A Freer Market for Heroin in Australia: Alternatives to Subsidizing Organized Crime - Part 2

Supply-Side Policies

There is a (black) market for heroin. It is useful to classify policies by their effects on the supply of, and demand for, black-market heroin. In this section we consider two policies, not necessarily mutually exclusive, for reducing the supply of heroin to the user:

• tighter customs searches, to prevent entry of heroin into Australia, and
• increased enforcement to prevent the "landed" drug from reaching the user on the street.

Opium is the hardened milky fluid obtained from pods of the opium poppy (Papaver somniferum) several days after the flowering in mid-summer. Morphine and codeine are two of the natural alkaloids of opium. On average, ten kg. of crude opium make one kg. of morphine base, and when this is heated in the presence of acetic acid and other chemicals, a little more than one kg. of heroin is produced. McCoy (1980:20-24) asserts that all of Australia's supply of illicit heroin comes from southeast Asia, mainly through Bangkok, and the William report (1980:A178) corroborates this.

Customs and Smuggling

The importation of heroin is prohibited, yet the prohibition is ineffective. If we assume 20,000 regular users of heroin, then annual consumption per user of 10 grams of pure heroin implies imports of 250 kg. of 80%-pure heroin; 20 grams implies 500 kg. The figure in Table 1 of 97.1 kg. seized in 1983, if 80% pure, would correspond to 38.8% or 19.4%, respectively, of these totals. Economic theory suggests that, with a short-run price-inelastic demand curve, such a significant reduction in supply as even 20% would be accompanied by a significant increase in the market-clearing price (of at least 20%). The comparison in the previous section of Elliott's recalculation of the Woodward report's prices for 1977-78 with Fitzwarryne's prices for 1984-85 suggests that no such increase has occurred.

There are four possible explanations: the average purity of the seized drug approached the 5% of the street, so that it corresponded to a maximum of 2.5% of annual supply, which would not cause a noticeable jump in price; importers were able to make up the shortfall with further imports, so that the price rise, even if it occurred, did not persist; the demand is price-elastic, perhaps because users turned to substitute drugs, or perhaps because of limits to the users' abilities to raise money to pay for the higher prices inelastic demand would result in, so that prices did not rise greatly as supply was reduced; and the total amount imported is much greater than the estimated lower limit of 250 kg., perhaps because the "heavy-user" population greatly exceeds 20,000, and may use more than 67 mg. of pure heroin per consuming day per user, on average.

We examine these possibilities one-by-one. First, since the amount of 97.1 kg. was seized by federal agencies, including the Australian Federal Police and the Customs Bureau, the purity is likely to be closer to the 80% of the "landed" drug than to the 5% of the street heroin seized in addition by state police forces. Second, if the structure of the importing "industry" and the level of official surveillance were such as to have allowed the shortfall to be made up by further imports, then the difficulties of attempting to staunch the flow are revealed. If, however, the shortfall was not made up, and yet the prices did not rise appreciably, then we must seek an explanation elsewhere.

Third, Moore (1977:9) argues that the aggregate demand for heroin is likely to be price-inelastic, but not perfectly price-inelastic, that is, a reduction in the consumption of heroin will lead to a large price increase (more than proportionate, but finite), and an increase in amount paid. If we take the empirical estimates of Silverman and Spruill (1977:97) of a long-run price elasticity of demand of approximately -0.25, then a 20% fall in the amount consumed would correspond to an 80% rise in the price, ceteris paribus. As remarked above, there is no evidence of such a price rise in 1983.

Fourth, it may be that the opiate-related deaths shown in Table 1 are a true indicator of current numbers, and that, instead of 20,000 heavy users each consuming 20 gram of pure heroin a year, there are 40,000 heavy users each consuming 25.5 gram of pure heroin a year. This corresponds to a daily habit of 100 mg. of pure heroin, or an annual habit of 32 gram of 80%-pure heroin, and is based on Elliott's recalculation of the William report estimates (Elliott 1982:15). In this case, the seizure of 97.1 kg., even if of 80% purity, would correspond to only 7.6% of the total quantity imported of 1,280 kg., which could result in a 30% price rise given a price elasticity of demand equal to -0.25. This is consistent with the statement in 1985 of the then head of the joint federal/NSW Joint Task Force on Drug Trafficking, Detective Chief Superintendent Jim Willis, that only 4% to 7% of imported illegal drugs were being interdicted (Davies 1986:133).

If we take the estimate of price elasticity of demand as roughly correct, we must conclude that absence of a significant price rise in 1983 means that our previous estimate of the amount of imported heroin of 250 kg. must have been a severe underestimate, and the increased effort which led to the seizure figure of 97.1 kg. will have to be magnified many times to make the prohibition absolute. As this effort is successfully rewarded with higher seizure figures, the prices of "landed" and "street" heroin will rise dramatically, and with them the potential for greatly increased costs - to the addicts, to property owners, and to the criminal-justice system itself.

