Tuesday, April 10, 2012

Weighing the Merits of Drug Legalization

George Will appears to be conflicted about drug legalization, recognizing the reality that there is a natural human attraction to intoxication but that substance abuse and addiction present genuine problems for society. I think he misses the big picture here,
Drinking alcohol had been a widely exercised private right for millennia when America tried to prohibit it. As a public-health measure, Prohibition “worked”: Alcohol-related illnesses declined dramatically. As the monetary cost of drinking tripled, deaths from cirrhosis of the liver declined by a third. This improvement was, however, paid for in the coin of rampant criminality and disrespect for law.
Prohibition lasted only from 1920-1933, and created a host of ills through the distribution of low-quality bootleg liquor and "medicinal alternatives". To the extent that prohibition affected cirrhosis rates, it seems likely that it was more of a result of its bringing about, coinciding with, and/or contributing to changes in how people consumed alcohol. From an era of hard liquor to mixed drinks and beer, from the rummy to the beer belly. As Will notes, even during prohibition "oceans of [alcohol] were made, imported, transported and sold."

Will imagines that changes in the legality or availability of specific addictive substances is likely to have a massive impact on the rate of addiction within a given society:
So, suppose cocaine or heroin were legalized and marketed as cigarettes and alcohol are. And suppose the level of addiction were to replicate the 7 percent of adults suffering from alcohol abuse or dependency. That would be a public health disaster.
Yes, if you assume that a public health disaster would result, the result will be a public health disaster. They joys of circular reasoning.

What appears to be true is that across societies, even in cultures that have strong prohibitions on the use of intoxicants and draconian penalties for drug use or trafficking, a relatively predictable percentage of the population will become addicted to alcohol or drugs. There's no reason to believe that legalizing cocaine or heroin would lead to massive increases in the overall rate of addiction. To that point, the overwhelming majority of people who receive opiate and opioid medication for acute injuries simply stop taking the medication when their pain subsides, and although an extraordinary number of G.I's experimented with heroin during the Vietnam war the overwhelming majority were able to stop using drugs when they returned home. I'm not going to suggest that people play with fire - I think people should assume that they will succumb to hopeless addiction if they start using, more to the point injecting, heroin - but it's quite clear that some people are predisposed to addiction and that predisposition can vary significantly by substance.

Also, while Will is correct that society is not "like a controlled laboratory", he is incorrect that a failed experiment with legalization could not be reversed. It might not be tidy, but it's difficult to imagine a bigger mess than we saw with prohibition and its repeal - and we pay a huge price for the "war on drugs" while making absolutely no progress against either drug availability or the rate of addiction.

Will's economic arguments against legalization make absolutely no sense. First he imagines that legalization will cause the prices of cocaine, heroin and marijuana to fall by 90%. Then he imagines that taxes will be so high that widespread tax fraud will occur and illicit sales will continue. Again, it's circular - Will presupposes the facts necessary to drive his conclusions.

I sense that Will does not partake of illicit substances, as his experience with drug dealers appears largely derived from television dramas,
Furthermore, legalization would mean drugs of reliable quality would be conveniently available from clean stores for customers not risking the stigma of breaking the law in furtive transactions with unsavory people.
I think he should ask his drug-using friends and colleagues how they obtain their substances of choice. Rush Limbaugh bought drugs through his maid - no need for any unsavory contacts. Drug dealing was1 historically a problem at large manufacturing plants, but the dealer wasn't a seedy criminal on a street corner - it was a co-worker. High school kids can buy drugs from other high school kids. Sure, of course, street corner dealing does occur, but huge numbers of drug users buy drugs from people in their own peer group. In some correctional facilities, prisoners buy drugs from prison guards. There are lots of small time marijuana dealers who support their own use by buying in bulk and selling to their friends. Although you always have that option, and as casual use turns to addiction you're more likely to go that way, it's simply not the case that the only way to get street drugs is through "furtive transactions with unsavory people". Ever since the pager came along, for a great many drug users the purchase of their substance of choice has been no more unsavory than ordering a pizza delivery.2

Will intimates at the end that he has an answer to the problem of illicit drug trafficking, at least for cocaine and heroin,
America spends 20 times more on drug control than all the world’s poppy and coca growers earn. A subsequent column will suggest a more economic approach to the “natural” problem of drugs.
I expect he's suggesting that we simply pay farmers not to produce coca or to grow poppies. That's going to be easier with coca, as it's pretty easy to grow opium poppies in a random patch of rain forest or jungle. Right now we're pushing crop substitution, but that creates a significant risk and cost for the coca farmer that is absent with coca production - the cocaine cartels will come to their farms, pick up their crops and pay cash, whereas if they grow alternative crops they run the risk that there won't be a market for their product, and have to get it to market in salable condition. You could pay them cash - well over what the cartels pay, simply based upon a periodic verification that they're not growing coca. If they also grow and sell a crop, all the more power (and profit) to them - we give them a windfall, and they still save money.

But even if we presuppose that such a model would work for opium and cocaine production, that you wouldn't simply push opium production onto wild lands, you would not solve the larger problem of addiction and drug use. When I was in Thailand a decade ago, during a hike through a national park our guide pointed to a field in the distance - opium poppies. He explained that the government would fly over the park during the times of year when poppies traditionally bloomed, looking for telltale patches of red, so the growers had switched to a poppy that bloomed at a slightly different time of year. It's not that the patch wasn't visibly cultivated, or that the government was unaware of the game - if my guide knew what was going on, so did law enforcement. But for some reason....

