, mayors, legislators and more; an incentive for addicted adults and youngsters alike to steal, burglarize, cheat, prostitute themselves and deal drugs for money to buy drugs; overcrowding of prisons and the inhumane warehousing of non-violent drug addicts; the ruining of employment chances by prosecution of people with productive potential; the fostering of business for cartels and large gangs so profitable they are able to buy guns, planes, “soldiers” and allies more than sufficient to overwhelm law enforcement; the engendering of wars between competing cartels, gangs and dealers resulting in the annual murder of tens of thousands of innocent people as well as the lawless; and the propagation of millions of small-scale dealers and user/dealers who provide easy drug access to minors.

It is this last point that makes the pursuit of prohibition wrong. As we cannot stop illegal traffickers from getting drugs into the hands of minors, nearly 200,000 new substance use disorders arise among them each year.

The lessons of history, which we learned with alcohol prohibition last century, led us to abandon that mistake in the early 1930s. It took us only eleven years of that folly to realize a law so out of “sync” with human nature causes more damage to individuals and communities than any measurable benefit. But, in fear they would destroy our culture, we continued the identical mistake in the laws against drugs. While many of us grasp the horrendous penalties we are paying for this mistake, too many do not and so the political paralysis continues.

Politicians win votes with emotional appeals for policies they think might help in the fight against addiction.  Emotions have been inflamed by the news media and the myths of imagined “dope fiends” and “fried egg” brains and other stories that spice up media content. In our moral confusion and lack of scientific knowledge of the realities of drug use and addiction, we fail to demand of our leaders the kind of public debate and creative re-thinking needed to reverse the destructive course we still follow.  Apparently, it seems to most people, even some who are experts in the field, that drug use prohibition is the only game in town.

This game costs us something in the neighborhood of $100 billion per year counting all costs at the local, state and federal government levels.[iii] This means that over the next ten years taxpayers will spend a trillion dollars, just as we already have in the past 10.  Over those past 10 years the drug use rates have remained essentially the same, but with the average age of initiation dropping to the 8th grade level.

It seems that our fear of what drugs do in society is so great it blinds us to the reality that prohibiting adult use fosters use also by minors and so creates more drug use. It does this by creating an underground illegal market, which minors can access—right along with the adults. As mentioned, this means that nearly 200,000 minors develop substance use disorders (SUDs) each year, graduating to adulthood to become profitable customers of drug peddlers. Teenagers are now using at the rate of 9.4% of the 12 through 17 age group. Between 10% and 20% of those adolescent users become addicted just as they are progressing to adulthood.[iv]

According to SAMHSA, at the time of this writing, there are about 7.1 million in our country with substance use disorders involving the illegal drugs. or about 2% of our population.  Despite the righteous stance of our government and politicians, millions of minors are accessing illegal drugs each year, with devastating consequences for some. Our fervid pursuit of adult use prohibition not only fails to protect adolescents, it fosters the very underworld industry that furnishes their means of self-destruction. Surely, we must seek out a better way forward for controlling drugs than with the blunt tools of the criminal justice system. The health based System proposed in this book offers that better way.

Try suspending skepticism for a moment and follow me into an imaginary world in which young people under the age of 21 cannot get their hands on any drugs unless they beg, borrow or steal from adults and that has become very difficult because adult users are carefully guarding their limited legal supply; the number of adult drug users has dropped below current rates; most users do so responsibly, meaning they are maintaining stable and generally productive lives; users access a reliable supply of safely manufactured affordable drugs of certified potency and purity; addicts no longer steal, cheat or sell their sex to get money for drugs; the police now have more time to focus their attention upon illegal drug suppliers and all the other crimes;  jails and prisons are no longer over-crowded;  addicted parents instead of doing jail time are working and supporting their children; health care costs in the country have dropped due to higher rates of addiction recovery;  state government budgets are free of the burden of enormous law enforcement and prison costs; the murder rates in the U.S. and Mexico have fallen to lows not seen for decades; police corruption has plummeted;  the kingpins of the drug cartels and gangs have stopped trying to make money on drugs in the U.S.

Impossible you say? In the pages that follow you will find this picture, or something very much like it, to be an expectable result of the dynamic System I propose.  We can create that world if we will heed the lessons of history; toss out biased and myth-based beliefs about drugs; and recombine the talents and technologies at our disposal in the modern world.

