The End of the Epoch of Prohibition

There is a growing drug policy reform movement in the United States. Although few agree upon which aspect of the war on drugs is most disgraceful, or on which alternative to our current policies is most desirable, we do agree on the following: the "war on drugs" has failed to accomplish its stated objectives, and it cannot succeed so long as the U.S. remains a free society; the prohibitionist approach to drug control is responsible for most of the ills commonly associated with America's "drug problem"; and some measure of legal availability and regulation is essential if we are to reduce significantly the negative consequences of both drug use and current drug control policies.

Proponents of the U.S. "war on drugs" focus on one apparent success: the substantial decline during the 1980s in the number of Americans who consume marijuana and cocaine.(1) Yet that decline began well before the federal government launched its "war on drugs" in 1986, and it succeeded principally in reducing illicit drug use among those middle class Americans who were least likely to develop drug - related problems.

Far more significant were the dramatic increases in drug and prohibition - related disease, death and crime.(2) Crack cocaine - as much a creature of prohibition as 180 proof moonshine during alcohol Prohibition - became the drug of choice in most inner cities. The scourge of HIV spread rapidly among American drug users, their lovers and children, destroying hundreds of thousands of lives and costing billions of dollars, while government officials studiously ignored evidence that making sterile syringes more readily available to addicts would save lives and dollars.(3) And prohibition - related murder and other violence reached unprecedented levels as a new generation of Al Capones competed for turf, killing not just one another but innocent bystanders, witnesses and law enforcement officials.(4)

The criminal justice system became bogged down in drug cases. Almost 1.4 million people were arrested for drug law violations in the U.S. in 1994: three - quarters were for simple possession and one - third were for marijuana violations.(5) One - third of felony convictions in state courts were for drug law violations.(6) And about 400,000 people were behind bars for drug law violations in 1995 (out of a total 1.6 million people in prisons and jails), at a cost of around $9 billion per year.(7) A study done for the White House showed that one - third of drug offenders in federal prisons had no history of violent crime and little or no criminal history whatsoever.(8) These prisoners are casualties of a failed policy aimed solely at being "tough on drugs".

Growing numbers of people have come to acknowledge certain basic truths about drugs and drug policy: first, most people can use most drugs without doing much harm to themselves or anyone else. Only a tiny percentage of the seventy million Americans who have tried marijuana have gone on to have problems with that or any other drug. The same is true for most of the tens of millions of Americans who have used cocaine or hallucinogens.(9) And even most of those who did have a problem at one time or another don't anymore. The fact that a few million Americans have serious problems with illicit drugs today is an issue meriting responsible attention, but it is no reason to demonize those drugs and the people who use them.

The second truth: drugs are here to stay. The time has come for the United States to abandon the tired and foolish rhetoric of a "drug - free society", and to focus instead on learning to live with drugs in such a way that they do the least possible harm to drug users and everyone else. Looking throughout history, one finds few if any civilized societies that did not encounter at least one powerful psychoactive drug. So far as I can ascertain, the societies that proved most successful in minimizing drug - related harms were not those that sought to banish drugs and drug users, but rather those that figured out how to control and manage drug use - through community rituals, initiation rites, the establishment and maintenance of powerful social norms, and so on.(10) It is precisely that challenge that American society now confronts with alcohol: how to live with a very powerful and dangerous drug - more powerful and dangerous than many illicit drugs - whose use we can not effectively prohibit.

The third truth: prohibition is no way to run a drug policy. Americans learned this with alcohol during the first third of this century(11) , and is probably wise enough to stop short of prohibition in its efforts to reduce tobacco use. Prohibitions make sense for kids, and it's reasonable to prohibit drug - related behaviors that pose substantial harms to others, such as driving under the influence of alcohol and other drugs, or smoking in enclosed spaces. It's also a fair compromise when communities acknowledge the right of adults to consume what they desire in private but restrict when and where drugs can be sold and consumed. But the indiscriminate sort of prohibition that now informs U.S. drug policy certainly causes more harm than good. Whatever its benefits in deterring some Americans from becoming drug abusers, drug prohibition is responsible for too much crime, disease and death to qualify as sensible public policy.