Police Enforcement

A more realistic goal is to attempt to tighten domestic law enforcement and to increase the effective operating costs (including risk) of the domestic distribution networks. This will become more important when domestic production of "designer drugs" means that customs seizures are even less effective at preventing the opiates from reaching the final consumers, as Andrews forecast at the 1985 ANZAAS conference (Levinson 1986:169). One such drug, 3-methyl fentanyl, is already sold as a cheap substitute for heroin in the United States (Stimson 1986). Moore (1977) has the most comprehensive study of the structure of illicit heroin-distribution systems and of the structure of narcotics-enforcement efforts. Moore (1977:52) argues that the most likely structure for the distribution system is one of monopolistic competition, which, as well as maximizing profit while the risk of detection, could most efficiently

• restrict the total supply of heroin to maintain prices,
• regularly and reliably supply an amount of heroin fairly close to the realized demand,
• manipulate upstream supply conditions in the system with a minimum of explicit planning and negotiation, and
• adjust to errors in supply with a minimum of communication and activity.

Such a structure requires product differentiation and barriers to entry. The illegality of the trafficking, possession, and use of the commodity provide these requirements: users on the street, for fear of arrest and of being "ripped off" by the dealers given their lack of knowledge of the quality of the heroin, will tend to do less "comparative shopping" than buyers in a legitimate market; and the distribution network can buy barriers to competitors' entry from corrupt law-enforcement officials, and use its own violent methods to deter competitors (Schelling 1967).

Gross profits of such distribution networks include the firm's opportunity cost, a risk premium, and a monopoly return. We might expect that increased enforcement of the prohibition would raise the price of street heroin by increasing the risks and the operating costs, as well as by reducing the supply of heroin. However, so long as the demand is price-inelastic, a higher price will increase the social cost of heroin use, by resulting in a greater turnover of the network, as discussed above. Moreover, given the probable structure of the distribution system, effective enforcement might lead to increased competition as networks became less able to protect their market segments, with consequent lower street prices and increased sales (see Elliott 1982:41). Only if the demand for heroin were price-elastic would a policy of increased enforcement be effective, but at a cost which the community has so far resisted. As Elliott (1982:25) reminds us:

Where heroin is difficult to obtain, and expensive, the expedients adopted by the user in securing his supply constitute a major component of the social problem of heroin use... The distinctive form of the social problem constituted by heroin use is a consequence of the illicit market which results from prohibition.

Managing Demand

"Demand" policies can fall into three categories: deterrents, cures, and continuing programs. Deterrent policies attempt to dissuade the individual from becoming, or continuing to be, a user, either by the threat of the consequences of the illegality of the possession and use of heroin, or by threat of the ill-health, suffering, and eventual death that are said to befall the addict. Cures attempt to treat the user so that he no longer wants or needs the drug, but is a socially valuable member of society, and is free from any illicit drug use. Continuing, or maintenance, programs attempt to enable the user to lead a reasonably normal fife, while undergoing continuing treatment or care, with no certain goal of eventual "cure," that is, eventual freedom from some drug use or treatment.

Rather than attacking the "means" of the heroin problem - the supply side of the illicit market - demand policies address the "ends." These are individual demands for the drug which provide the driving force behind the acquisitive crimes, the distribution networks, the smuggling, and the original farming of the poppy fields in Asia. If the demand for heroin were zero, there would be no heroin problem.

Deterrents

As Moore (1977) points out, in enforcing narcotics laws there is a dilemma common to all negative-incentive systems. To the extent that people notice and respond to the incentives, a desirable result occurs: people are deterred from using heroin. For the people who do not respond and who begin using heroin in spite of the incentive system, punishment entails a deadweight loss. The policy is to deter, not to punish. Unless punishment will result in future deterrence, there is little to be gained by further action. "The problem is fundamental: the desire to have the incentive conflicts with the desire to minimize the damage done to people who do not respond to the incentive" (Moore 1977:237). If one needs only a modest disincentive to discourage users, then one can do a great deal to dampen the adverse consequences of the incentive system on current users.

The possibility of a long prison term has proved to be little or no deterrent at all. Indeed, as Wardlaw (1981) argues, a substantial percentage of Australian drug offenders have been convicted for criminal offenses prior to their first drug offense. It is reported that 80% of inmates in NSW prisons are there for drug-related crimes, and that half of the inmates are drug addicts; further, that drug use is implicated in half of the break-enter-and-steal crimes committed in NSW and in 63% of Victorian house burglaries, and that 46% of the armed robberies in NSW are committed by drug addicts (Sydney Morning Herald, 21 November 1984). Moreover, attempts to convince non-users of the deleterious effects of addiction have failed, and may even have contributed to the allure of heroin: the irony of this is that unadulterated heroin properly administered causes few, if any, side effects. (Marks 1974:75 and Kaplan 1983:127-129 discuss the evidence confirming this.) On the other hand, public appearances by apparently "cured" addicts, with their tales of redemption from the sin of heroin use, may fascinate non-users and suggest that giving up heroin is easy (see the example in Elliott 1982:6). This is what Brecher (1972) calls "the lure of the warning." The 1985 "drug summit" in Canberra has apparently put its faith in proper education, with $20 million a year for three years committed for education and rehabilitation program by the federal government. Blunt honesty will be needed in education campaigns, especially those directed at addicts: "Anyone that says heroin is bad, heroin is evil, will lose all credibility with addicts because they know better, they know how good it is" (Kevin O'Neil, NSW Department of Health spokesman, as quoted in the Sydney Morning Herald 21 November 1984).

