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: An Idea Whose Time Is Now

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

Albert Einstein

The enlightened call for change

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 complaints impossible to ignore.  Some of the best minds in the world, among whom are represented at 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 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.  Shortly I will present you with the idea for reversing these consequences.

Most of us know something about the havoc wreaked by our drug prohibition policies and some of that will be reviewed in the chapters that follow.  Allow me to just identify the more prominent ones.  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 and cheat, to 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 the guns, planes, “soldiers” and influence with which to overwhelm law enforcement agencies; 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 time dealers and user/dealers who provide easy drug access to children.

The lesson of history, which we learned with alcohol prohibition early in the 20th century, was that it spawned violent criminals and official corruption as well.  It took us only eleven years of that folly to realize we had violated the laws of human nature and caused more damage to individuals and communities than any measurable benefit. Once we learned that prohibition was a mistake we got rid of it, but continued the identical mistake in the laws against drugs.  While many of us grasp the horrendous penalties we are now paying for our failure to heed history, too many do not and the political paralysis continues.  Much of the information available to the voting public is incomplete and often erroneous.  Politicians win votes with the emotional appeal of policies promoted to fight addiction. Those emotions are enflamed by the news media who spread the myths of imagined “dope fiends” and “fried egg” brains and other stories that sell newspapers and TV ad time.  In our moral confusion and weak grip on the realities of drug use, 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 that costs us 25 billion dollars per year at the federal level and another 100 billion at the state level has grossly under -achieved its purpose. We have spent a trillion dollars in just the past 10 years.  Yet over those same 10 years the drug use rates have remained essentially unaffected and with the average starting age dropping down to the 8th grade level with some children beginning as early as age nine.

Is drug addiction such a huge problem that it justifies such an expensive policy, a policy as we shall see that results in an enormous annual loss of life to disease and violence?  According to prominent researchers we have probably fewer than 6 million addicts at any given time.  That is less than 2% of our population.   Compare that 2% with the statistic that 47 million or 15% of our fellow citizens are on food stamps. We do not interpret the food stamp statistic as a crisis, though poverty in our country continues to be a regrettable problem.  Drug addiction impacts us in costly ways, but its scope is tiny compared to many other concerns.  Clearly we are not in a drug use crisis such as might justify the war metaphor, yet our laws against drugs are aimed at all drug users whether they are at risk of addiction or not, and , as we shall see,  a  majority of them  are not.  And despite the righteous stance of our government and politicians, children by the millions are taking up drugs each year and becoming the spawn of the adult addict population so profitable to the drug trade. Surely we need a better way forward for reducing addiction than we now employ.  The System proposed in this book is such a better way.

Try suspending  skepticism for a moment and follow me into an imaginary world in which youngsters under the age of 18 cannot get their hands on any drugs unless they beg, borrow or steal from  adults and that has become very difficult because adult users carefully guard their limited supply; the number of drug users, all adults, has dropped to or below about 6% of the population; most users do so responsibly, meaning they are not impairing their ability to behave properly; users enjoy a reliable supply of safely manufactured affordable drugs of certified potency and purity; addicts no longer steal, cheat or prostitute themselves 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 half a century;  police corruption has plummeted;  the kingpins of the drug cartels and gangs are frustrated and losing money.

Return now if you must to skepticism, but in the pages that follow you will find this picture entirely possible and likely to result over time from the system proposed.  We can create that world if we will heed the lessons of history; toss out biased and myth based thinking; and recombine the talents and technologies at our disposal.

The idea whose time is now

The idea 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 supplies 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 testing (to discourage excessive use) and regular ongoing contact with counselors who keep them informed of all relevant drug knowledge, and treatment methods and options. Clients who play by the rules no longer fear prosecution, but those caught gaming the program or who fail to abide by its rules are subject to ouster from it.