There's a fourth truth, one that often gets lost in the polarized debate between those, such as Milton Friedman and Thomas Szasz(12) , who favor a fairly free market approach, and those like William Bennett, who favor demonizing drug users and executing drug sellers.(13) Between those extremes lie a plethora of drug policy options, some of which can reduce drug - related crime, disease and death more effectively, and often less expensively, than anything being done now.(14) American drug warriors like to mock the Dutch, pointing to their legalized red light zones, but the fact remains that Dutch drug policy has been dramatically more successful than U.S. drug policy.(15) The average age of their heroin addicts has been increasing for almost a decade(16) , HIV rates among addicts are dramatically lower than in the United States(17) , police focus on major dealers and petty dealers who create public nuisances rather than wasting resources on non - disruptive drug users(18) , and the decriminalized cannabis markets are regulated in a quasi - legal fashion that is far more effective, and inexpensive, than the U.S. approach.(19)

In the Netherlands, as in Switzerland(20) and Australia(21) , and parts of Germany(22) , Austria, Britain(23) , and a growing number of other countries, pragmatism often counts more than moralism in designing drug policies.(24) They officially acknowledge the obvious: that drugs are here to stay and that drug policies need to focus on reducing drug - related harms even among people who can't or won't stop taking drugs. Sterile syringes are readily available, over the counter, from vending machines, or from syringe exchange programs, to prevent the spread of HIV. In the United States, one scientific study after another, culminating in a recent National Academy of Science report commissioned by Congress, has concluded that making sterile syringes available over the counter and through needle exchange programs can save lives and dollars.(25) But politicians still refuse to change the law.

We face similar foolishness when it comes to methadone. Methadone is to street heroin more or less what nicotine chewing gum and skin patches are to cigarettes. Hundreds of studies, as well as a National Academy of Science report last year, have concluded that methadone is more effective than any other treatment in reducing heroin - related crime, disease and death.(26) In Australia and much of Europe, addicts who want to reduce or quit their heroin use can obtain a prescription for methadone from a general practitioner and fill the prescription at a local pharmacy.(27) In the United States, by contrast, methadone is the most strictly regulated drug in the pharmacopoeia. It's only available at highly regulated clinics, where clients often receive less than the appropriate dose and are treated more like criminals than patients. There is no good reason for this, just politics, prejudice and ignorance.

Consider one more example: heroin prescription. The Swiss have embarked on a national experiment to determine if they can reduce drug and prohibition - related crime, disease, and death by making pharmaceutical - grade heroin legally available to addicts at regulated clinics.(28) It's now almost two years into the experiment, and the results have been sufficiently encouraging that the experiment has been extended to over a dozen Swiss cities.(29) The Dutch(30) and the Australians(31) now are poised to start their own experiments in 1996, and a number of cities in Germany have petitioned their federal government to do likewise.(32)

These programs make sense in part because heroin is safe when prescribed and consumed under sanitary, controlled conditions.(33) Unlike cigarettes and alcohol, it does not destroy human organs. The "high" of heroin, for many experienced consumers, is neither intoxicating like alcohol nor tranquilizing like benzodiazepams. Perhaps the closest analogy is to "smoke - free" cigarettes that deliver a dose of nicotine with fewer associated tars and other carcinogens.(34) Thousands of people have held and/or hold responsible jobs while injecting heroin two or three times per day.(35) This is not, of course, to recommend heroin, but it is to say that there is a world of difference - to both addicts and the rest of us - between "legal" heroin obtained from legal sources and adulterated street heroin purchased at black market prices from criminal entrepreneurs. There are no good scientific or ethical reasons not to try a heroin prescription experiment in the United States - only bad political reasons.

In the 1950s, numerous medical and criminal justice organizations voiced support for heroin maintenance, and many, including the New York Academy of Medicine, proposed restricted programs to provide heroin for "confirmed addicts".(36) The government soundly rejected all maintenance proposals.(37) And in the 1970s, a heroin maintenance project was quashed in New York City under the widespread opposition of conservatives and traditional anti - drug organizations. President Nixon denounced heroin maintenance as a surrender to "weakness and defeat in the drug struggle".(38)

One of the standard claims spouted by opponents of drug policy reform is that there's no going back once we reverse course and legalize drugs. But what the reforms in Europe and Australia demonstrate is that the choices are not all or nothing. Virtually all the steps described above represent modest, and relatively low risk, initiatives to reduce drug and prohibition - related harms within the current prohibition regime. At the same time, these steps provide valuable insights for thinking through the consequences of more far reaching drug policy reform.

