The Case for Legalization. Part 2

Dealing with Drugs' Dangers

The dangers associated with cocaine, heroin, the hallucinogens, and other illicit substances are greater than those posed by marijuana, but not nearly so great as many people seem to think. Consider the case of cocaine. In 1986 NIDA reported that over 20 million Americans had tried cocaine, that 12.2 million had consumed it at least once during 1985, and that nearly 5.8 million had used it with the past month. Among those between the ages of eighteen and twenty-five, 8.2 million had tried cocaine, 5.3 million had used it within the past year, 2.5 million had used it within the past month, and 250,000 had used it weekly. Extrapolation might suggest that a quarter of a million young Americans are potential problem users. But one could also conclude that only 3 percent of those between the ages of eighteen and twenty-five who had ever tried the drug fell into that category, and that only 10 percent of those who had used cocaine monthly were at risk. (The NIDA survey did not, it should be noted, include people residing in military or student dormitories, prison inmates, or the homeless.)

All of this is not to deny that cocaine is a potentially dangerous drug, especially when it is injected, smoked in the form of crack, or consumed in tandem with other powerful substances. Clearly, tens of thousands of Americans have suffered severely from their abuse of cocaine, and a tiny fraction have died. But there is also overwhelming evidence that most users of cocaine do not get into trouble with the drug. So much of the media attention has focused on the small percentage of cocaine users who become addicted that the popular perception of how most people use cocaine has become badly distorted. In one survey of high school seniors' drug use, the researchers questioned recent cocaine users, asking whether they had ever tried to stop using cocaine and found that they couldn't. Only 3.8 percent responded affirmatively, in contrast to the almost 7 percent of marijuana smokers who said they had tried to stop and found they couldn't, and the 18 percent of cigarette smokers who answered similarly. Although a similar survey of adult users would probably reveal a higher proportion of cocaine addicts, evidence such as this suggests that only a small percentage of people who use cocaine end up having a problem with it. In this respect, most people differ from monkeys, who have demonstrated in experiments that they will starve themselves to death if provided with unlimited cocaine.

With respect to the hallucinogens such as LSD and psilocybic mushrooms, their potential for addiction is virtually nil. The dangers arise primarily from using them irresponsibly on individual occasions. Although many of those who have used one or another of the hallucinogens have experienced "bad trips," others have reported positive experiences, and very few have suffered any long-term harm.

Perhaps no drugs are regarded with as much horror as the opiates, and in particular heroin, which is a concentrated form of morphine. As with most drugs, heroin can be eaten, snorted, smoked, or injected. Most Americans, unfortunately, prefer injection. There is no question that heroin is potentially highly addictive, perhaps as addictive as nicotine. But despite the popular association of heroin use with the most down-and-out inhabitants of urban ghettos, heroin does relatively little physical harm to the human body. Consumed occasional or regular basis under sanitary conditions, its side effect, apart from addiction itself, is constipation. That is son why many doctors in early twentieth-century America rte addiction as preferable to alcoholism, and prescribed the as treatment for the latter when abstinence did not seem a option.

It is important to think about the illicit drugs in the same way talk about alcohol and tobacco. Like tobacco, many of the illicit substances are highly addictive, but can be consumed on a regular or decades without any demonstrable harm. Like alcohol, the substances can be, and are, used by most consumers in moderation, with little in the way of harmful effects; but like alcohol also lend themselves to abuse by a minority of users who become addicted or otherwise harm themselves or others as a consequence. And as is the case with both the legal substances, the active effects of the various illegal drugs vary greatly from one person to another. To be sure, the pharmacology of the substance is important, as is its purity and the manner in which it is needed. But much also depends upon not only the physiology and psychology of the consumer, but also his expectations regarding the drug, his social milieu, and the broader cultural environment - what Harvard University psychiatrist Norman Zinberg has called the "set and setting" of the drug. It is factors such as these that change dramatically, albeit in indeterminate ways, were the drugs made legally available.

Can Legalization Work?

It is thus impossible to predict whether legalization would lead to greater levels of drug abuse, and exact costs comparable to that of alcohol and tobacco abuse. The lessons that can be drawn from other societies are mixed. China's experience with the British pushers of the nineteenth century, when millions became led to the drug, offers one worst-case scenario. The devastation many native American tribes by alcohol presents another. On the other hand, the legal availability of opium and cannabis in Asian societies did not result in large addict populations until recently. Indeed, in many countries U.S.-inspired opium bans imposed during the past few decades have paradoxically contributed to dramatic increases in heroin consumption among Asian youth. In the United States, the decriminalization of marijuana by about a dozen states during the 1970s did not lead to increases in marijuana consumption. In the Netherlands, which went even further in decriminalizing cannabis during the 1970s, consumption has actually declined significantly. The policy has succeeded, as the government intended, in making drug use boring. Finally, late nineteenth-century America was a society in which there were almost no drug laws or even drug regulations-but levels of drug use then were about what they are today. Drug abuse was considered a serious problem, but the criminal-justice system was not regarded as part of the solution.

