Fighing the War on Drugs... With Anecdotes and Bad Reasoning

Although he makes his own view difficult to pin down, George Will seems to endorse the war on drugs, from marijuana to... whatever, quoting Gil Kerlikowske, Director of the Office of National Drug Control Policy, i.e., the "Drug Czar".

Nature made Kerlikowske laconic and experience has made him prudent, so he steers clear of the "L" word, legalization, even regarding marijuana.

Asked whether he thinks that it is a "gateway" drug leading to worse substances, he answers obliquely: "You don't find many heroin users who didn't start with marijuana."

I doubt that you find many heroin users who "didn't start with cigarettes", or "didn't start with alcohol", or "didn't start with"... something else. That people who are inclined to seek out an illegal, highly addictive street drug have previously tried various legal and more easily obtained illegal drugs is anything but a surprise. The question is, does that suddenly transform correlation into causation. Obviously it does not.

But Kerlikoswke also served up this anecdote, offered with a distinct lack of detail:

During his immersion in his new job, Gil Kerlikowske attended a focus group of 7-year-old girls and was mystified by their talk about "farm parties." Then he realized they meant "pharm parties" - sampling pharmaceuticals from their parents' medicine cabinets.

The Post added a short description to Will's piece - a tag line - "Seven-year-olds party with pharmaceuticals they steal from their parents", but that's not what Will wrote. It's not clear from the anecdote whether the girls were asked if they knew about "pharm parties" as opposed to participating or organizing them. Were we to shift back a few decades, I could see Kerlikoswke being similarly surprised that what he thought was a focus group about cooking utensils turned out to be about marijuana. ("I was mystified by their talk about 'pot', but then I realized....")

Note that it's not just older siblings or relatives who could be introducing seven-year-olds to the concept of "pharm parties", but that knowledge can also come from anti-drug education. Consider, for example, DARE:

Statistics have shown that teens believe prescription drugs are safer than illicit drugs, driving the proliferation of such trends as "pharm parties" where teens mix and trade pills with one another to get high, leading to dangerous and sometimes deadly outcomes

At least DARE's not trying to depict this as a new trend for second grade students.

But let's go back to the notion of the gateway drug. Is Kerlikoswke suggesting that these kids are finding Marinol in their parent's medicine cabinet, and that it becomes a "gateway drug" to other medications? Or are the kids heading right to the opiate medication and benzodiazepines? There has been a huge uptick in opiate abuse in our nation, and of other pharmaceutical drugs, and it's not because of "gateway drugs".

Further, one of the problems of depicting a drug as a "gateway drug" that leads kids down a slippery slope into "harder" drugs is that you create a context where a lot of kids will find out that you're lying to them. They'll try marijuana, not get addicted, and may wonder if the anti-drug messages given about "harder" drugs are also overhyped. Tens of millions of Americans have tried marijuana - 42% of the population - including quite a few recent Presidents. While it would be interesting to hear Presents Bush and Obama speak to the notion of marijuana as a gateway drug to cocaine, it should be remembered that the addictions they did develop - Obama's nicotine addiction and Bush's alcoholism - were to legal drugs.

Commenting on legalization, Will also offers the nebulous comment,

Kerlikowske is familiar with Portugal's experience since 2001 with the decriminalization of all drugs, including heroin and cocaine.

What lessons can we draw from that experiment?

Compared to the European Union and the U.S., Portugal's drug use numbers are impressive. Following decriminalization, Portugal had the lowest rate of lifetime marijuana use in people over 15 in the E.U.: 10%. The most comparable figure in America is in people over 12: 39.8%. Proportionally, more Americans have used cocaine than Portuguese have used marijuana.

The Cato paper reports that between 2001 and 2006 in Portugal, rates of lifetime use of any illegal drug among seventh through ninth graders fell from 14.1% to 10.6%; drug use in older teens also declined. Lifetime heroin use among 16-to-18-year-olds fell from 2.5% to 1.8% (although there was a slight increase in marijuana use in that age group). New HIV infections in drug users fell by 17% between 1999 and 2003, and deaths related to heroin and similar drugs were cut by more than half. In addition, the number of people on methadone and buprenorphine treatment for drug addiction rose to 14,877 from 6,040, after decriminalization, and money saved on enforcement allowed for increased funding of drug-free treatment as well.

Kerlikowske sees that as a policy failure? It would have been interesting to hear his explanation.

Unfortunately, to the extent that it suggests Kerlikowske has a different opinion, when it comes to law enforcement policy Will quotes The Economist and not Kerlikowske:

"There is no correlation between the harshness of drug laws and the incidence of drug-taking: citizens living under tough regimes (notably America but also Britain) take more drugs, not fewer." Do cultural differences explain this? Evidently not: "Even in fairly similar countries tough rules make little difference to the number of addicts: harsh Sweden and more liberal Norway have precisely the same addiction rates."

You might even infer that there's a subset of the population that is predisposed toward addiction and, whether given an "open market" where they can find their drug of choice or a more limited market where they must instead choose a drug they find somewhat less appealing, most will become addicted to something. Talk to some alcoholics and see how hard it is to find one who, following their first exposure to alcohol, thought of little beyond their next opportunity to get drunk.¹ There's no magic answer to eliminating drug abuse and addiction, but the evidence is pretty clear that addiction is better approached as a public health matter than as a criminal matter.²

Update: An editorial takes on the latest version of "reefer madness" (the correlation between marijuana use and psychosis, the notion that marijuana is stronger than it used to be, and that this justifies increasing criminal penalties for possession and use:

The other paradox is that schizophrenia seems to be disappearing (from the general population), even though cannabis use has increased markedly in the last 30 years. So, even though skunk has been around now for 10 years, there has been no upswing in schizophrenia. In fact, where people have looked, they haven't found any evidence linking cannabis use in a population and schizophrenia.

The author expresses concern that criminalization and misinformation make the drug more enticing, and advocates honesty about drugs:

We therefore have to provide more accurate and credible information. We have to tell them the truth, so that they use us as their preferred source of information. If you think that scaring kids will stop them using, you're probably wrong.

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1. It isn't hard.

2. There's an argument that having a criminal law element can be important both to helping some addicts find their "rock bottom" - the point where the cost of addiction exceeds the benefit - although my experience is that few addicts are inspired toward sobriety by an arrest. There's also an argument that the coercive element of probation and possible incarceration can help keep people in treatment; countered by the fact that treatment really only seems to work when the addict wants to get better, and not in the sense of "all I want for Christmas".