The truth of the matter, however, is that we're unlikely to evolve toward a more effective and humane drug policy unless we, as a society, begin to change the ways we think about drugs and drug control. Consider what may qualify as the most outrageous drug scandal in the United States - the epidemic of undertreatment of pain.(39) Every year, millions of Americans, both adults and children, some terminally ill with cancer, some experiencing severe post - operative pain, others struggling with chronic pain, receive insufficient doses of opiates to treat their pain. In many of those states where a physician can prescribe opiates indefinitely to treat intractable pain, the patient must be reported by the physician to the state as a drug addict.(40) Abundant studies now indicate that the risks of addiction to opiates prescribed for pain relief are slight, and that "addiction" to opiates among the terminally ill is an appropriate course of medical treatment.(41) There are no good medical or other scientific reasons for failing to prescribe adequate doses of opiates to relieve pain - only a pervasive "opiaphobia"(42) that causes doctors to ignore the medical evidence, nurses to turn away from their patients' cries, and patients themselves to prefer debilitating and demoralizing pain to a proper dose of morphine, heroin or Demerol. The origins of this maltreatment are inseparable from those that underlie inhumane policies toward heroin addicts.

Why do a few million Americans persist in using cocaine and heroin despite its illegality? For many, perhaps a majority, it represents a form of self - medication against physical and emotional pain(43) among groups in society that are not so well hooked in to the psychotherapy, Prozac, and other anti - depressants that ease the pain of middle and upper class Americans. Add to that factor one perverse paradox of prohibition: that the market in illicit drugs is so powerful in the inner cities because residents perceive not just a lack of other palliatives for their pain but also few economic opportunities that can compete with the profits of violating prohibition.(44)

The tendency to put anti - drug ideology ahead of the compassionate treatment of pain is apparent in another area as well. Thousands of Americans currently smoke marijuana for purely medical reasons: to ease the nausea of chemotherapy; to reduce the pain of multiple sclerosis and other debilitating diseases; to alleviate the symptoms of glaucoma; to improve appetite among people wasting away from AIDS; and for much else.(45) They use it because it works for them better than any pharmaceutical concoction. Many of these people never smoked marijuana until they discovered its medicinal value. Some are elderly. Some don't particularly care for taking a drug by smoking it; and many don't care for marijuana's psychoactive effects.(46) But virtually all of them are regarded as criminals under the law, and every year many are arrested and jailed. Apart from eight lucky souls who managed to obtain a legal source for their medical prescriptions years ago,(47) everyone else is obliged to obtain their marijuana on the black market. Although more than 75% of Americans believe that marijuana should be available legally for medical purposes(48) , the U.S. federal government refuses to allow legal access or even to sponsor or permit research.(49)

Look within the federal government and it is easy to spread the blame for America's backward drug policies: a cowardly White House unwilling to assume leadership in this area;(50) a Congress so obsessed with looking tough on crime that it's no longer interested in figuring out what makes sense; a former drug czar who debased public debate in this area by equating legalization with genocide(51) ; and a drug enforcement/treatment complex so hooked on government dollars that few are willing to speak truth to power. But perhaps the worst offender is the U.S. Drug Enforcement Administration - not the agents who risk their lives trying to apprehend major drug traffickers, but rather the ideologically - driven bureaucrats who intimidate and persecute doctors for prescribing pain medication in medically appropriate (but still legally suspicious) doses, who hobble methadone programs with over - regulation(52) , who acknowledge that law enforcement alone cannot solve the drug problem but then proceed to undermine innovative public health initiatives, who connive against efforts to make marijuana medically available, and who abuse their power to classify and thereby prohibit psychoactive drugs under federal law. The first step in any real drug policy reform effort at the federal level must be to strip the D.E.A. of the powers it has abused and give them to some other agency - public or private - better able to act in the interests of science, public health, and human rights.