The dynamic idea

The fundamental premise of the idea may be the hardest for many to believe: we cannot keep drugs out of the hands of minors unless we tolerate drug use by adults. This book shows its truth. The second premise is that the protection of minors against addiction is paramount under any drug policy. Nine in ten addicts got that way by starting drug use between the ages of 12 and 17.[v] One in four Americans who began using any addictive substance before age 18 are addicted, compared to 1 in 25, who started at age 21 or older.[vi]  The question before the country, is how do we allow adults to use drugs, without them leaking into the hands of minors.

The answer this book offers — pared to its essential elements– is this:

Adult drug users become clients of a drug dispensary service operated by an entity which delivers legally manufactured drugs of certified potency and purity, at regular intervals, and at below street prices to most and free to some. Clients commit to responsible use, the following of certain rules, random blood or urine testing (to discourage excessive use) and regular ongoing contact with counselors who keep them informed of relevant drug knowledge, and treatment options. Clients who play by the rules no longer fear prosecution, but those who fail to abide by the program’s rules are subject to ouster from it. Preventing access to drugs by minors is emphasized.

Any new and seemingly ambitious or radical idea will often be rejected out of hand by those who misinterpret it or the realities on which it is based.  In Chapter 6, biases and irrationalities, which. to an extent, help maintain the status quo are discussed, as is the dynamism that underlies the change proposed. There are many reservations various people will have about this idea, all of which will be addressed along the way. These reservations include 1) a tolerant system will be enabling to addiction; 2) it will send the wrong signal to young people; 3) drug using parents will share with their kids and/or neglect them while using; 4) it will be too expensive to operate; 5) it will never be politically feasible; 6) it will add to the costs of health care; 7) it will produce more crime and violence; 8) and turn the country into a drug culture.  These are legitimate concerns, but I show how the new System would aptly deal with each and all of them.

Throughout the book I use the capitalized word System to denote what I also sometimes refer to as the “proposed system” or the “System I propose.”

Fact checking popular assumptions.

The public discourse on drug policy is based on various incorrect assumptions. Let’s set the record straight on a few important ones.

  1. Drug users include, equally, all economic and racial groups.

As a thought experiment, picture in your mind the typical drug user. Then answer whether this person is employed full time, part time, or unemployed. Then choose which annual income level is closest to this person’s: $20,000 or more than $50,000.  Got the picture? I’ll give a score of ten for the correct image. You get 5 points for seeing a white instead of a minority person, 2 ½ pts. for selecting employed full time. And if you picked more than $50,000 as closer than $20,000 to this person’s income you get 2 ½ points. If you scored low, you are like me, before I did the research for this book.

Drug use is not a behavior mostly of the poor and the minorities. More whites than blacks use illegal drugs and the per capita rate of use of the two groups is about equal.  While poverty and privation certainly do play a role in drug use, as one might expect of a life oppressed by despair and boredom, on PBS Frontline in the winter of 1997-98, drug policy expert, Mark Kleiman said: “most people who are illicit drug users are employed, stable respectable citizens.”  Unfortunately, newscasts feature drug arrest stories more often occurring in minority neighborhoods, and in relation to crimes of various sorts. It should not surprise us that drugs are associated in the minds of most of us with poverty and crime.

  1. The cause of addiction is not what you think

I’ll bet more than 99% of Americans believe that using mind-altering drugs cause addiction. I believed that until I was well in to my studies of addiction. Science now shows something quite different. Most drug users do not become addicted. Some percentage, ranging from 10% to about 25%, depending how widely or narrowly addiction is defined, do fall into that trap.

So, what is it that causes addiction? The drug use is obviously part of it, but the critical part is vulnerability—a mental condition rendering an individual susceptible. Such vulnerabilities arise sometimes from personality development, which may stem from troubled childhood conditions, poor parenting, child abuse or other trauma. Genes sometimes play a role in this too. Some treating specialists such as Gabor Maté suggest drug dependence can always be traced back to childhood trauma.[vii] But, NIDA Director Volkow and her colleagues tell us genetic variations can play a role too.[viii]

In a 2016 paper, Director Volkow and colleagues[ix] explain that without vulnerability, drug use does not result in addiction, and that addiction occurs in only about 10% of users. They define addiction as the severe form of substance use disorder, discussed below.[x] In a textbook authored by Carl Hart and Charles Ksir, they speak of dependence (addiction) as an overwhelming involvement with getting and using drugs, as in recurrent over-eating or gambling.[xi]  But, all experts agree that mere drug use alone, absent vulnerability that promotes recurrent use despite harmful consequences is not addiction or dependence.

