Thinking Seriously About Alternatives to Drug Prohibition. Part 2

The Right of Access Model

We thus return to the question: How can the risks and harms of the free market model be reduced without undermining the many benefits that such a model offers? And how far can the free market model be stretched without giving up its essential feature? That essential feature, it must be stressed, is the legal availability of drugs in the absence of any requirement that the permission of a government- sanctioned gatekeeper be obtained beforehand. It is that feature that distinguishes the legal status of alcohol, tobacco, caffeine, and aspirin from that of marijuana, cocaine, morphine, and Valium--and that accounts for the generally greater and easier availability of the legal drugs compared to the illegal drugs. Legal drugs are almost always available over-the-counter; illegal drugs are not. Government-sanctioned medical authorities and pharmacists, and sometimes additional barriers as well, stand between the illegal drug and the person who wishes to obtain it.

It is important to recognize that legal availability does not always connote easy availability, and that the restricted legal status of a drug does not always make it that difficult to obtain. Legal drugs may, for instance, be so expensive--either because of high costs of production or high taxes--that they are for all intents and purposes unavailable to many potential consumers. Distribution channels may be relatively undeveloped or otherwise circumscribed. And efforts by government to restrict severely the availability of a legal drug without depriving consumers entirely of the right to purchase it legally may prove successful. Powerful evidence in support of these propositions can be found in the alcohol control efforts of the United States, Australia, and much of Europe during the 1920s and 1930s. Whereas the former initially favored Prohibition, the latter opted instead for tough, but nonprohibitionist, regulatory regimes. The results were more substantial, and more lasting, declines in alcohol consumption and alcohol-related ills in Europe and Australia than in the United States.(33)

Illegal drugs, by contrast, can occasionally prove to be highly available. Medical practitioners often write prescriptions for mild tranquilizers, sedatives, and other psychoactive drugs in response to their clients' plaints. They may do so because they believe that such drugs are a proper and effective way of medicating their clients, or because they believe that a client's satisfaction with a visit to her doctor depends in part upon the doctor's willingness to end the visit by writing a prescription. And even apart from such channels, illegal drugs can prove readily available wherever substantial markets generate high levels of supply--as was the case with marijuana in much of the country during the 1970s and 1980s. The same holds true of more localized markets, in particular the inner-city markets for cocaine since the mid-1980s as well as for other drugs that have attained high levels of popularity in particular neighborhoods or cities. In cases such as these, illegal drugs may prove more available than many legal drugs, such as alcohol, for which the hours of sale are often restricted by government. In many highly restricted environments, moreover, such as prisons, jails, and mental institutions, illegal drugs are often more available than alcohol because their smaller bulk makes them easier to smuggle past guards and other barriers.

The foregoing analysis suggests that it is possible to construct legal drug control regimes in which certain drugs may be less available than is the case under prohibition regimes. When we stretch as far as possible from the free market extreme of the drug policy continuum, but seek at the same time to retain the basic feature of nongatekeeper accessibility, the model that emerges is one that might be called the "right of access" or "mail-order" model. It is based on the notion that adults should be entitled not merely to the right to possess small amounts of any drug for personal consumption but also to the right to obtain any drug from a reliable, legally regulated source responsible (and liable) for the quality of its products. In identifying such a right, I must stress, I do not mean to suggest that it is on a par with the more privacy-based right of possession and/or consumption, but merely that it provides a useful parameter--both ethically and conceptually--for designing alternative drug control policies. Unlike the supermarket model, the right of access model is one that can be superimposed on the current drug prohibition system.

If such a right of access were legally acknowledged by Congress or the Supreme Court--a prospect, I recognize, with scant political or jurisprudential potential in the foreseeable future--those desirous of minimizing the potential threat to public health might well advocate the notion of a mail order system. In order to ensure a right of access to all residents of the United States no matter where they might live, at least one mail order source would have to be available in the United States from which any adult could order a modest amount of any drug at a reasonable price reflecting production costs and taxes. Most states, cities, and other communities might well continue to prohibit the sale and public consumption of most drugs within their jurisdictions as they do now, but would be obliged to acknowledge the basic right of access by mail order as well as the basic right of possession and consumption. Some localities might also adopt, if they had not already done so, the various sorts of harm reduction policies that are advisable under any regime. One might also imagine many other local variations by different states and municipalities to accommodate the particular health, criminal justice, and moral concerns of each. But the option of ordering one's drugs by mail would allow any adult to opt out, in effect, of the local control system insofar as private consumption was concerned.