In the past decade, many prominent Americans have spoken out against drug prohibition. Mayor Kurt Schmoke of Baltimore voiced support for legalization in April of 1988. In 1989 both U.S. District Judge Robert Sweet, and former U.S. secretary of state and treasury, George Shultz, endorsed drug law reform, drawing severe criticism from the Bush administration.(53) In 1993, President Clinton's surgeon general, Jocelyn Elders, suggested a government study of legalization, and was fired within months. In September of 1995, Chicago federal appeals court judge Richard Posner, a Reagan administration appointee and leading legal scholar, stated his support for the legalization of marijuana.(54) In April, 1996, Juan R. Torruella, chief judge of the Boston Circuit Court of Appeals and the highest ranking Puerto Rican in the federal judiciary, recommended a study of alternatives to prohibition. William Buckley's conservative weekly, The National Review, came out in favor of drug legalization in February, 1996, with the cover "The War on Drugs Is Lost: Kill It, Go for Legalization, Free Up Police, Courts, Reduce Crime". The famous economist, Milton Friedman, and Executive Director of the American Civil Liberties Union, Ira Glasser, have long supported drug policy reform. And many others have begun to voice their dissatisfaction. Yet the U.S. government refuses to listen or even to discuss the issues. Although Americans are usually loathe to look abroad for solutions to domestic problems, perhaps trends in Europe and Australia will begin to change the debate here.

Footnotes

1. U.S. Department of Health and Human Services National Household Survey on Drug Abuse: Main Findings 1993 pp.19 - 39.

2. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, HIV/AIDS Surveillance Report Volumes 1 - 7; U.S. Department of Justice, Bureau of Justice Statistics, A National Report: Drugs, Crime, and the Justice System, December, 1992: pp.2 - 8.

3. Fred K. Hellinger, "Forecasts of the Costs of Medical Care for Persons with HIV: 1992 - 1995," Inquiry, v. 29, Fall 1992, p. 356; Peter Lurie et al., The Public Health Impact of Needle Exchange Programs in the United States and Abroad, Centers for Disease Control, v. 1, 1993: p.11; National Research Council and Institute of Medicine, Preventing HIV Transmission: The Role of Sterile Needles and Bleach, National Academy Press, Washington, DC, 1995; National Commission on AIDS, The Twin Epidemics of Substance Use and HIV, Washington, DC, 1991; U.S. General Accounting Office, Needle Exchange Programs: Research Suggests Promise as an AIDS Prevention Strategy, 1993.

4. See U.S. Department of Justice, Bureau of Justice Statistics, Drugs and Crime Facts, 1989 - 1994.

5. Federal Bureau of Investigations, Uniform Crime Reports, 1995: p.216.

6. Bureau of Justice Statistics, "Felony sentences in state courts, 1992".

7. 61% of federal prisoners were drug offenders (U.S. Bureau of Justice Statistics, "Jurisdictional Population of Federal Prisons", 1994); 22.1% of state inmates were drug offenders (U.S. Bureau of Justice Statistics, Correctional Populations of the U.S., 1992, p.53); and 23% of jail inmates were drug offenders (U.S. Bureau of Justice Statistics, Sourcebook of Criminal Justice Statistics, 1991, p.622). According to U.S. Bureau of Justice Statistics, Press Release, 12/3/95, there were 1.1 million inmates in state and federal prisons mid - year 1995; jail data was estimated from mid - year 1994 at a 6% growth rate (U.S. Bureau of Justice Statistics, Sourcebook of Criminal Justice Statistics, 1994, p.543). Incarceration costs $20,000 - 40,000 / year / inmate (Criminal Justice Institute, The Corrections Yearbook: Instant Answers to Key Questions in Corrections (New York: Criminal Justice Institute, 1995); G. Godshaw, R. Koppel, R. Pancoast, "Anti - Drug Law Enforcement Efforts and Their Impact" (Washington, D.C.: U.S. Customs Services, Dept. of the Treasury, August, 1989), cited in N. Swan, Research Demonstrates Long - Term Benefits of Methadone Treatment." NIDA Notes, 9, no. 4, 1994.)

8. Department of Justice Executive Summary, "An analysis of non - violent drug offenders with minimal criminal histories," 1994.

9. There is no consistent relationship between the use of different drugs over time: U.S. Department of Health and Human Services National Household Survey on Drug Abuse: Main Findings 1993.

10. Andrew Weil, The Natural Mind: An Investigation of Drugs and the Higher Consciousness Boston: Houghton Mifflin Co. 1986.