Meanwhile, what drug was exploding in popularity in the cities? Meth. And that's a big part of the story of prohibition - you don't eliminate drug use, but instead inspire drug substitution. So when the war "works" you can end up creating a population of drug addicts that is dependent upon a much more harmful, toxic, polluting alternative to the drug you've targeted. When people are addicted, you should never underestimate their willingness to ingest or inject toxic waste as part of the small price they're willing to pay to get high.

If the trade-off between having a licit, pharmaceutically pure line of substances of choice for addicts to use, and their relying upon contaminated street drugs, we need to consider the impact of toxicity when calculating which is better for society.

Will also seems to view legalization as an all-or-nothing proposition. He recognizes that cigarettes and alcohol are legal, but cannot imagine how we might legalize marijuana without also legalizing heroin. There's an old joke, "What's a lethal 'hit' of marijuana" - "A twenty-five pound brick falling from a tenth floor window." The various state-level experiments with legalization have not been a model of sound public policy, but they do suggest that Will's notion of increased usage and of a collapse in the market price will not occur with legalization. Portugal's experience with transitioning from a criminal justice model to a public health, harm reduction model has been associated with a decline in marijuana use.

There's something else to consider, as well: Even though we're still fighting the old drug war against cocaine, heroin and marijuana, we're in a culture in which people are increasingly addicted to pharmaceuticals - pain medications and benzodiazepines. If you look at the massive quantity of pills that are diverted into the illicit market, it's difficult to imagine how the status quo could exist without a great many drug manufacturers and politicians turning a blind eye to the problem. And if you want to talk about the potential to increase the number of addicts, consider that pharmaceuticals are designed to target specific receptors more quickly and more efficiently than their natural counterparts. For some addicts, heroin is what you have to settle for when you can't find a source for your pills. A public health problem?
Drug overdose death rates in the United States have more than tripled since 1990 and have never been higher. In 2008, more than 36,000 people died from drug overdoses, and most of these deaths were caused by prescription drugs.
That's the future.3

As with any discussion of drug policy, I would like to tell you that there are easy answers and solutions, but there aren't. Whichever door we pick, we will find pain, misery and suffering on the other side. We can at least conclude this much, though: The present approach of criminalization and interdiction has proved to be ridiculously expensive and a policy failure.
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1. It probably still is an issue, but I haven't heard much about it lately.

2. Way back when I was in law school, a clinical professor described a drug dealer who in fact owned pizza stores - and customers "in the know" would order, let's say, special toppings to be delivered with their pizzas. A little baggie slipped into the pizza box.

3. Dystopian science fiction, notably including the works of Philip K. Dick, often pictures a world in which highly addictive pharmaceuticals have displaced all other forms of drug abuse. So far the primary pharmaceutical "drugs of choice" have been developed as bona fide medicines, but if you liberate them to do so you can anticipate that companies will seek to make drugs that are addictive beyond anything presently on the licit or illicit markets.

4 comments:

  1. The War on Drugs failed $1 Trillion ago! This money could have been used for outreach programs to clean up the bad end of drug abuse by providing free HIV testing, free rehab, and clean needles. Harmless drugs like marijuana could be legalized to help boost our damaged economy. Cannabis can provide hemp for countless natural recourses and the tax revenue from sales alone would pull every state in our country out of the red! Vote Teapot, PASS IT, and legalize it. Voice you opinion with the movement and read more on my artist’s blog at http://dregstudiosart.blogspot.com/2011/01/vote-teapot-2011.html

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    1. While tax revenue from legalized drug sales can be used to provide rehab, and perhaps a lot of it could be free, for a lot of addicts "rehab" is only the beginning - and for a lot, even if it is free and available, they won't enter, will quickly leave, or will relapse shortly after completing their programs. "Free rehab" is, alas, not a solution to addiction.

      Let's also not confuse hemp with cannabis, any more than we confuse the ornamental poppies in your garden or the poppy seeds in your muffin with a crop of opium poppies. Yes, the war on cannabis also squelched most of the hemp market, but the biggest reason for the decline in hemp production (and the lack of a push-back when hemp became difficult to grow) was that nylon rope replaced hemp rope.

      State budgets aren't typically "in the red", as states have to balance their budgets - although no doubt there have been problems (and some deficits or creative accounting) with the recession. (Every state but Vermont has some form of balanced budget requirement.) Assuming that marijuana is a $40 billion / year enterprise (see info here) and state taxes pulled back 30% of the proceeds, we would be talking about $12 billion per year. Total state funding is about $1.43 trillion per year. That is to say, it would be a drop in the bucket. Even if you were to assume a $100 billion market and were to further assume that states could pulling 40% of that in taxes, we're talking $40 billion / $1.43 trillion = less than .3% of spending. Granted, some law enforcement expenditures would go down but, again, we're not talking about something that is going to significantly change the budgetary picture for state governments.

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  2. Will's economic arguments against legalization make absolutely no sense.

    You could write this as "Will's __________ arguments for/against __________ make absolutely no sense" on just about any subject. He's parleyed expertise in baseball into a pretense that he can speak meaningfully to any other topic whatsoever.

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  3. "...You could write this as "Will's __________ arguments for/against __________ make absolutely no sense" on just about any subject...."

    No argument.

    "... He's parleyed expertise in baseball into a pretense that he can speak meaningfully to any other topic whatsoever...."

    Wait, isn't that Mitch Albom? ;-)

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