For an effective policy of deterrence, better understanding of the causes of heroin use is essential. In a comprehensive discussion of the psychological, sociological, and pharmacological/physiological possibilities, Lennings (1981) is unable to isolate any particular cause. He concludes that a "structure theory" (in which heroin use is a response to the psychological aspects of the drug routine) is "most useful." It is not as though one needle is enough. In experiments in which volunteers received injections of morphine (only slightly less potent than heroin), fewer than 10% liked the experience (Chein 1964; McAuliffe 1975). In a controlled double-blind experiment in which heroin was injected, only about 10% of the subjects were enthusiastic or mildly pleased (Lasagna 1955). It usually takes several weeks of using between 50 and 100 mg. a day to acquire any noticeable physical dependence, although even that is not infallible (Ashley 1972:61), and, on the street, addiction is rare within six weeks of a user's first experience with the drug (McAuliffe and Gordon 1974). We should emphasize that the subjective experience of any drug user is a function of the set (expectation) and setting (environment) of the user, as well as of the pharmacology of the drug itself (Kaplan 1983:12), to the extent that clinical tests may not reveal the appeal of the drug on the street.

We are caught on the horns of Moore's dilemma: society has prohibited heroin and established strong direct deterrents (the criminal-justice system) to enforce this which have resulted in strong indirect deterrents (the high prices, the sickness, the possible death). But deterred sufficiently they have not. Is the answer to turn the screw tighter (Peyrot's stage four), or is it to look for radical alternatives (Peyrot's stage five)?

Treatments to "Cure" Addiction

It is not entirely clear what the goals of "cure" treatment should be, although for the addict to stop using heroin, to stop committing crimes, and instead to find a job, to stabilize his personal life, and to become a useful and productive citizen are commonly stated goals (DeLong 1972:178). To judge to what extent alternative -cures" have been successful is difficult, not least because of the lack of data; what data there are have tended to concentrate on whether the patient has stopped using heroin, with any lapse back into heroin use spelling failure. Such focusing on one indicator of success overlooks the fact that after treatment an addict may hold a job, support a family, refrain from other criminal activity, and yet still occasionally use heroin; or his crime rate might fall; or his physical health might improve although otherwise his behavior remains unchanged; or he might swap his heroin habit for alcoholism.

We shall classify alternative "cures" into four categories:

• Detoxification - the addict is helped through withdrawal from the drug in hospital or in a clinic, and then released. (Earlier this century, withdrawal was though to be caused by an accumulation of poisons in the body, according to Dole 1980).
• Civil commitment - this has been extensively used in the United States. The addict is given a choice by the court: jail or commitment in an institution to help him overcome his addiction. The Drug and Alcohol Court Assessment Programme (DACAP) in Sydney is probably the closest Australian equivalent. Before passing sentence on drug offenders, three petty-sessions courts can send the offenders for six-week's treatment (including detoxification) to the Bourke Street outpatient clinic, and receive a probation officer's report for sentence (Bush and Scagliotti 1983). In its present form the DACAP began in 1980.
• Therapeutic communities - such as Odyssey House and We Help Ourselves in NSW, which operate on the basic assumption that drug use is caused by a "character disorder" (Luger 1983:30) or an "addictive personality." They treat drug users with encounter group therapy in a drug-free "therapeutic milieu." The communities have high rates of initial rejection and attrition, and treatment can take up to several years of confinement.
• Outpatient abstinence - programs which bolster continued abstinence by counseling and group therapy while the addict is living at home.

Cures have not proved very successful, even when measured only by the single criterion of heroin abstinence. Robins (1979) found that the likelihood of cessation of opiate use among Vietnam veterans was the same for those who had entered treatment as for those who had not. Is there an element of wishful thinking associated with wanting to cure the addict? At the same time as asserting the addict's helplessness to stop being an addict, conventional wisdom has it that "outside forces" can cure the addict: a claim of our power to influence others - in this case, addicts - through legislation, punishment, and perhaps medical treatment (Kaplan 1983:38)? Indeed, the three characteristics of a disease - that the diseased suffers, that the sufferer has no control when diseased, and that the medical profession has primary competence to cure or alleviate the disease may not be satisfied by heroin addiction. Nonetheless, the medical model is very influential. Lennings (1981:379) reviews recent outcome studies, and Marks (1974:77) reviews data on U. S. programs, which can be summarized as follows:

Detoxification programs - with an abstinence rate (for one month or more) of below 5% among the 10%-20% of addicts who "graduate" - have virtually no long-term successes. (There is a minor benefit in that addicts lose some drug tolerance after detoxification, and so need less heroin; by the same token, the street user is more at risk of overdosing.) To use Milner's words (1976:551) detoxification is only a "palliative procedure," with a cost only one-tenth that of hospital residential treatment.