The right of access notion offers us, I think, a more valuable, modest, and realistic alternative extreme than the supermarket model from which to stretch toward the optimal policy. As a model, it retains in skeletal form the essence of a legalization regime, which is the elimination of any sort of gatekeeper--policeman, doctor, pharmacist, etc.-- between the seller and consumer of drugs with the power to deny the latter access. It thus strikes at the heart of much of what is wrong with drug prohibition, in particular the creation of violent and powerful black market entrepreneurs, the harms that result from unregulated production of psychoactive drugs, and the many infringements on individual freedoms. But it also provides a skeletal framework that can be filled out with many of the sorts of antidrug abuse measures that we associate with both harm reduction approaches to illicit drug control policy and public health approaches to alcohol and tobacco control. It has the advantage of resembling actual models in other domains of public policy both today and in recent history, including the alcohol distribution system in Canada and Sweden during the early decades of this century as well in pre- and post- Prohibition United States, and the modification of FDA policy in recent years to allow individuals to import by mail small amounts of drugs that are legally available outside the United States but that have yet to be approved by the FDA for the treatment of AIDS or cancer.(34) Given the preference among critics of drug prohibition for a fairly high degree of "local option," it addresses the inevitable tensions among different state and local drug control policies, between those policies and federal policies, and even (albeit to a lesser extent) between domestic policies and international requirements. At the same time, it offers a paradigm for addressing and reconciling the tensions between individual rights and communitarian interests that lie at the heart of so many struggles over public policy in democratic societies.

This model is not, I must stress, a panacea, nor should it be misconstrued as a final proposal for an alternative drug control regime. It raises numerous questions such as how such a mail-order system would be established and maintained, who would run it and profit from it, who would oversee it, who would have access to its mailing lists and other information about consumers, how consumer privacy would be protected, how minors would be prevented from taking advantage of it, how new drugs would be made available, and so on. Most of these questions strike me as susceptible to fairly precise answers, in good part because there are so many close analogies to a mail-order system. More difficult to assess are the same sorts of questions raised by the supermarket model and all other alternative models, in particular those that focus on assessing changes in psychoactive drug consumption--although I assume that they are easier to answer with respect to a mail-order model since such a system is more readily integrated with the current prohibition model than is the case with the supermarket model.

One prominent difference between the right of access or mail-order model and the supermarket model is that the former fails to eliminate the black market. Just as some gun control laws rely on waiting periods between the time a person orders a firearm and the time he obtains possession, so a mail-order system imposes a sort of waiting period--presumably a minimum of one day. It is highly reasonable to assume that black markets would persist not only to supply minors--which is presently the case with most psychoactive substances, including alcohol and tobacco--but also to supply those who will not or cannot wait to obtain their drugs from the mail- order system, as well as those who want to obtain more at any one time than is allowed by law.

We typically assume that an important objective of legalizing drugs is to undercut the black markets and place them in the hands of either government or government-licensed and regulated distributors. This objective is tempered by the recognition that there are better and worse features of illicit markets, and that a preferable drug policy ideally would focus on eliminating the worst while tolerating the better features. It would, for instance, attempt to undermine the accumulation of power by organized criminals, reduce the violence that attends such markets and generally push large- scale production into the hands of regulated, tax paying, and collecting producers and distributors. But at the same time, it might well choose to ignore smaller scale illicit markets- -what are often referred to less disparagingly as informal or unregulated markets--which are of value not just because they often prove more innovative and enterprising in designing and offering new products but also because they provide an important source of income for many people who face substantial disadvantages in their efforts to penetrate and succeed in the more established legitimate markets. This holds true, for instance, of both rural producers of marijuana and inner-city entrepreneurs engaged in the low- level distribution of crack and other drugs. Two probable advantages of the right of access model are that it would effectively undercut efforts by organized criminals to create highly profitable national distribution systems, since any adult could purchase the drugs by mail. At the same time, it would not eliminate many illicit small scale, localized production and distribution systems that meet local demands for immediate availability, rapid delivery, and specialized products. Local authorities could choose, in effect, either to suppress such black markets vigorously or to manage them through conventional vice control methods. But the scale of such markets would probably bear a closer resemblance to illicit prostitution rings in cities that sanction regulated prostitution than to contemporary illicit drug markets.

