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Imagining a Post-Prohibition World
What would happen if drugs were legal? Proponents of the status quo triumphantly present that question to would-be reformers as if the answer were not only obvious but devastating: There would be a huge increase in drug abuse, with all its horrifying implications—the orgiastic lusts, the drug-crazed frenzies, the children turned from bright-eyed innocents to pot-befogged zombies, the sunken-eye junkies prowling the neighborhoods, the buck Negroes hopped up on cocaine raping our white women.
But while this puritanical prohibitionist imagery of a world run amok on drugs is widely held in a culture raised on anti-drug propaganda, and even appears commonsensical—more people would use drugs if they were legal, right?—there is little hard evidence to support it. More on that below, but what's more, by focusing solely on whether or how much drug use would increase if punitive laws were removed, prohibitionists encourage a blinkered view of social reality, one that blinds us to the myriad ways the current global drug prohibition regime affects our societies or what a change in that regime might really mean.
Driven by what is in the final analysis a deeply totalitarian impulse—to control what others do with their own consciousness—the effects of drug prohibition as a public policy are broad and deep, spreading inexorably across more and more aspects of social life, impacting more and more institutions. A change from our current prohibitionist model to "legalization" in any of its various forms—decriminalization, medicalization, regulation, or a full-blown, free market in currently illicit drugs—has tremendous implications at every level, from the lives of individuals to the structures of global political and economic power.
But after a century of drug prohibition, many people cannot even imagine that things could be any other way. And change is a scary thing. Those who flex their minds enough to consider the possibility of ending prohibition recoil in fright from the spectral horrors they think they glimpse. According to a Pew poll in 2001, 74% of Americans believe the war on drugs is a failure, but support for legalization remains infinitesimal, and even efforts to nibble at the edges of prohibition, such as decriminalizing pot possession or allowing for medical marijuana, are fiercely contested and hard-won, if they are won at all. "Prohibition may not work, but what's the alternative?" people ask, as if the consequences of ending prohibition were too grim to even imagine.
But let's do just that. First, just what is the problem? Why do we invest so many resources in attempting to prohibit drug use and the trade which supplies it? The answer is that some drug use has negative consequences, for drug users themselves, for their families and communities, and for society as a whole. Drug users can suffer physical ill-effects from their use, ranging from malnutrition to contracting diseases and, ultimately, death by accidental overdose. They can suffer mental health consequences. They can suffer moral consequences, especially if they become dependent on a drug, losing some degree of personal autonomy to the substance they crave.
Some drug users neglect their children or endanger them through drug-induced stupidity. They get fired from jobs because they're too busy getting high. They cause their families to split up. They diminish the quality of life for others in the community by lying around in pools of vomit or by behaving psychotically in the street. There is no denying that drug use can have a very nasty downside, nor that society has a legitimate interest in trying to minimize those adverse effects.
Drug prohibition is ostensibly aimed at doing just that. The logic is simple: Reducing drug use will reduce the harm associated with drug use. But it is also simplistic, because prohibition carries with it its own negative consequences, for which drug users are unfairly and unthinkingly blamed. For example, we hear often of "drug-related deaths," a phrase that is accurate if one is talking about an OD or a deranged tweaker who shoots his girlfriend in a fit of paranoid rage. But many of the most unsettling "drug-related deaths"—the chaotic street shootings as dealers engage in turf battles, the cop killed during a drug raid—are not "drug-related" but "drug law enforcement-related." Drugs didn't kill these people; the drug laws did.
There is harm related to drug use and there is harm related to the way we attempt to deal with drug use as a social problem. In order to tease out the consequences of a drug policy regime change, we must remember not to confuse the two.
There are a variety of alternatives to the current global prohibition regime:
Decriminalization—the removal of criminal sanctions for the use or possession of small amounts of drugs—would remove the threat of jail from tens of millions, but would leave intact the global black market in illicit substances.
Medicalization—making drugs available through prescription or by maintenance doses in a controlled fashion—would transfer power from the law enforcement establishment to the medical/psychiatric establishment.
Regulation—making drugs available in roughly the same manner as currently licit drugs, such as alcohol and tobacco—would perhaps be nearest to what is commonly thought of as "legalization."
A free market approach—with illicit substances being treated as coffee is today— would be true legalization, or perhaps, normalization of drug use.