There are, however, reasons to believe that none of the currently illicit substances would become as popular as alcohol or tobacco, even if they were legalized. Alcohol has long been the principal intoxicant in most societies, including many in which other substances have been legally available. Presumably, its diverse properties account for its popularity-it quenches thirst, goes well with food, and promotes appetite as well as sociability. The popularity of tobacco probably stems not just from its powerful addictive qualities, but from the fact that its psychoactive effects are sufficiently subtle that cigarettes can be integrated with most other human activities. The illicit substances do not share these qualities to the same extent, nor is it likely that they would acquire them if they were legalized. Moreover, none of the illicit substances can compete with alcohol's special place in American culture and history.

An additional advantage of the illicit drugs is that none of them appears to be as insidious as either alcohol or tobacco. Consumed in their more benign forms, few of the illicit substances are as damaging to the human body over the long term as alcohol and tobacco, and none is as strongly linked with violent behavior as alcohol. On the other hand, much of the damage caused today by illegal drugs stems from their consumption in particularly dangerous ways. There is good reason to doubt that many Americans would inject cocaine or heroin into their veins even if given the chance to do so legally. And just as the dramatic growth in the heroin-consuming population during the 1960s leveled off for reasons apparently having little to do with law enforcement, so we can expect a leveling-off-which may already have begun-in the number of people smoking crack. The logic of legalization thus depends upon two assumptions: that most illegal drugs are not so dangerous as is commonly believed; and that the drugs and methods of consumption that are most risky are unlikely to prove appealing to many people, precisely because they are so obviously dangerous.

Perhaps the most reassuring reason for believing that repeal of the drug-prohibition laws will not lead to tremendous increases in drug-abuse levels is the fact that we have learned something from our past experiences with alcohol and tobacco abuse. We now , for instance, that consumption taxes are an effective method of limiting consumption rates. We also know that restrictions and bans on advertising, as well as a campaign of negative advertising, can make a difference. The same is true of other government measures including restrictions on time and place of sale, prohibition of consumption in public places, packaging requirements, mandated adjustments in insurance policies, crackdowns on driving while under the influence, and laws holding bartenders and hosts responsible for the drinking of customers and guests. There is even some evidence that government-sponsored education programs about the dangers of cigarette smoking have deterred many children from beginning to smoke.

Clearly it is possible to avoid repeating the mistakes of the past in designing an effective plan for legalization. We know more about .legal drugs now than we knew about alcohol when Prohibition repealed, or about tobacco when the anti-tobacco laws were red by many states in the early years of this century. Moreover, we can and must avoid having effective drug-control policies undermined by powerful lobbies like those that now protect the interests of alcohol and tobacco producers. We are also in a far better position than we were sixty years ago to prevent organized criminals from finding and creating new opportunities when their most lucrative source of income dries up.

It is important to stress what legalization is not. It is not a capitulation to the drug dealers-but rather a means to put them out of business. It is not an endorsement of drug use-but rather a recognition of the rights of adult Americans to make their own choices of the fear of criminal sanctions. It is not a repudiation of the "just say no" approach-but rather an appeal to government to provide assistance and positive inducements, not criminal penalties and a repressive measures, in support of that approach. It is not even a call for the elimination of the criminal-justice system from drug regulation-but rather a proposal for the redirection of its efforts and attention.

There is no question that legalization is a risky policy, since it may lead to an increase in the number of people who abuse drugs. But that is a risk-not a certainty. At the same time, current drug control policies are falling and new proposals promise only to be more costly and more repressive. We know that repealing the drug prohibition laws would eliminate or greatly reduce many of the ills that people commonly identify as part and parcel of the "drug problem." Yet legalization is repeatedly and vociferously dismissed, without any attempt to evaluate it openly and objectively. The past twenty years have demonstrated that a drug policy shaped by exaggerated rhetoric designed to arouse fear has only led to our current disaster. Unless we are willing to honestly evaluate our options, including various legalization strategies, we will run a still greater risk: we may never find the best solution for our drug problems.