With a graduation rate of between 10% and 100%, civil-commitment programs seem to be slightly more successful - up to 30% of graduates are abstinent for one or more months. However, the cost of six-months to five-years institutionalization and aftercare is very great. Moreover, there is evidence of a marked rise in the use of other drugs among the "successes." The DACAP program boasts that jail sentences among its graduates are only a quarter as likely as for non-DACAP criminals, whereas therapeutic-community treatment is seven-eights as likely (Bush and Scagliotti 1983: Table 5), but its goals are extremely unclear, with no long-term follow-up.

In the United States, only between 10% and 50% of those who want to join therapeutic communities are considered "acceptable" and fewer than 15% "graduate" (participation in some programs is considered semi-permanent), although abstinence is very high (90%) among these few "successes." But the cure does not come cheap. Eighteen months to two or even five years at $6,300 per year in 1983 (Luger 1983:30), although this cost is less than a quarter of a year in jail ($31,000 in 1985) and less than a seventh of a year in hospital, as Luger points out. It is clear that for most addicts, therapeutic communities are not the answer.

Outpatient-abstinence program have low success rates, and high drop-out rates. This marked lack of success may explain the lack of further data on costs, length of treatment, and abstinence rates.

In conclusion, we can state that no effective "cure" for heroin addiction has been found - not rapid or gradual withdrawal, not long terms of imprisonment, not civil commitment, and not therapeutic communities. Nor should this surprise us. Despite the recent advances in neuro-pharmacology and the discovery of endorphins - naturally produced analgesics in the body (Akil 1977) - medical science is a long way from unraveling the enigma of heroin addiction (Wodak 1985). It is said by staff who work with addicts that they must want to solve their day-to-day problems without the use of heroin (Sydney Morning Herald 21 November 1984); heroin addicts in Australia either die or grow up (Williams 1980:C21). This "maturing out" is examined by Waldorf and Biernacki (1981), and is also seen in a longitudinal study of U.K. addicts from 1968, when the clinic system began, to 1976 (Stimson and Oppenheimer 1982:244). As Kaplan (1983:36-37) argues, the rarity of addicts over forty is not because. all die younger; rather, many have stopped using heroin, at least regularly and frequently. After summarizing previous "natural history" studies of heroin users through time in both the United States with illicit heroin and the United Kingdom with legal heroin, Wodak (1985) concludes that a steady 2%-3% of users become abstinent and 1%-2% die or become institutionalized each year. A recent study of "resistance" (Biernacki 1986) leads to some unsettling conclusions for those heavily invested in the criminal-justice and medical models of addict management, which we explore below.

Continuing Programs

By "continuing programs" we mean programs in which the user is continuously treated with a drug, usually an opiate, whether natural or synthetic (heroin, methadone, morphine, dipipanone, etc.). Roughly, there are three forms of continuing programs (Marks 1974), depending on the degree of medical supervision. Meyers (1980) considers a fourth - medical and drug treatment research - which is not relevant to the social problems we address here. First, there are maintenance programs in which the drug and dosage are determined by medically qualified personnel and in which the doses are administered under close medical supervision. We shall consider two versions of this form: methadone maintenance, examples of which have been operating in Australia since the late 1960s, and which are to be found in the United States and Britain, as well; and heroin maintenance, an example of which was the treatment of registered addicts in the British clinics immediately after their establishment in 1968. The proportion of addicts receiving prescribed heroin fell from 54% in 1970 to 21% in 1978 (Stimson and Oppenheimer 1982:100).

Second, there are program in which the drugs and dosage are determined by a doctor, who supplies the addict with a prescription to be filled by a pharmacist and administered by the addict. Again, we shall consider two versions of this form: first, prescription methadone, a situation which applies in Australia (under the National Policy on Methadone authorized doctors may prescribe maintenance doses of methadone syrup for drug-dependent patients) and in Britain (where methadone can be prescribed for addicts by any doctor) (Williams 1980:C26-33); and, second, prescription heroin, which was available in Britain before 1968.

Third, there are program with no medical supervision. Included in this category are the highly controversial policies of freely available methadone and freely available heroin, one example of which was the pre-First World War situation, when there were no restrictions on the sale or possession or use of heroin in Australia, Britain, and the United States. Methadone is an opioid analgesic which was first synthesized in 1941 by I.G. Farben chemists in response to the war-time blockade of opium imports to Germany (Bellis 1981:38). There has never, to this writer's knowledge, been a time in which methadone was as freely available as was pre-1914 heroin. Consequently, there are no empirical data on the freely available methadone policy.