The latter approach represents the far, utopian (some would say dystopian) end of the policy spectrum. And neither decriminalization nor medicalization addresses the problem of that black market. So, for comparison's sake, let us use the model of regulation. Under regulated legalization, the international production of and commerce in currently illicit substances is integrated into legal markets and those substances are available to buyers with only minimal restrictions. Such a model does not presuppose that all countries would "legalize drugs," but it does assume that hold-outs would be few and would shrink over time. More importantly, it assumes that the United Nations Single Convention on Narcotics and its fellow conventions have been effectively repealed, and that in the United States, the federal Controlled Substances Act has been repealed and the various states treat illicit drugs the way they treat alcohol and tobacco, with a patchwork of different restrictions and regulations, but within a framework where a legal commerce in drugs is the bottom line.
How would such a world differ from ours? To answer that question, we must first return to the question of whether and how much drug use would increase if it were legal. If drug use were to increase dramatically under legalization, the harms fairly associated with some drug use would also presumably increase. In that case, the argument for prohibition becomes stronger. On the other hand, if drug use were to stay level or rise only slightly or temporarily under legalization, prohibition becomes increasingly untenable.
Will drug use go up?
Despite the common sense notion that drug use would increase dramatically if drugs were more freely available, there is little hard evidence to either support or dispute that notion. Cross-national comparisons of drug use rates suggest that drug use patterns are not a function of drug policy (in fact, the opposite may be more true), but of broader, more complex social forces at work. In their comprehensive look at drug policy, Drug War Heresies, (Cambridge University Press, 2001) US academics Robert MacCoun and Peter Reuter reviewed studies of marijuana use in the US and Western Europe. While their findings are limited by a paucity of hard numbers and the less than perfect fit among different surveys, their results indicate that marijuana use levels have little relation with official stances toward the drug. Among the 16 studies compared by MacCoun and Reuter, the single highest lifetime usage figure (42%) came among seventeen–to-twenty-year-old Americans. Likewise, when looking at pot use among teens, prohibitionist Sweden reported the lowest prevalence (8% for thirteen–seventeen-year-olds), but pot-friendly Holland was next lowest (10% for thirteen–fifteen-year-olds), with teen use levels well below those of the prohibitionist United States (14% for twelve–eighteen-year-olds) and Denmark (17% for thirteen–seventeen-year-olds). From these findings, it appears that drug prohibition has little impact on marijuana use rates.
Likewise, MacCoun and Reuter analyzed marijuana use within the Netherlands to examine whether increased access to pot under the Dutch government's coffee shop policy led to increased pot use. While they found that use began to increase after the coffee shops opened, there was a lag of several years. It was not a change in the law that caused the increase, they suggested, but commercialization. "There is no evidence that the [coffee shop] policy per se increased levels of cannabis use," they wrote. "On the other hand, the later growth in commercial access to cannabis, following the de facto legalization, was accompanied by steep increases in use." This is an important point, and one that does not bode well for the United States, where commercial advertisers can wrap themselves in the First Amendment as they lure prospective customers.
But the larger point is that drug policies in general seem to have limited impact on drug use levels. A comparison of European "drug-related deaths," which in this instance means primarily injection drug overdoses and chronic illnesses from a lifetime of drug abuse, shows an upward trend since 1985 across the continent—regardless of whether drug policies were prohibitionist or user-friendly. Similarly, a comparison of heroin use in Italy since 1975 found little correlation between policies, which oscillated between prohibition and depenalization of drug use, and drug use levels. As the Italian social scientist Solivetti noted, "the intervention of the criminal law has a very limited effect on a phenomenon whose evolution can be linked with the far more powerful pressure exerted by structural forces that lie at the very heart of the way society is organized."
In other words, broader social and cultural processes are a much more critical force than the law in determining drug use levels. Which is not to say that a regime of regulated, legal access to drugs would have no impact on drug use levels. According to MacCoun and Reuter, the result of a legalization regime would be a "non-trivial" increase in drug use, and a corresponding increase in the negative consequences of drug use.
So, would drug use go up in a regime of regulation and legalization? The short answer is probably yes, but by less than the amount commonly assumed, and the degree of increase would depend not only on broader social forces at play, but also on the precise nature of the regulatory scheme and the degree of commercialization allowed.
But unless reducing drug usage is the sole measure of success for a drug policy, usage rates provide only a hint of the consequences of drug legalization.