11. See David E. Kyvig (1979) Repealing National Prohibition Chicago: University of Chicago Press.

12. See Milton Friedman & Thomas Szasz, On Liberty and Drugs: Essays on the Free Market and Prohibition, Arnold Trebach & Kevin Zeese, eds., Washington, DC: The Drug Policy Foundation Press, 1992; Thomas Szasz, Our Right to Drugs: The Case for a Free Market New York: Praeger, 1992.

13. Jacob Sullum "Bill Bennett's Blinders" Reason March, 1990: pp.20 - 25; James Gerstenzang, "Expanded death penalty weighed for drug crimes," Los Angeles Times, 1 / 10 / 1990, p.A4.

14. Ethan Nadelmann "Thinking seriously about alternatives to drug prohibition", Daedalus 121(3), 1992: 85 - 132. Reprinted in De - Americanizing Drug Policy, Lorenz Böllinger, ed. and as "Das klägliche Scheitern der Kreauzritter. Über die widersinnige Logik der Prohibition," in Vorgänge, Zeitschrift für Bürgerrechte und Gesellschaftspolitik, 118, August 1992, pp. 61 - 69.

15. M Grapendaal, Ed Leuw, & H Nelen, "Legalization, decriminilization, and the reduction of crime," in Ed Leuw & Haen Marshall, eds., Between Prohibition and Legalization: The Dutch Experiment in Drug Policy, New York: Kugler Publications, 1994: 233 - 254; Drug policy in the Netherlands: Continuity and Change, Tweede Kamer, vergaderjaar 1994 - 1995, 24077, nrs. 2 - 3, Ministerie VWS (URL: http://www.minvws.nl/drugnota/o/index.htm).

16. "Introduction and definition of problem: Current situation and evaluation," Drug policy in the Netherlands: Continuity and Change, Tweede Kamer, vergaderjaar 1994 - 1995, 24077, nrs. 2 - 3, Ministerie VWS (URL: http://www.minvws.nl/drugnota/o/s12.htm).

17. van Den Hoek, J.A.R., & Coutenho R. (1994) "Evaluation of the needle/syringe exchange in Amsterdam, The Netherlands." In Proceedings of the National Academy of Sciences Workshop on Needle Exchange and Bleach Distribution Programs Washington DC: National Academy Press.

18. "Policy on the use of hard drugs," Drug policy in the Netherlands: Continuity and Change, Tweede Kamer, vergaderjaar 1994 - 1995, 24077, nrs. 2 - 3, Ministerie VWS (URL: http://www.minvws.nl/drugnota/o/s21.htm).

19. A.C.M. Jansen, "The development of a 'legal' consumers' market for cannabis - the 'coffee shop' phenomenon," in Ed Leuw & Haen Marshall, eds., Between Prohibition and Legalization: The Dutch Experiment in Drug Policy, New York: Kugler Publications, 1994: 169 - 182; "Policy on soft drugs and coffee shops", Drug policy in the Netherlands: Continuity and Change, Tweede Kamer, vergaderjaar 1994 - 1995, 24077, nrs. 2 - 3, Ministerie VWS (URL: http://www.minvws.nl/drugnota/o/s41.htm).

20. Ethan Nadelmann, "Switzerland's heroin experiment", National Review July 10, 1995: 46.

21. The Report of the Heroin Pilot Task Force, funded by the ACT Confiscated Assets Trust Fund and the National Drug Strategy Cost Shared Grants Program, January, 1996; "ACT heroin trial should go ahead" The Cranberra Times 1/12/1996: p10; Alex Wodak, "Harm reduction: Australia as a case study," Bulletin of the New York Academy of Medicine 72(2), Winter 1995: p339 - 347.

22. Benedikt Fischer, "Drugs, communities, and 'harm reduction' in Germany: The new relevance of 'public health' principles in local responses", Journal of Public Health Policy 16(4): 1995, 389 - 411.

23. See, for example, The Oxfordshire's Council on Alcohol and Drug Use Libra Project's URL: (http://www.brookes.ac.uk/health/libra/n2/index.html); Lart, R. & Stimson G.V. (1990) "National survey of syringe exchange schemes in England," British Journal of Addictions 85: 1433 - 1443.

24. See Nick Heather, Alex Wodak, Ethan Nadelmann, & Pat O'Hare, eds., Psychoactive Drugs & Harm Reduction: From Faith to Science, London: Whurr Publishers, 1993; also see the papers in Chapter Three of this book.