Another possible candidate for inclusion among the continuing programs is treatment with an opiate "antagonist," a drug which, if administered before heroin is taken, blocks both the relief and the euphoric effect of the heroin, or, if administered after, precipitates withdrawal. In neither case does the antagonist ease the craving for heroin, or even allow the heroin, if then taken, to relieve the craving itself. It seems a particularly cruel sort of treatment to impose on an addict, who would presumably not choose it for himself. The main value of the antagonist drugs appears to be in the treatment of victims of acute opiate overdose, who may otherwise die of respiratory depression.

The pharmacological comparisons of morphine, heroin, and methadone are well known (see Marks 1974:78; Kaplan 1983:5-8 for more details). The drugs vary in several ways, which affect their apparent attractiveness (for the user and for the maintenance program), their abuse potential, and their effects on the user's day-to-day living patterns. The major elements of variance involve the time before onset of withdrawal and the method of administration. For any drug the first of these varies with mode of administration: intravenous administration results in a higher peak effect (euphoric and analgesic) and a shorter duration until withdrawal than does oral administration. Whereas all three of the drugs can be administered intravenously, heroin loses much potency when administered orally, since the liver neutralizes most of the drug (Jaffe and Martin 1980). In Britain and Australia both injectable and oral forms of methadone may be prescribed for addicts. In the United States methadone is only dispensed in syrup form for oral administration, blocking withdrawal and heroin craving, but not the resulting euphoria. Oral methadone peaks after four hours, with a duration of 24-hours slow decline. Injected heroin peaks in less than 30 minutes, with a duration of between four and six hours and a rapid decline; morphine is almost as fast (Marks 1974:78).

For these reasons, program administrators have preferred to supply methadone (oral, no euphoria) rather than heroin (injected, euphoria). Only one dose a day is needed to stabilize the user, without heroin's "disadvantages" of euphoria versus premature withdrawal. There are few data for prescription methadone or methadone maintenance. In the only controlled trial to date to evaluate (injectable) heroin maintenance against (oral) methadone maintenance, Hartnoll et al. (1980) found no differences between the two in terms of employment, health, or consumption of non-opiate drugs; there was, however, a lower dropout rate with heroin maintenance (26%) than with methadone maintenance (71%) after twelve months. Another criterion for comparison is the crime rate; there was a slightly higher level of criminal activity among those denied heroin but offered oral methadone. This is partly explained by a tendency for this group to have been more criminally active at intake. The authors caution against extrapolation of their findings in Britain to proposals abroad, in agreement with Wodak (1985).

As suggested above, prescription heroin occurred during the forty years in Britain after the Rolleston Committee and before the clinic system was introduced. Data are scarce and unreliable, but a study by Zacune (1971) of 25 Canadian addicts who immigrated in Britain in the early 1960s in search of cheap, pure heroin suggests a fall in the crime rate of between 30% and 90%; heroin was prohibited in Canada.

The Australian National Policy on Methadone distinguishes methadone maintenance from the use of methadone withdrawal (Williams 1980:C25). Both are permitted by the policy for "patients" who are over 18 years of age, who have a well-established physical addiction (usually demonstrated by use of an antagonist), and who have a history of fairly continuous opiate usage over at least one full year (methadone withdrawal) or two full years (methadone maintenance). In addition, admission to methadone maintenance requires that the "patient" has attempted other treatment alternatives extending over a period of at least six months and including at least two withdrawals.

Baldwin (1987) has made a close study of the costs of public and private methadone maintenance programs in NSW and finds that the mean cost of public clinics was $113 per client per month in early 1986, with a range of $61 to $239 depending on support services offered. The mean cost of clinical management alone is similar for both private and public clinics, but the private pathology laboratories are much dearer than the NSW government laboratory's charges. These figures must be considered as lower bounds for heroin maintenance clinics, given the need for more frequent visits by clients, because of the shorter duration of heroin's effects.

There has been criticism of methadone maintenance in general and the National Policy in particular. First, there is opposition from some groups in society who deny that methadone is in any sense a treatment for opiate addiction; they see use of methadone as no better than use of heroin, but for its legality. If withdrawal from opiate use were alleviated by methadone, this criticism might be muted. Unfortunately, daily methadone usage below 20 mg. sometimes results in withdrawal symptoms, the so-called 20 mg. barrier; indeed, it has been argued that withdrawal from methadone is sometimes more difficult than withdrawal from heroin (Williams 1980:C30). Second, there may be "leakage" of legal methadone onto the street, the so-called grey market (Preble and Miller 1977). In 1976 approximately two-thirds of persons receiving methadone had received no prior treatment for drug dependency, and many unauthorized doctors were prescribing methadone. The Williams report (1980:C27) notes that the national policy has not always been observed. In the mid-1970s) Australia had the second highest per capita consumption of methadone after the United States, and in 1977 the Commonwealth restricted methadone prescribing under the National Health Scheme to treat disabling pain from transient disorders or malignant cancers which had defied treatment with non-opiate analgesics. On the other hand, oral methadone has undoubted value if it reduces the user's reliance on the needle.