What would a new regime bring in terms of other impacts, such as health and public health, public safety and criminal justice, and respect for freedom and human rights in the United States? Internationally, what would a system of legal, regulated commerce in currently illicit drugs mean in terms of corruption, the black market, and the millions of people who currently work in the drug business, from Afghan opium farmers and Andean cocaleros to Brooklyn crack-slingers and Oklahoma meth cooks?
Health and Public Health
Assuming that regulated legalization would lead to higher levels of drug use, we can anticipate corresponding higher levels of adverse drug-related personal and public health consequences. But the correlation is not so simple, because a regime of regulated legalization would also remove some of the barriers to proper health care imposed by prohibition.
More drug users implies more drug abusers, which in turn implies more demand for drug treatment and for other drug-related health care costs. The United States already suffers from an identified lack of adequate treatment capacity, so the nation would presumably have to increase expenditures for treatment and other health care. But current drug treatment programs are also "demand side," in that arrested drug users are forced into them by drug courts and similar programs that demand they go to treatment or else face prison time. As a result, we face the truly bizarre situation of marijuana smokers taking up almost half the treatment slots in the US, a phenomenon that is certainly not justifiable on any medical basis. In a society where drug treatment has not been colonized by law enforcement and the courts, the treatment slots filled by casual potheads in court-ordered treatment could be filled by people who would actually benefit from them.
Thus, while legal, regulated drug sales would presumably lead to increases in use, abuse, and the demand for treatment, the removal of drug treatment as a tool of the criminal justice system would free up so many slots that an expansion in resources devoted to drug treatment may be minimal. (Such a regulatory regime could maintain a vestigial role for drug courts and court-ordered drug treatment: Such courts could be used, but only for people whose drug use has led them to commit other crimes, much as alcohol abusers today are not sent to treatment for drinking alcohol, but for committing the crime of driving while intoxicated. If someone does methamphetamine and neglects her children, she would be a candidate for drug court. If someone does cocaine and flies into a psychotic rage, attacking others, he would be a candidate for drug court. If someone smokes heroin and picks his nose all day, he may be a candidate for a slap in the face, but not for court-ordered drug treatment.)
The impact of regulated legalization on other health aspects of drug use, such as HIV and Hepatitis C infection rates or drug overdose deaths, is two-way. On the one hand, with some increase in overall drug use, there presumably would be some increase in infections and overdose deaths. On the other hand, a regime where drug use and sales were legal would presumably remove all barriers to harm reduction approaches that could minimize those negative effects. Under regulation, hard drug users would have access to clean needles. Similarly, the friends, families, and acquaintances of people suffering from drug overdoses would not have to fear arrest upon notifying authorities, thus leading to a much greater willingness to seek medical help when necessary.
One other health and public health consequence of regulated legalization would be the virtual disappearance of medical marijuana and chronic untreated pain as burning political issues. The 50 million people reporting chronic pain and the millions more who claim relief from an array of symptoms with marijuana would have the ability to medicate themselves as they or their doctors see fit.
Overall, then, we could expect some increase in negative personal and public health consequences of regulated legalization, given an anticipated increase in drug use. But the impact of that increase would be mitigated by a social structure that worked with and for drug users to minimize harm instead of criminalizing drug users. Indeed, implicit with a regulated legalization model is the assumption that revenues from the drug trade will be taxed and that at least some portion of those proceeds will be dedicated for drug abuse prevention, education, and treatment programs.
Public Safety, Quality of Life, and the Criminal Justice System
But if regulated legalization would lead to some increase in drug use and therefore some increase in negative personal and public health consequences, when it comes to the impact of regime change on costs associated with public safety, quality of life, and the criminal justice system, the balance begins to swing dramatically to the plus side. Many of the harms and costs attributed to "drugs" are in fact the result of efforts to enforce their prohibition—and the costs are both monetary and social.
In the United States alone, the federal government and states and localities spend in excess of $50 billion per year on drug law enforcement. This figure does not include such downstream costs as paying to imprison half a million Americans for years at a time, nor does it include the economic costs of all those human-years of lost labor which come to additional billions each year. In short, the US spends about as much each year to enforce prohibition as it costs to occupy a mid-sized foreign country.
Excerpted from UNDER THE INFLUENCE by Preston Peet. Copyright © 2004 The Disinformation Company Ltd.. Excerpted by permission of The Disinformation Company Ltd..
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