Transition Issues

Few drug control regimes are static. Prohibitions, regulations, and decriminalizations tend to evolve as new drugs emerge, as drug use patterns shift, as other drug- related norms change, and as popular and elite perceptions of various drugs, drug consumers and drug problems shift. In contemplating alternatives to the current drug prohibition regime, we need to distinguish between transition phases, longer term consequences and equilibria, keeping in mind that there is no drug control regime that will suffice forever. The distinction is important with respect to issues of both drug consumption and black markets. It is safe to assume that illicit markets do not just shrivel up and die when confronted with competition from licit markets. Rather, illicit entrepreneurs may continue to compete with licit markets during the initial phase when licit producers and distributors are still gearing up, having the advantage of their previous investments in production and/or distribution as well as their expertise. The share of the market that is captured by legal producers and distributors in the long- term, however, probably would depend more on price, availability, competition, the intensity of continued law enforcement efforts to suppress the remaining black market, and changing tastes and fads among consumers. There are also important policy questions regarding the extent to which those involved in the illicit markets during prohibition should be allowed or encouraged to play a role in legal markets after prohibition.

Close examination of the aftermath of Prohibition in the United States, other post-prohibition periods elsewhere, and other decriminalizations, such as of gambling, prostitution, pornography as well as of nonvice markets in countries experiencing significant deregulations (such as the former Soviet bloc countries) can provide important insights into how drug markets are likely to evolve.(35) The impact of decriminalization on those involved in illicit drug dealing, as well as on those who would have become involved in drug dealing but for decriminalization, is especially important when we focus on African-American and Latino youth in the urban ghettos. Clearly the dramatic drop in the price of currently illicit drugs following decriminalization would greatly reduce one of the most powerful incentives for engaging in drug dealing and other criminal activities. According to a recent report by the Justice Department's Bureau of Justice Statistics, 13 percent of all convinced jail inmates, and 19 percent of those convicted of drug trafficking offenses, said they had committed their offense to obtain money to buy illicit drugs.(36) Dramatic reductions in the size and profitability of the illicit markets would also remove the powerful financial and social incentives that have lured so many urban youth into drug dealing activities even before they began to consume illicit drugs. Further insights into this question can be derived both from analyzing the response of bootleggers to the repeal of Prohibition and from observing how illicit drug dealers adapt when illicit drug markets decline, as seems to be the case today.(37) Illicit vice entrepreneurs seem to respond to decriminalizations and shrinkages in illicit markets in any of four ways. Some succeed in making the transition to legal entrepreneurship in the same line of work. Some seek to remain in the business illegally, whether by supplying products and services in competition with the legal market or by employing criminal means to take advantage of the legal markets. For instance, following Prohibition, some bootleggers continued to market their products by forging liquor tax stamps, by strong-arming bartenders into continuing to carry their moonshine and illegally imported liquors, and by muscling their way into the distribution of legal alcohol. Some also fought to retain their markets among those who had developed a taste for corn whiskey before and during Prohibition. The third response of bootleggers and drug dealers is to abandon their pursuits and branch out instead into other criminal activities involving both vice opportunities and other sorts of crime. Indeed, one potential negative consequence of decriminalization is that many committed criminals would adapt to the loss of drug dealing revenues by switching their energies to crimes of theft, thereby negating to some extent the reductions in such crimes that would result from drug addicts no longer needing to raise substantial amounts of money to pay the inflated prices of illicit drugs. The fourth response--one that has been and would be attractive to many past, current, and potential drug dealers--is to forego criminal activities altogether. Relatively few criminal pursuits can compare in terms of paying so well, requiring so few skills, remaining fairly accessible to newcomers, and presenting attractive capitalist opportunities to poorly educated and integrated inner-city youth. During Prohibition, tens if not hundreds of thousands of Americans with no particular interest in leading lives of crime were drawn into the business of illegally producing and distributing alcohol; following its repeal, many if not most of them abandoned their criminal pursuits altogether. There is every reason to believe that drug decriminalization would have the same impact on many involved in the drug dealing business who would not have been tempted into criminal pursuits but for the peculiar attractions of that business. The challenge for researchers, of course, is to estimate the relative proportions of current and potential drug dealers who would respond in any of these four ways. The even broader challenge is to determine the sorts of public policies that would maximize the proportion that forego criminal activities altogether.