The Policy of Choice

In a paper which should be compulsory (and compulsive) reading for all who grapple with the dilemma of heroin policy, Moore (1976) lays bare the heroin problem in a way that has not been equaled. To summarize: the choice of policies to deal with the heroin problem can be substantially affected by the definition of the problem. Definition of the problem entails exhaustively listing its attributes (broadly, the effects on heroin users and the effects on others), listing the government's role and objectives, and listing possible policy instruments.

Moore lists two areas of the heroin problem's effects on users: health (including mortality, morbidity and intoxication), and dignity and autonomy (economic independence, conventional responsibilities and satisfaction with life). He also lists four areas of its effects on others: crimes (economic losses to victims, private costs of protection, and fear and anxiety), contagion, public resources (special services provided to heroin users, their share of general services, the value of public facilities to others, and the impact on the balance of payments and on taxation and local government revenues), and the overall morale of society (the state of civil liberties, the power of organized crime, the integrity of the police and customs officials, the degree of upward mobility, and finally morality and esthetics.) He argues that these attributes should be included in any discussion of policy alternatives towards the heroin problem.

The government's role and objectives are more controversial. Moore lists three possible boundaries to the government's role. First, the government should intervene in private decisions only when these have a harmful effect on others. This belief implies that the government should not concern itself with the "private" costs of heroin use, but only with the "externalities" of crime and contagion. Second, government intervention in private decisions is justified when the decision maker is either unable to determine or incompetent to evaluate the decisions' consequences - hence, laws for the protection of minors and the insane. Third, the government, perhaps through Hardin's (1968) "mutual coercion, mutually agreed upon," has an obligation to enable every citizen to enjoy a life consistent with current views of human dignity - hence, the government provision of "merit" goods; moreover, this view might provide justification for laws against selling oneself into slavery, or against choosing to go to hell via the heroin route, for example. Depending on one's view of the role of government, its objectives might include improving the health of heroin users, enhancing their dignity and autonomy, reducing the crimes they commit, reducing the spread of heroin use, bolstering society's morale, and reducing the drain of pubic resources caused by heroin users.

We have considered some of the government's policy instruments above. Moore posits a 2 x 2 classification scheme: policies that affect the behavior of current heroin users only, and policies that affect a broad range of behavior versus policies that affect heroin use only. This scheme ranges from policies which influence the macro "causes," such as unemployment, to policies which influence the symptoms only, such as current users' heroin consumption. Policies for prevention and cure lie between.

Moore makes the point that few could object to the strategic objectives of reducing the number of heroin users and/or improving their behavior and condition. If their socially and privately costly behavior were improved, or if there were fewer of them, or both, then the heroin problem would be less severe. Although the heroin user's behavior may be affected by his consumption of the drug itself, by his skills, habits, and attitudes before the onset of heroin use, by the set of opportunities accessible to him, and by his participation in supervised programs, of most profound impact on the heroin user's behavior is prohibition - the manufacture, distribution, possession, and use of heroin virtually absolutely prohibited throughout Australia. As we have seen, the user faces high prices, heroin of unknown purity and potency, and of irregular supply. Consequently, the user's autonomy is reduced, he may commit more crime, and his risk of premature death is increased. Moreover, he is liable to arrest and conviction merely for being an addict, which brands him for life.

Moore argues that if illicit heroin consumption is the problem, then eliminating heroin use entirely (whether by effectively enforcing the supply side prohibition, or by eliminating the demand for heroin use) is a policy alternative to legalizing all heroin use. To advocate legalization is to believe that legalization is easier or less costly than elimination and to believe that legalization will not change other objectives of society. Australia has tried elimination of heroin use with prohibition. It has been a costly failure. It is now time to move beyond Peyrot's stage-four muddling to stage one of a new cycle: decriminalization of the market for heroin.

In a short paper some years ago Dr. L.R.H. Drew, the senior medical advisor on alcohol and drug dependence in the Commonwealth Department of Health, asked four questions about illegal narcotics [heroin] use: "Are narcotics a threat to national security? Are narcotics a threat to law and order? Are narcotics a threat to the personal development, and lifelong contribution to society, of young people? Are narcotics a threat to the health of the young?" (Drew 1979). He argued that the real threat to national security lies not in the drug use, but in the possibilities for corruption and organized crime, and that "drug abuse and crime are what we choose to make them," in the words of Goldman (1981). That is, both heroin abuse and crime are socially defined, not inherent. Both are artefacts of prohibition. Moreover, as Wardlaw (1981) and Dobinson and Ward (1985) argued, the crime antedated the drug taking, on the whole. Drew (1979:158) answered the third question by noting that

the more we know of drug use and drug takers the more it appears that drug dependence is more often a symptom than a primary cause of maladjustment. The drug-using subculture and lifestyle may be the best adjustment possible for some people at some times in their lives.