Addiction is a habit-like behavior in response to an urge so strong the person’s self-control has been compromised.  Evidence of this loss of control is present when the person uses despite wanting to quit, repeatedly uses more than intended or gives up other important activities in deference to the substance.[xii] However, there are people who have become drug dependent, who do not exhibit those signs: they simply continue a habit they believe is critical in their lives. But, if they tried to quit they would not find it easy. For them the benefit outweighs the negative consequences.

The national survey SAMHSA, (Behavioral Health Trends in the United States: Results from the 2014 National Survey on Drug Use and Health) shows as of this writing, we have about 27 million current illegal drug users, age 12 and above, and about 7.1 million of those have a substance use disorder (SUD). Not all SUDs are necessarily addictions.  SUDs are defined by the American Psychiatric Association in their DSM V publication, as a condition in which three of eleven diagnostic criteria are present.[xiii]  I summarize those below.  According to APA one must have 6 or more of those criteria present to qualify as a severe SUD.  And Volkow, et. al. tell us they use the word addiction to refer only to those severe cases. We do not know how many SUDs are severe and therefore deemed to be addiction. But, even if we pretended all to be, we would have to say that only about 25% of current drug users are drug dependent or addicted.

In their paper, Volkow and colleagues say true addiction involves a substantial loss of self-control as indicated by compulsive drug taking despite the desire to quit. That is one of the APA’s DSM V criteria for SUD. Two other criteria common in addiction are tolerance (needing more to get the same effect, and withdrawal (feeling sick when the drug is not used). This fits with what I sense is the most usual view of addiction. Some addictions do not involve the severe withdrawal symptoms common to the opioids and heroin. Meth and cocaine addicts experience tolerance, but do not fear sickness from withdrawal.

The other eight SUD criteria set out in DSM V can be summarized as: using more or for longer than intended; spending a lot of time getting, using, or recovering from drug use; cravings and urges to use; failing to manage obligations of work, home or school, because of use; continuing to use, even when it harms relationships; giving up important social, occupational or recreational activities because of drug use; using again and again, even when it poses danger; continuing to use despite a physical or psychological problem caused or worsened by the use.

The APA considers 2 or 3 of these symptoms to be a mild substance use disorder, 4 or 5 to be moderate, and 5 or more to be severe.

Before we leave this section, there is an additional insight that helps further illuminate the nature of addiction. Scientists speak of the role of dopamine in the brain. It’s a natural chemical that stimulates activity in brain regions involved with habit and self-control.  Stress triggers a dopamine reaction, which activates a region in the brain involved with coping habits. And so, if one feels stress, dopamine works to get her going on what is needed to relieve the stress. She is “coping” in her usual, habit based way. Drugs can induce dopamine release also and this can light up pleasure centers. In the initial stages of drug use the person feels a dopamine induced pleasure, but after a time, as Volkow, et. al., explain, it no longer works that way. Where a habit of using the drug has been formed, what has happened is the learning centers of the brain have become conditioned to coping with stress by using a drug—the coping method has become: “get the drug into my system.” So even when the drug no longer produces pleasure, the addicted person wants it, just to relieve the stress.[xiv]Drug craving may often just be  a matter of needing to cope with a stressful situation.

Now we can see that an addict’s drug taking is not a case of seeking a high, it is a form of medicating a stressful condition. This occurs with stimulants such as cocaine or methamphetamine, or narcotics like marijuana and heroin. Heroin and the opioids, however, do bring an additional dimension. If you don’t take the drug after a period of regular use you get sick. Withdrawal from heroin and the opioids that imitate it can be quite distressing and the addicted put it off compulsively.

Why is all this important? The common assumption that drug taking is the cause of addiction discourages willingness to consider toleration of responsible adult drug use as a matter of policy. At the same time, we unfairly stigmatize repeat drug “offenders” by failing to understand addiction as a temporary mental disorder which is characterized by loss of self-control.  The genetic factors and special vulnerabilities at the root of addiction explain both the intensity of drug craving and severity of withdrawal.[xv] Shouldn’t we conclude that making moral judgments against such troubled people is itself morally deficient?

  1. Using drugs for many is a rational decision and they do it responsibly.

Rational drug use, as we discuss in Chapter 5, is use that confers a benefit which is not outweighed by negative consequences.  Many use drugs without ruining social relationships, or materially weakening their ability to function normally and productively. Compare moderate alcohol use.  Most of us accept that a drink or two for relaxation at the end of a day can be beneficial. The medical profession does not oppose moderate use of alcohol and total abstention is now even deemed a risk factor for various illnesses.