Any new and seemingly ambitious or radical idea is easily picked apart by those who misinterpret it or the realities on which it is based.  In Chapter 6, biases and irrationalities are discussed. The following are among the many reservations some will have about this idea, all and more of which were considered in the writing of this book:  Such a system will be enabling to addiction; send the wrong signal to kids; allow drug use to parents who will share with their kids and/or neglect them while using; be too expensive to operate; never be politically feasible; add to the costs of health care; turn the country into a drug culture.  These are legitimate concerns.  The aim of what follows in this book is to demonstrate the merits of the idea and to show how it overcomes those concerns.

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

The eight facts you need to know

The public discourse on drug policy is misinformed in a number of important ways.  Just as in scientific discussions erroneous assumptions and mistakes of fact lead to wrong conclusions, so too do they in public policy discussions.  You, the reader, are more likely than most to be well informed, but nevertheless, we here review some important facts not commonly appreciated in the U.S.    If you disagree with any of the following eight points or the brief discussions of them here,  perhaps your thinking will be changed by reading the more detailed discussions of them in later chapters.

1. As much drug use occurs among employed middle class and stable groups as among minorities and persons in poverty.

It is important that we understand that drug use is not a behavior to be associated with the poor and the minorities. There are more whites than blacks who 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 would expect despair  to do, in a PBS Frontline interview in the winter of 1997-98 , drug policy expert, Mark Kleiman said: “It’s certainly true that most people who are illicit drug users are employed, stable respectable citizens.”  Unfortunately for the public understanding, the news media feature drug arrest stories, which occur disproportionately in minority neighborhoods, where various other crimes are also more frequent. In poorer neighborhoods drug dealing takes place more often on the street where it is easier to be spotted and reported.  Whether racial bias plays a role in the disproportionate impact of drug arrests in the black community is a controversy outside the themes of this book.

2.       The cause of addiction in individual users is difficult to isolate.

The causation of addiction is a complex issue and while drug taking is a contributing factor, the data displayed in Chapter 5, show that a large majority of users of drugs of all kinds including the very potent ones such as crack cocaine and methamphetamine do not become addicted to them.  The common assumption that  that drug taking is the cause discourages willingness to consider toleration of responsible adult drug use as a matter of policy.  Instead we should say that some drug use leads to addiction in some people. Genetic factors play an important part both in the intensity of the craving and severity of withdrawal.[ii]   Some argue that we need drug prohibition for the paternalistic protection of the relatively few who become addicted.  That is a different discussion, which we take up later.

3.     It is counterproductive to call addiction a disease of the brain.

Most treating professionals are probably aware that the only useful reason for using the “brain disease” terminology is because it is believed to help in obtaining government funding for research, or in promoting rehab treatment of one sort or another.  The metaphor of brain disease provides too many addicts with the false excuse that there is nothing they can do to help themselves because their brain is not normal,[iii]  and so encourages them to postpone trying until the day that never comes, such as “when I can afford treatment” or “an addiction cure pill is invented.”   Addiction is certainly a form of illness, but one that results from normal not abnormal brain functioning.  It has been called a consequence or concomitant of “addicted thinking” or “distorted thinking.” [iv]  It is a self-destructive behavior the addict finds difficult to quit, and recovery requires a focused effort on his or her part in the context of choices and consequences.[v]  By a large majority, addicts recover, often on their own without treatment. [vi] In Chapter 7 we more fully discuss treatment of addiction and the immense value of counseling contact outside the clinic: an element of the system proposed.

4.     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 deemed a risk factor for various illnesses, although, excessive drinking may also be a risk factor for the same illnesses.

5.    Most crime is committed by individuals on drugs, but it is not the drugs that cause that behavior.

It is important to keep this reality in mind when addressing the drug policy issues if we accept that it is inhumane to imprison people whose only offense is the possession or use of drugs.  This is why we have drug courts.  Justice system professionals came to realize how dehumanizing and degrading it is to incarcerate decent people who for whatever reason became involved in using the forbidden substances.  About 80% of incarcerated convicts had drugs in their systems when arrested.  But, correlation is not causation and it cannot be said that drug use induced their crimes.  That 80% applied to a federal and state prison population of two million gives us a calculation of 1.6 million convicts of all forms of crime who were on drugs at the time of their arrest.  Of the total drug using population of 22.5 million that number amounts to only 7% of regular users.  Obviously the vast majority of drug users do not do violence things to other people.   Property crimes committed to get money to buy drugs are a result of the high prices generated by prohibition, not of the neurobiological effect of the drug.   Meth and cocaine cause the user to be more alert and focused, not moved to crime or violence. Heroin and cannabis make one feel good, relaxed, and without worry.  Is it not more likely that violent behavior is the result of a violent personality, not drugs?