The need to distinguish between transition phases and longer term consequences and equilibria also applies to the impact of decriminalization on potential and current illicit drug users. The initial liberalization of availability is likely to spark high levels of curiosity, stimulated both by the media and by the mere fact of legal access, and substantial experimentation with different drugs--but it is reasonable to assume that this would moderate over the long- term. At the same time, the initial reluctance of many Americans to try newly available drugs to which they are unaccustomed may fade over time. Those who have grown up under a prohibition system, moreover, and have thus been influenced to one degree or another by the many assumptions that prohibition conveys about drug use, are likely to experience a legal regime differently than succeeding generations for whom it will represent the norm.

Gatekeepers, Norms, and Information Systems

There is also the question of how a liberalization of legal availability will affect both the doctor-patient relationship and the role of pharmacists. It would be useful to know, for example, what proportion of visits to doctors are motivated principally by the desire or need to obtain a prescription for a controlled substance. Between one-half and two-thirds of all consultations with doctors result in the writing of a prescription.(38) A legal drug regime would negate the need for visits motivated solely by the need to obtain a prescription, with mixed results. Some people would suffer as a result of not being obliged to consult with a doctor, but many others who now must waste time and money on unnecessary doctor visits would surely benefit. The problem of undermedication, and particularly under-treatment of pain, would almost surely be less of a problem than it is now. But some people would surely be more likely to use inappropriate drugs and to develop unhealthy dependencies on drugs that are now available only by nonrenewable prescription. Better insights into these issues can be gained by analyzing the available evidence about why people go to doctors as well as patterns of self-medication and doctor visitation in other times and places in which there have been fewer controls on the availability of drugs.(39)

The role of doctors and pharmacists as gatekeepers for prescription drugs is of course part and parcel of a broader question about the basic need for creating and maintaining a distinction between over-the-counter and prescription drugs. This question has been addressed most sharply by economists, although the literature on the broader implications of the distinction remains quite limited.(40) The notion of requiring prescriptions for drugs other than cocaine and opiates is, as Peter Temin wrote in his historical study of drug regulation in the United States, a relatively recent notion--one that was not consonant with the 1938 Federal Food, Drug, and Cosmetic Act but that emerged in spite of a legislative intent to the contrary.(41) Implicit in the notion was the belief that many Americans would not act rationally in their choice and use of drugs and thus needed to be shielded from their own irresponsibility by governmental controls. One result was a significant constriction in the provision of information about drugs to consumers. The supposition that a mandatory drug prescription system plays an essential role in protecting the health of consumers has yet to be systematically tested. One study that employed a cross-national comparative perspective concluded that the prescription requirement did not yield a net benefit in health effects.(42) Another, by Peter Temin, suggested certain criteria that could be used to determine when a drug should be restricted or made available over-the-counter.(43) These studies provide valuable insights, but they represent only a small step in the direction of determining the likely consequences of severely restricting or eliminating the mandatory prescription system.