He notes that, although more freely available heroin would result in some experimentation with an increase in drug use, "drug problems would only follow suite if our community is raising a very maladjusted generation of young people," in which event problems would occur, drugs or no drugs.

The Patterns of Heroin Use

This question of the spread of heroin use with easier availability is one that several researchers have addressed. It appears to be the main reason why the Rankin report on the legal provision of heroin to diminish crime associated with its supply and use refused the fence, despite agreement among all witnesses that "the only possible way to eliminate the organized black market in heroin would be to make the drug available over the counter on demand, free of charge or very cheap, to all who wanted it" (Rankin 1981:29), and despite its recognition that the more restrictive the policy of legal heroin, the larger the illicit black market in response. It argued that the social cost of the rise in addiction which would inevitably follow would be "wholly unacceptable." The Williams report agreed, characterizing the proposal for freely available heroin as "naive and unrealistic" (Williams 1980:D10), and argued against prescription heroin for the paradoxical reason that a significant proportion of young heroin users would not be attracted to it (Williams 1980:C197).

Although freer availability of heroin may be necessary for a large growth in its use, it may not be sufficient for this to occur. Up to a point we are the victims of our own myth making. We have already noted above that use does not inevitably lead to addiction. A policy of easier access to heroin for all adults not only those already habituated to its use raises the issue of the new patterns of use - the number of subsequent new users and the extent to which some of these people would become problem users, with regular and heavy habits. So long as the demand for heroin is not completely inelastic, relaxation of the prohibition will increase the numbers of users, although many might be expected to be moderate, infrequent users, such as Zinberg (1979) has reported finding.

In the absence of previous experience of the relaxation of a prohibition against opiates, we can turn to experiences with alcohol, and also look at the behavior of groups with easier access to opiates than most: physicians, Vietnam servicemen and villagers in societies where opium is grown or readily available.

Those who fear that easier access to opiates would result in a large, disruptive increase in the number of users are in general those who most strongly believe that prohibition and the criminal-justice system have been successful, despite the evidence of this paper. They point to the "gin epidemic" of eighteenth century England and the growth in the consumption of spirits in post-Revolutionary America, but these episodes may not be germane since, as Aaron and Musto (1981:137) argue

[a]s in England, when the gin epidemic spread during a period of social and economic transformation, the sharp rise in the amounts of alcohol consumed coupled with the deterioration of drinking behavior reflected the deepening cultural turmoil and impaired the capacity of institutions to relegitimate themselves.

The evolution of cultural norms (Axelrod 1986) will result in a stable regime emerging.

If it is accepted that some patterns of heroin use - of the occasional user - are benign, then the question must be to what extent easier access will result in significant increase in heavy use. There are two arguments to suggest that the number of heavy users will not grow greatly, at least not proportionately. Meyers (1980) argues that the distribution of drug-using behavior of most psychoactive substances (alcohol, for instance) is usually skewed toward light use, with few heavy users on the right-hand tail, and that recent studies (Robins 1979; Zinberg 1979) have suggested that this is also true for heroin. Then a relaxation of the prohibition would result in more users, but relatively few heavy users. Moreover, to the extent that heavy users' elasticity of demand is less than light users, the reduction in effective price of heroin from the relaxation will result in a lower proportional increase in heavy users than in light users.

Prohibition of alcohol production, transport, and sale in the United States led to falls in alcohol consumption as reflected in arrests for public drunkenness, incidence of alcoholic psychosis, acute alcohol over-dose deaths, and the rate of mortality due to liver cirrhosis (Aaron and Musto 1981). At the same time drinking customs persisted possession and consumption were not generally illegal - a crucial supply network quickly arose, and the law was increasingly held in contempt. Despite the fears of the U. S. prohibitionists, the repeal of the Volstead Act and the 18th Amendment did not result in wide-spread inebriation (Aaron and Musto 1981). Kaplan (1983:146) argues that had the prohibition against alcohol lasted seventy years - the length of the prohibition against heroin in the United States - then the level of inebriation may have been higher, and he points to the first effects of alcohol on societies previously innocent of the drug, such as the Eskimos of Alaska and the Indian tribes of the U. S. Northwest. It is not clear, however, that the analogy will hold. The "firewater" was but one introduction of a conquering culture to an ignorant people. Relaxation of the prohibition against heroin would occur with full knowledge of the drug's nature. Indeed, despite their unfamiliarity with alcohol when first introduced to it by the Europeans, Aborigines in the Northern Territory have a much higher rate of abstinence (60%) than do the population at large (12%), although the incidence of tobacco smoking is twice as high among Aborigines than among Australians at large (Watson and Fleming 1988).