It is plausible to say that many adults who use drugs derive valuable relief of anxieties and stress. Not all drug taking is a bad idea. Among other things, the System proposed makes it possible to focus on those who are not using rationally, a fraction of the total user population. It is also plausible to say that some people, deprived of their preferred drug, turn to the generally more harmful (less rational) use of alcohol.

  1. The association of drugs with crime is no reason to reject a use tolerant system.

 

A popular assumption is that drug users do terrible things and we tend to associate drug use with underworld activities. Yet, confusion  surrounds the question of what induces a drug user to commit crime. Is it the pharmacological effect of the drug, or is something else at work?

Crime related to drug use falls into three categories. First there are crimes committed by addicts who cannot otherwise afford their drugs. Facing withdrawal or otherwise feeling a need of the drug, they commit crimes to buy drugs. These include the acquisitive crimes such as burglary, theft, armed robberies, car jackings, but also prostitution and small-scale drug dealing. The second category involves the crimes incident to the illegal drug trade itself, often violent, as dealers enforce their “rights” against each other and sometimes against their customers. Included here also are smuggling, bribing of officials, money laundering and the like.

Those first two categories account for all but a small percentage of criminal activity. The third category are the crimes thought to have been either induced or encouraged by the chemical effects of a drug—pharmacological effect. There is no clear evidence that drugs chemically induce otherwise honest people to behave criminally and as Hart and Ksir put it, “…it is incorrect to conclude that using any particular drug will turn a person into a criminal.”[xvi] These experts point out that longitudinal studies of children and adolescents show tendencies toward crime and other anti-social behavior appear before first drug use.

Still drug use and personality disorders sometimes go together and it seems plausible that a drug such as a stimulant might embolden some to go over the line. For example, PCP can cause such a disorientation an arrestee may resist violently. While most crime in which drugs were involved can be explained on grounds other than the chemical effects of the drug, we cannot rule out the possibility that chemical effects play a causative role in some cases.

Does such a possibility suggest we should pause before moving to a drug tolerant program? Quite the opposite. Because anti-social tendencies can now be identified at early ages and increasingly records are available to identify those who have them, the System’s monitoring feature would help to head off tendencies toward drug induced crime. The monitoring feature is discussed in Chapters 8 and 10. Moreover, by allowing drugs such as marijuana, cocaine, certain amphetamines and heroin, we would be allowing these users far better alternatives to the more dangerous types such as PCP.

So, here we see that we will have a more effective means to prevent chemically induced crime in a system that all but eliminates the major inducements to crime, namely, crime committed to buy drugs and crime related to dealing in drugs.

 

  1. Tolerating adult drug use will not produce more of it.

Most adults show no interest in the pleasures of drug taking at the risk of the negative consequences to normal life activities they bring. In Chapter 3 we discuss the countries whose liberalizing of drug use has not resulted in higher use rates. While a RAND study concluded that legalization of marijuana in California would result in increased use, statistical data in Holland, where all forms of cannabis are legal, show that among young people of the medium age 28 in the Netherlands, where cannabis products are sold in widely available “coffee shops.”  only 16% ever smoked marijuana.[xvii] Soft drugs when widely accessible seem to lose much of their appeal and there is no empirical evidence that toleration of their use results in increase. In fact, as we shall later see, under the proposed system there is reason to expect, over time, a reduction in adult use as users become better informed about how to use responsibly and far fewer minors have access to drugs on which to start use.

 

  1. Addiction is treatable and can be resolved, usually by one’s early thirties.

Despite the frequent claim that addiction is a lifetime disorder, most of the addicted recover without any recurring symptoms by their early thirties and many before that. Roughly 75% of people who are drug dependent by age 24 become symptom free by the age of 37.[xviii]   It is important that addicts are given this information.  Addicts who want to recover should not be discouraged from doing so by the belief in the old “once addicted, always addicted” assumption. There is ample reason for optimism that they will achieve complete recovery.