25. Peter Lurie et al., The Public Health Impact of Needle Exchange Programs in the United States and Abroad, Centers for Disease Control, v. 1, 1993; Normand, et al., Preventing HIV Transmission: The Role of Sterile Needles and Bleach. Washington, DC: National Academy Press, 1995; .; National Commission on AIDS, The Twin Epidemics of Substance Use and HIV, Washington, DC, 1991; U.S. General Accounting Office, Needle Exchange Programs: Research Suggests Promise as an AIDS Prevention Strategy, 1993.

26. Institute of Medicine, Treating Drug Problems, vol. 1 (Washington, DC: National Academy Press, 1990), 187; Institute of Medicine, Federal Regulation of Methadone Treatment (Washington, DC: National Academy Press, 1995); J.C. Ball and A. Ross, The Effectiveness of Methadone Maintenance Treatment (New York: Springer - Verlag, 1991); V.P. Dole, M. Nyswander, and A. Warner, "Successful treatment of 750 criminal addicts." Journal of the American Medical Association 206, 1968: 2708 - 2711; M.D. Anglin and W.H. McGLothlin, "Outcome of narcotic addict treatment in California." In F.M. Tims and J.P. Ludford (Eds.), Drug Abuse Treatment Evaluation: Strategies, Progress, and Prospects, NIDA Research Monograph 51 (Maryland: National Institute on Drug Abuse, 1984); R.L. Hubbard et al., "Treatment Outcome Prospective Study (TOPS): Client characteristics and behaviors before, during, and after treatment." In F.M. Timms and J.P. Ludford (Eds.), Drug Abuse Treatment Evaluation: Strategies, Progress, and Prospects, op. cit.; Also see the primary randomized controlled studies of methadone's effectiveness: V.P. Dole et al., "Methadone treatment of randomly selected criminal addicts." New England Journal of Medicine, 280, 1969; R.G. Newman and W.B. Whitehill, "Double - blind comparison of methadone and placebo maintenance treatments of narcotic addicts in Hong Kong." Lancet, Sept. 8, 1969; and L. Gunne and L. Grönbladh, "The Swedish methadone maintenance program: A controlled study." Drug and Alcohol Dependence, 24, 1981.

27. Ward, Mattick, and Hall, Key issues in methadone maintenance treatment, op. cit.; Marc Reisinger, personal communication, 5 February, 1996; Marc Reisinger, Methadone Treatment and AIDS in Western Europe (paper presented at the National Conference on Methadone, Geneva, June 23, 1995), Marc Reisinger, Methadone As Normal Medicine (Paper presented at the European Methadone Assoc. Forum, American Methadone Treatment Assoc. Conference, Phoenix, Arizona, Oct. 31, 1995); AIDS and drug addiction in the European Community: treatment and mistreatment, Marc Reisinger, Ed. (Brussels, Belgium: European Monitoring Centre for Drugs and Drug Addiction, Commission of the European Communities, Sept., 1993); Gerry V. Stimson, AIDS and injecting drug use in the United Kingdom, 1988 - 1993: The policy response and the prevention of the epidemic (unpublished paper, 1994).

28. Ethan Nadelmann, "Switzerland's heroin experiment," National Review July 10, 1995: 46.

29. Ueli Locher, "Switzerland's heroin prescription experiment: Update," Seminar at The Lindesmith Center, New York: 1/4/96.

30. "Prevention and the care and treatment of addicts: Provision of heroin on medical grounds," Drug policy in the Netherlands: Continuity and Change, Tweede Kamer, vergaderjaar 1994 - 1995, 24077, nrs. 2 - 3, Ministerie VWS (URL: http://www.minvws.nl/drugnota/o/s37.htm).

31. The Report of the Heroin Pilot Task Force, funded by the ACT Confiscated Assets Trust Fund and the National Drug Strategy Cost Shared Grants Program, January, 1996; "ACT heroin trial should go ahead," The Cranberra Times 1/12/1996: p10.

32. Benedikt Fischer, "Drugs, communities, and 'harm reduction' in Germany: The new relevance of 'public health' principles in local responses," Journal of Public Health Policy 16(4): 1995, 389 - 411.