6.       We can tolerate adult drug use without producing more of it.

It is logical to suppose that there might be some increase, but this has not been the experience of several countries including our neighbor Canada.  In Chapter 3 we discuss the countries whose liberalizing of drug use as distinguished from a general legalizing of it has not resulted in higher use rates. While a RAND study concluded that legalization of marijuana in California would result in increased use, there is no empirical evidence that toleration of adult use, with tight controls to protect against childhood initiation, would result in any increase. In fact as we shall later see, under the system proposed there is reason to expect, over time, a reduction in use as users become better informed about the hazards and alternatives.

7.    It is now known that addiction can be cured and generally is by one’s late thirties.

As has already been noted addicts by a large majority recover without any recurring symptoms of addiction, and most of those do so on their own without formal rehab treatment.  There are data indicating that roughly 75% of those drug dependent by age 24 become symptom free by the age of 37. [vii]   It is important that addicts are given this information.  Addicts who want to recover should not be discouraged from doing so by the myth that addiction is a lifetime disease – that he or she is condemned to wear the label “addict” for the rest of his or her life.

8.      Most addicts are capable of living productive lives.

Consider the case of one of the founders of the Johns Hopkins Hospital, a prominent surgeon by the name of Dr. William Stewart Halstead praised by his peers for his swift and sure surgical technique.  Having first become addicted to cocaine while studying its anesthetic properties, his colleagues aggressively intervened and he stopped using cocaine, but unknown to most of them he self-treated with morphine, an opiate.  He carried on a renowned surgical practice for decades as a morphine addict.[viii]  Criminologists have found that addicts devote very little time to getting high and spend most of it working or hustling.[ix] Wouldn’t we prefer that instead of inducing addicts to hustle for drugs or the money to buy them, we could tolerate their drug use, encourage them toward productive employment and toward recovery at a pace commensurate with their particular circumstances?

***

More confusion in the federal scheduling scheme

The Controlled Substances Act of 1970 in Title 21, Section 812, categorizes a large number of drugs into five schedules in descending order of importance to drug law enforcement, though they do not relate to punishment severity.  The criteria for inclusion in each schedule are summarized as follows:

Schedule I drugs are those having a high potential for abuse, have no currently accepted medical use in the U.S., and lack “accepted safety” for use of the drug under medical supervision. Placed in this category by the Attorney General were many opiates and opium derivatives and hallucigens. Here you will find heroin and morphine, Ecstasy (MDMA), mescaline and peyote along with LSD and “marihuana”. Many will find it surprising that marijuana is here side by side with heroin.  Schedule I criteria do not include reference to the addictive quality of these drugs.

Schedule II includes drugs which in addition to having a high potential for abuse and without accepted safety under medical supervision, and which also may lead to severe “psychological or physical dependence” or as most of us say “addiction.”  Here we find cocaine and methamphetamine among others.

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 a high 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 similar to 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.  That this statute was poorly drafted and creates a good deal of confusion in public discourse the scholarly work of Douglas Husack is instructive.[x]

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.  Husack 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; or drugs so similar to listed drugs they will have a similar potential.  So now we know that drug “abuse” equals drug “use,” that is, initiating use without medical advice. Why didn’t they just say that in the first place?