  1. Addicts can live productive lives.

Some addicts will choose to continue to live with addiction in a use tolerant system, and do so as useful, productive members of society. Consider the case of one of the founders of the Johns Hopkins Hospital, the famed surgeon, Dr. William Halstead– praised by his peers for his technique and teaching. He first became addicted to cocaine while studying its anesthetic properties. Some close friends aggressively intervened and he stopped using cocaine, but unknown to most of them he began self-treating with morphine, an opiate.  He carried on his surgical practice for decades as a morphine addict.[xix]  Other productive drug addicts include authors Stephen King and William Burroughs, Hunter Thompson; actors Alex Baldwin and Liz Taylor, famous funny man Robin Williams and a vast array of others who pursued their careers while dependent on drugs. Criminologists have found that addicts devote very little time to getting high and spend most of it working or hustling.[xx] Wouldn’t we prefer that they be allowed  the chance to work productively, instead of hustling for drugs or the money to buy them? Drug use toleration accompanied by a robust counseling program is surely a better way to foster both responsible use and earlier quitting of drugs, than our criminal justice regime that forces them to get their drugs in the underworld.

***

The federal drug scheduling scheme

The Controlled Substances Act of 1970 in Title 21, Section 812, categorizes the many drugs into five schedules. The criteria for inclusion in each schedule are summarized as follows:

Schedule I drugs are those with no currently accepted medical use and a high potential for abuse. Placed in this category by the FDA were many opiates and opium derivatives and hallucinogens. Here you will find heroin, Ecstasy (MDMA), mescaline and peyote along with LSD and “marihuana”. It seems absurd today that marijuana is listed here. The weight of authority is on the side of medically beneficial use of cannabis.

Schedule II includes drugs which in addition to having a high potential for abuse could potentially lead to severe psychological or physical dependence—also called addiction. Here we find cocaine and methamphetamine among others, including methadone which is used in the treatment of addiction.

The criteria for Schedule III drugs are that they have a potential for abuse, but one which is less than that for the first two schedules; that they have a currently accepted medical use; but “abuse” may lead to some low level of physical dependence or an elevated level of psychological dependence.

Schedule IV drugs are those that have accepted medical uses, but have a low potential for abuse and, compared to the drugs of the first three schedules, they lead to “limited” physical or psychological dependence.

Schedule V drugs are defined with criteria like those of Schedule IV, only they are less risky still.

It is to these schedules and the drugs placed by the government within them that various federal and state laws apply to ban their possession, and by extension, their use.

Each of the schedules speaks of potential for abuse, but it does not tell us how to quantify “high potential” or some other level of “potential” and it doesn’t define abuse.  Law professor Douglas Husak looked at the legislative history and found that Congress considered the potential for abuse to exist when some individuals were found to be taking a drug in sufficient quantities to risk harm to themselves or others; or when there is evidence of diversion of drugs from legitimate channels; or where individuals are initiating the drug use on their own without medical advice.[xxi]

 

Use, abuse and responsible use

That latter point, using without medical advice reflects a common understanding of drug abuse. You read articles in the paper and hear politicians speak of people “abusing” drugs. What they are saying is merely that they are using drugs illegally. In this book. I speak of drug use and substance use disorders. I seldom use drug abuse, which to me can only mean a disordered or irresponsible use.  This is consistent with the position of the American Psychiatric Association (APA). They have abandoned the term altogether.

The term abuse appeared in the APA’s diagnostic manual, DSM-IV up until 2013, under the heading Substance Abuse and Substance Dependence. It was defined as one or more of four criteria: use resulting in failure in obligations at work, school or home; use in situations where physically hazardous; recurrent use-related legal problems, or continued interpersonal (social) problems caused or worsened by the substance use.

But, the term “abuse” has been dropped from the medical vocabulary. In the APA’s 2013 publication of DSM V, the single term “substance use disorder,” was adopted. As mentioned above, it is defined as having three or more of eleven signs or symptoms.

Using drugs can be done in a rational, responsible way as we later discuss. Use that is not responsible includes consumption of drugs in such doses or frequency that the user’s judgment is impaired and he or she engages in risky or socially offensive behaviors. It also includes driving while impaired, using in hazardous situations, neglecting children in the user’s care, the persistent alienation of family, friends, and co-workers, and using drugs when they reduce the ability to perform one’s job.  This is what I would call drug abuse.  Merely using should not be confused with abusing.

Can addicted persons use responsibly?  In most cases, the answer is an emphatic yes. Most users and many addicts use responsibly, and those who don’t can learn to do so. The common image of the doped-up loser staggering or slouching on the street characterizes some, but the majority are not like that.  It is the addicts who use and behave irresponsibly in the way or under the circumstances in which they use, we should focus on. Teaching these people how and why to use responsibly is one of the key features of the proposed system, which also insists upon it.