I should stress that these issues are at least as important with respect to the urban ghettos as they are in thinking about middle class drug usage. Much illicit drug abuse in urban ghettos can fairly be described as a form of self-medication for depression and other psychological pain among people who tend not to seek out psychiatrists and other doctors for such ills. The drugs they use to hide and forget their pains--alcohol, illegal heroin and cocaine, and other "street" drugs--are often more dangerous but no more effective than those prescribed to middle class patients by their doctors. At the same time, urban ghettos are full of poor people who might well benefit from access to the same sorts of antidepressants and other drugs that middle class Americans obtain from their doctors but who fail to obtain them both because they eschew the illicit markets and because financial and cultural limitations preclude visits to doctors. Here it is worth pointing out the patent absurdity of the claim that drug legalization would devastate inner- city populations. Both legal and illegal drugs are already so widely available in inner cities that virtually any resident can obtain them far more quickly than in suburban neighborhoods. But a liberalization of drug availability would make more easily available drugs that are safer than those now sold in urban liquor stores, crack houses, and street markets. At the same time, it would substantially reduce the negative consequences of prohibition--all of which are felt most severely in the urban ghettos. More broadly, there is good reason to think that a regime of legal availability would substantially, even radically, transform the ways in which Americans relate to psychoactive drugs. One might well imagine that pharmacological experts, certified perhaps by either government or professional agencies, would play an increasingly important role not so much as gatekeepers but as educators and consultants on the preferred uses of drugs for medicinal, psychotherapeutic, recreational, and other purposes. But even more importantly, nonlegal norms would undoubtedly emerge in the absence of current prohibitionist norms to shape the way people relate to drugs, the ways in which they use them, and the cautions they exercise. Here again, there is the question of determining which people are likely to prefer the least potent and least risky drugs and which are more likely to opt for the most potent, quickest acting, and so on. There is also the possibility that a world of widespread drug availability might be more likely to generate self-protective norms against all forms of drug taking. And it is fair to assume that far more people would assume greater responsibility for their relationship to drugs than is currently the case, since the gatekeeper role of doctors effectively transforms consumers into far more passive actors.

This in turn leads to the question of how information about psychoactive drugs could be better distributed to a population so that it is readily available and intelligible to typical consumers. The challenges here are fourfold. The first is to design an effective means of distinguishing among categories of drugs so that those who purchase either by mail or at retail outlets are properly informed of the risks and appropriate uses. This task could be performed by either a Food and Drug Administration (FDA) or a nongovernmental agency such as Consumer Reports, or both. The second is to design an information system separate from the distribution systems whereby consumers can obtain necessary information on their own at little or no cost. This might involve information distribution systems accessible by telephone or other easily accessed computer hookups. Current efforts by the FDA, and by consumer organizations such as those promoted by Ralph Nader, to ensure that consumers are provided with both more accurate and more accessible information may well provide something of a model in thinking about issues such as these. The third challenge is to create honest drug education programs that tell children the truth about drugs without stimulating premature desires to try them.(44) And the fourth is to design public health campaigns that effectively discourage drug misuse without resorting to lies, scare tactics, and the demonization of people who use drugs. The public service advertisements directed at discouraging tobacco consumption and drunken driving provide far better models in this respect than the "Fried Egg" ads, caricatures, and untruths promoted by the Partnership for a Drug-Free America.(45)

Most of what people know about drugs they have never used comes from the commercial media. It has repeatedly played a central role in transforming local fads and fashions into national and even international phenomena.(46) We can safely assume that it will play a crucial role in the distribution of information and the shaping of public perceptions about drugs, particularly those that are relatively unfamiliar to most Americans. One need only imagine what impact the news magazines' cover stories in late 1989 and early 1990 on the new antidepressant, Prozac, would have had if Prozac were available over-the-counter or by mail; indeed, it would be interesting to know what impact those stories actually did have on potential consumers.(47) How many people, for instance, visited doctors thereafter with the intention of obtaining prescriptions for Prozac, how many succeeded, and--even more difficult to say--how many benefited or suffered as a consequence? Conversely, how many people who might benefit from Prozac have not yet tried it solely because they are unaccustomed to visiting a doctor to obtain assistance in alleviating depression? Certainly there is good reason to fear the media's impact on drug consumption preferences under a legal regime given its historic and persistent incapacity to provide accurate and balanced information about psychoactive drugs.(48) On the other hand, the media occasionally has demonstrated its capacity to shape preferences in healthier and otherwise better directions. It is certainly a loose cannon insofar as our efforts to evaluate the future direction of drug use are concerned. But there is good reason to devote at least some effort to considering how the media has shaped drug consumption patterns in the past.