Although the rate of opiate addiction is much higher (twenty times) among U. S. physicians than in the population as a whole (Kaplan 1983:113), it is not a problem, despite their greater easy access to pharmaceutical-quality morphine.

Rosenthal (1979:460) discusses research on U. S. servicemen in Vietnam which suggests that addiction, if acquired, need not persist, and that the route of drug administration is significant. Robins (1979) reports that up to 14% of servicemen became "actively addicted" - a high figure perhaps resulting from the high levels of boredom, alienation, and fear of the war zone. Of those actively addicted just before departure from Vietnam, 50% used no opiates after returning to the United States, and only 14% became readdicted. Most servicemen in Vietnam (where the heroin was good, plentiful and cheap) preferred smoking or sniffing the drug to injecting it. It was only when the Army's anti-heroin campaign raised prices from $2 or $3 to $12 per 250 mg. that injecting increased as users administered their supplies for the same cost-effectiveness (Marks 1974, fn.25). Moreover, Kaplan (1983:10) notes that "in Iran and Hong Kong, where heroin, though illegal, is far cheaper than in the United States, the drug is much more frequently inhaled." Those who had injected heroin in Vietnam were almost four times as likely to use it on their return to the States as those who had not injected, whereas 75% of those who had injected heroin before Vietnam continued to use it afterwards. Only 25% of those who had first injected in Vietnam continued to use the drug on their return. There are high rates of heroin use without addiction, and it is likely that most users do not become addicts (Rosenthal 1979:460).

To this author's knowledge, there are only three studies of the use of opiates in traditional societies: Akcasu (1976) found that although opiates are widely available in Turkey, Pakistan and India, they seem to be used by only a very small percentage of the population. McGlothlin et al. (1978) studied Pakistani opium users in the city of Rawalpindi and in a small village with an unusually high level of opium use - opium eating is legal in Pakistan but smoking it is forbidden. The city users were less addicted (only 59% were liable to suffer severe withdrawal symptoms) and they regarded their use as mainly therapeutic; only one (of 90) ate the opium. The village users were addicted (100%) and saw their usage primarily as social and recreational; of the twenty-eight subjects, twenty-four smoked, two ate, and two both smoked and ate. Despite the low cost of opium in Pakistan ($.20 per gram legally or $.10 per gram illegally), users were spending up to 15% of their income for eating opium, or 30% for smoking, but both groups were atypical. The authors estimated that no more than 0.5% of all city dwellers ate opium frequently, and that in the North West Frontier Province the proportion of opium smokers in the 1.2 million population was about 1 in 2,000 (McGlothlin et al. 1978) - forty times lower than the 2% of the Australian population estimated to have injected illicit drugs in the last twelve months (National Advisory Council on AIDS 1988). Similarly, Suwanwela et al. (1978) report a low proportion of opium smokers among the hill tribes in Thailand. Both surveys reveal a strong social stigma attached to opium use, and users' disapproval towards opium use by their children. Indeed, McGlothlin et al. (1978) remark that a significant number would likely apply for treatment to give up opium use were it available.

Nonetheless, it is undeniable that a policy of freely available heroin or methadone would lead to more widespread use, even if not addictive use, than would prescription heroin or methadone (Trebach 1982:277). The trade-off is the rise of the black or grey, market. There is no way around it. Libertarians would see no dilemma: Szasz (1972) argues that every adult should have the right to self-administer whatever substances he pleases, even if they lead to addiction, so long as he is subject to existing laws which preserve the rights of every person not to be hurt, physically or financially, by the actions of another. Szasz would argue for complete legalization of heroin, which, as we have argued above, would be unlikely to result in the disaster foreseen by some. A step in the right direction would be to allow any doctor to prescribe National Health Service heroin (or methadone) for any patient, whether dependent or not. Or might this not be another example of stage-four muddling through? Harking back to 1937 in the Northern Territory and foreshadowing Wardlaw (1982), Marks (1974) suggests an alternative in which the government would control the prices of over-the-counter heroin and methadone, making heroin sufficiently more expensive than methadone so that its "excessive" use was discouraged, but cheap enough to completely undermine the black market, with its attendant evils. In the light of our understanding of the trade-off, complete collapse of the black market would require virtually no restrictions on the sale of heroin, and a price very close to that of methadone. Thus, the proposal win reduce the subsidy to organized crime from all Australians, as reflected in our home insurance premiums, via the benighted heroin users.

Conclusion

In Australia in 1988 the prohibition against heroin use has failed, despite our society's best endeavors. There is no escaping the trade-off. any restrictions on the market for legal heroin will result in stimulation of the demand for illegal heroin on the black market. And this demand win be met, at a cost, not only to the user, but to society at large. In utilitarian terms the costs of the prohibition far outweigh the costs of a policy of free heroin. The time has come for a radical reassessment of the Australian drug laws by academics, by politicians, by the media, and by the public. Almost one Australian in ten already sees the wisdom of providing free heroin or methadone to registered addicts. The debate must continue.