Pursuing prohibition, we lose the benefit of federalism

Our pursuit of drug prohibition deprives us of the benefits of state experimentation with alternative policies. In drafting the Constitution, the founders were intent upon preserving federal and state separation.  The 10th Amendment addressed it:  powers not delegated to the U.S. government were reserved to the states and to the people. The idea was to keep government as close to the people as practicable. The famous social observer Alexis d’Tocqueville pointed out in the early 19th century that the several states serve as experimental laboratories for policies that might then be adopted beneficially in other states or even nationally.

Today those benefits of federalism are only awkwardly enjoyed in the case of drug policy. While several states have legalized recreational marijuana and more than half have legalized medical marijuana, they have done so despite the power of federal authorities to arrest and imprison people for possessing and selling it. In recent years, the U.S. Attorney General adopted a policy of benign neglect in those states, choosing to look the other way–but not in the others. There is an incoherence here, since marijuana is classified as a Schedule I drug–one lacking in any accepted medical use, and the Attorney General and the DEA have continued to maintain their power and right to investigate and raid those who possess it for sale. Even possession for medical purposes is a federal crime. As time passes the picture will surely clarify, but it strikes many of us as unfortunate the federal government so dominates the terrain of drug policy.  The states could be trying new approaches to dealing with all the drugs and we could be learning how to control them without jailing people.

[i] Global Commission on Drug Use, (2011) Executive Summary http://www.globalcommissionondrugs.org/wp-content/themes/gcdp_v1/pdf/Global_Commission_Report_English.pdf

[ii] Lancet Commissions, (2016) Public health and international drug policy Retrieved from: http://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(16)00619-X.pdf

[iii] Becker, G., (2005) The Failure of the War on Drugs, Retrieved from: http://www.becker-posner-blog.com/2005/03/the-failure-of-the-war-on-drugs-becker.html

[iv] According the National Center for Addiction and Substance Abuse (CASA) 90% of all addictions stem from initiation of use between the ages of 12 and 17. Dr. Carl Hart states that between 10% and 20% of those who initiate drug use become addicted. Dr. Nora Volkow, et. al. of NIDA state that vulnerability to addiction is greatest during the adolescent years.

[v] CASA (2012) Retrieved from https://www.centeronaddiction.org/newsroom/press-releases/national-study-reveals-teen-substance-use-america%E2%80%99s-1-public-health-problem

[vi] Ibid.

[vii] Maté, G. (2010) In the Realm of the Hungry Ghosts, Berkeley, CA North Atlantic Books

[viii] Volkow, N., Koob, G.F., McLellan, A.N., (2016)) Neurobiologic Advances from the Brain Disease Model of Addiction., NEJM, accessed 11/8/2016 at http://www.nejm.org/doi/full/10.1056/NEJMra1511480#t=article

[ix] Volkow, et. al. Ibid.

[x] Volkow, et. al. Ibid.

[xi] Hart, C.L., and Ksir, C., (2015)  Drugs, Society & Human Behavior (16th ed.) New York, N.Y. McGraw Hill pp 34-40.

[xii] Hart and Ksir, Ibid.

[xiii] American Psychiatric Association, (2013) Diagnostic and Statistical Manual of Mental Disorders, 5th Edition: DSM-5: Substance Use Disorder

[xiv] For an instructive treatment of this phenomenon see Korb, A., (2015) The Upward Spiral Oakland, CA New Harbinger Publications, p 70 et. seq.

[xv] Satel, S., & Lilienfeld, S.O., (2013) Brainwashed.  The Seductive Appeal of Mindless Neuroscience, New York NY, Basic Books, Chapter 3.

[xvi] Hart and Ksir, Ibid. p 42.

[xvii] Amsterdam Info., Amsterdam Drugs Policy. Information accessed 7/10/2017 at https://www.amsterdam.info/drugs/

[xviii] Satel & Lilienfeld, Ibid. See also Kleiman, M. A. R., Caulkins, J.P. &Hawken, A., (2011) Drugs and Drug Policy, New York, NY, Oxford Univ. Press, p 95.

[xix] Gray, Mike. (2000) Drug Crazy: How We Got into This Mess and How We Can Get Out of It.  Routledge, NY, pp 54,55.  Gray is an acclaimed film writer.  I rely here on this well sourced history of the drug war.  He is not to be confused with Judge James Gray whose book is later cited herein.

[xx] Satel & Lilienfeld, Ibid

[xxi] Husak, D. (1992) Drugs and Rights, New York, N.Y. Cambridge Univ. Press, pp 27-37

 

 

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