This fact of federal legislation in the drug field raises an  important issue related to the constitutional doctrine of federalism: the recognition of the separate powers of state and federal governments. Are we being deprived of the benefits of state experimentation with alternative policies?  In drafting the Constitution the founders were intent upon preserving that 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.  As Alexis d’Tocqueville pointed out in the early 19th century, 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.  For example, while Colorado and Washington have taken the step of legalizing marijuana possession and use, they have done so in spite of the power of federal authorities to arrest and imprison that conduct and as of this writing it is unclear what federal authorities will do in the case of retail pot shops inventorying large quantities of that drug.  Laws in a number of states  allow  marijuana for medical uses, though it has been classified as a Schedule I drug as one lacking in any accepted medical use, and  the DEA has continued to assert its discretion to investigate and raid those who possess it for sale for those uses. As time passes the picture will undoubtedly clarify, but it strikes many  as unfortunate that the federal government so dominates the terrain of drug policy.

What is drug abuse?  Defining the terms

In the wording of the federal scheduling scheme addiction is called “severe psychological or physical dependence.”  The medical profession no longer favors “dependence” as a component of addiction. That word has separate meanings not truly applicable to it.  Addiction as generally understood and as I use the term here simply means the condition in which a user finds it extremely difficult to abstain and does not do so unless and until advantages of abstinence offer a stronger motivation than the drug taking pleasure provides for its continuation.

The terms “drug abuse” and “substance abuse disorder”  have been dropped in the American Psychiatric Association’s 2013 publication of it Diagnostic and Statistical Manual, DSM V.  That earlier terminology has been  subsumed in the term “substance use disorder,”  a condition clearly more problematic than  mere use of a scheduled drug.  In this book I also  decline to speak of  “abuse” as  merely “use” and employ  the term drug abuse only to mean a 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.  Driving while impaired is a crime and is evidence of drug abuse, and so is the neglecting of children who are in the care of an impaired user.  I also consider drug abuse to include the persistent alienation of family, friends, and co-workers, or the use of drugs when they reduce the ability to perform one’s job.  It is distinguished from addiction in that it does not necessarily stem from a compulsion to use, but unlike addiction, by definition involves risky or harmful conduct.

Responsible use is a term I introduce here to indicate use which is moderate and not done in a way that results in risk or harm to one’s self or others.  It is use that does not result in the consequences of abuse.  The term “responsible use” as I use it refers also to use by addicts who do so moderately and without harm such as the previously mentioned Dr. Halstead.  It will come as a surprise to many readers of this book that a majority of addicts do use their drugs in a responsible manner.

 

 


 

[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] Satel, S., & Lilienfeld, S.O., (2013) Brainwashed.  The Seductive Appeal of Mindless Neuroscience,  New York NY, Basic Books,  Kindle ed. Location 1106-13:

[iii] Satel and Lilienfeldt, Ibid, Location 1340-47,   “Recovery is a project of the heart and mind.  The Person, not his or her autonomous brain, is the agent of recovery”. Location 1212-19

[iv]  Twerski, A.J., (1997)  Addictive Thinking, Understanding Self-Deception   Center City, MI,   Kindle ed. Location 226-32: See also Fletcher, A. (2013) Inside Rehab: The Surprising Truth About Addiction Treatment –and How to Get Help that Works, New York, NY, Viking, Kindle ed. Location 126-32 (Introduction by A. Thomas McLellan, PhD, Treatment Research Institute)

[v] Satel & Lilienfeldt, Ibid. Location 1422-29 to 1436-42

[vi] Satel & Lilienfeldt, Ibid. Location 1072, 1160-67

[vii] Satel, S. & Lilienfeldt, S.O. (2013) Brainwashed; Basic Books, New York, NY  Kindle ed. Location 1166-72  See also Kleiman, M. A. R., Caulkins, J.P. &Hawken, A.,  (2011) Drugs and Drug Policy, New York, NY, Oxford Univ. Press, p 95.

[viii] Gray, Mike.(2000) Drug Crazy: How We Got Into This Mess and How We Can Get Out of It.  Routledge, NY, pp 54,55.

[ix] Satel & Lilienfeldt, Ibid  Location 1136-43

[x] Husack, D. (1992) Drugs And Rights, New York, N.Y. Cambridge Univ. Press, pp 27-37

 

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