33. Robert Marks (1990) "Relaxing the prohibition: Effects on supply and demand," in Hando J. & Carless J, eds., Controlled Availability: Wisdom or Disaster? National Drug and Alcohol Research Centre, Sydney, Australia; Strang J. (1990) "The roles of prescribing," in Strang J & Stimson GV, eds., AIDS and Drug Misuse: The Challenge for Policy and Practice in the 1990's, London: Routledge.

34. James Hirsch, "'Smokeless' cigarette a failure for Reynolds," The New York Times 3/1/89: A1.

35. Norman E. Zinberg, Drug, Set, and Setting: The Basis for Controlled Intoxicant Use, New Haven: Yale University Press, 1984: pp. 46 - 81.

36. Ronald Bayer, "Heroin Maintenance: An historical perspective on the exhaustion of liberal narcotics reform," Journal of Psychedelic Drugs 8, April - June, 1976: 157 - 160.

37. Hearings of the Committee on the Judiciary 1956, a subcommittee of the United States Senate, as cited in Ronald Bayer, "Heroin Maintenance: An historical perspective on the exhaustion of liberal narcotics reform," Journal of Psychedelic Drugs 8, April - June, 1976: 159 - 160.

38. Ronald Bayer, "Heroin Maintenance: An historical perspective on the exhaustion of liberal narcotics reform," Journal of Psychedelic Drugs 8, April - June, 1976: 162.

39. David E. Joranson & Aaron Gilson, "Controlled substances, medical practice, and the law," in Harold I. Schwartz, ed. Psychiatric Practice Under Fire Washington, DC: American Psychiatric Press, Inc. 1994: 173 - 193.

40. Joranson D. E., "Federal and state regulation of opioids," Journal of Pain and Symptom Management 5 1990, (supplement 1): S12 - 23.

41. Kathleen M. Foley, "The 'decriminalization' of cancer pain," in C.S. Hill & W.S. Fields, eds., Advances in Pain Research and Therapy Volume 11, New York: Raven Press, Ltd., 1989: 5 - 18; Porter J & Jick H, "Addiction rare in patients treated with narcotics," New England Journal of Medicine 302 1980: 123.

42. John P. Morgan, "American opiophobia: Customary underutilization of opioid analgesics," in Controversies in Alcoholism and Substance Abuse The Haworth Press, Inc., 1986: 163 - 173.

43. Stanton Peele?

44. See Geoffrey Canada, Fist, Stick, Knife, Gun: A Personal History of Violence in America, Boston: Beacon Press, 1995.

45. See L. Grinspoon and J. Bakalar (1993) Marihuana: The Forbidden Medicine New Haven: Yale University Press.

46. L. Grinspoon and J. Bakalar (1993) Marihuana: The Forbidden Medicine New Haven: Yale University Press, pp.36 - 38.

47. L. Grinspoon and J. Bakalar (1995) "Marihuana as medicine: A plea for reconsideration" JAMA 273(23).

48. American Civil Liberties Union survey, "American voters' opinion on the use and legalization of marijuana for medical purposes," 1995.

49. Lester Grinspoon, James Bakalar, & Rick Doblin, "Marijuana, the AIDS wasting syndrome, and the U.S. government," New England Journal of Medicine 333, 9/7/1995: 670 - 671.
Donald I. Abrams, Carrol C. Child, & Thomas F. Mitchell, "Marijuana, the AIDS wasting syndrome, and the U.S. government," New England Journal of Medicine 333, 9/7/1995: 671.

50. See Diana R. Gordon, The Return of the Dangerous Classes: Drug Prohibition and Policy Politics. New York: W.W. Norton, 1994.

51. Carolyn Skorneck, "Drug Director Says He Was 'Out Of The Loop' During Budget Talks," The Associated Press, July 7, 1993.

52. Ethan A. Nadelmann & Jennifer McNeely, "Doing methadone right," The Public Interest 123, Spring 1996: 83 - 93; Institute of Medicine, Federal Regulation of Methadone Treatment (Washington, DC: National Academy Press, 1990), 116.

53. Federal News Service, "CB The White House Washington, DC regular briefing," 11/6/1989, Briefer: Marlin Fitzwater.

54. "Judge pushes for legalizing pot," Visalia Times - Delta, 9/15/1995: p4A.