The issue of advertising is a difficult one. In 1986, the Supreme Court ruled in Posadas de Puerto Rico Associates vs. Tourism Company of Puerto Rico that strict restrictions on advertising casino gambling were constitutionally permissible.(49) There seems to be little question that comparable restrictions on advertising psychoactive drugs would also be regarded as legal.(50) The difficult issues thus involve balancing the costs and benefits of both specific types of advertising as well as the advertising of psychoactive products generally. There is good reason to fear, and to curtail, the mass promotion of psychoactive drugs that present the sorts of harm associated with alcohol and cigarettes.(51) There are also substantial incentives to avoid a revival of medical quackery and the mass marketing of patent medicines that once tricked millions of Americans into buying products that did them little good and occasionally much harm. On the other hand, advertising can play a valuable role in informing people of new and beneficial products, in luring consumers to switch from more dangerous to less dangerous drugs, and in promoting competition that saves consumers money.(52) This is true of both psychoactive and nonpsychoactive drugs as well as those used for both recreational and more traditional therapeutic purposes. The solution to the advertising dilemma--to the extent we are willing to put aside First Amendment concerns--may well lie in a combination of restrictions on the promotion of more harmful products with vigorous educational campaigns to discourage their consumption.

Conclusion

Predicting human behavior remains, and shall always remain, an imprecise art. Social science can provide modest insights into the consequences of incremental changes in regulatory structures on human behavior. But when we try to envision the consequences of more far reaching changes in such structures, our confidence in social science insights falters. The variables are too numerous, the changes in individual and societal consciousness too unpredictable, and the tools too paltry to pretend that we can really know the future. Here history offers a more powerful guide--with its potential to shed light on both the accretion of incremental changes and the suddenness of revolutionary change. But even its lessons are limited by unanswerable questions regarding the potential of the future to evolve in unprecedented ways. Ultimately our predictions are bounded by theories of human behavior, and particularly of human and societal vulnerability and resilience, that have more to do with our visceral fears and confidences than any objective readings of the evidence.

When we switch from predicting the future to trying to plan it, our preferences are determined not only by our calculations of their consequences but also by our choices among competing ethical values. Such choices may be made implicitly, as when we accept without question conventional ethical values, or explicitly. They establish the parameters beyond which policy options will not be considered. They influence our calculations of the costs and benefits of various options. And they guide us in deciding who should benefit and who may be harmed by choosing one option over another. There are no objective standards by which to choose among ethical values. One can only appeal to conscience, principle, and empathy.

The challenges of evaluating radical alternatives to our current drug prohibition system are formidable. But so are the challenges of predicting the consequences of persisting with our current policies. In 1960, few Americans had ever heard of LSD, and the notion that sixty million Americans would smoke marijuana during the next three decades would have seemed bizarre to most Americans. In 1970, few Americans gave much thought to cocaine, and most would not have believed that twenty-five million Americans would try it during the next two decades. By the late 1970s, many Americans believed that marijuana would be sold legally within a few years. In 1980, no one had ever heard of "crack" cocaine; the notion of an AIDS epidemic among injecting drug users seemed inconceivable; and the prospect of a quarter- million Americans in jail or prison by 1990 for violating drug prohibition laws seemed preposterous. Clearly, retention of our drug prohibition system provides no guarantees about future patterns of drug use or the scale of future drug problems. Legalization may present a wider array of possibilities, but its uncertainties are not dramatically greater than those of persisting with prohibition.

There are powerful reasons for taking seriously the alternatives to drug prohibition. The first is simply that drug prohibition has proven relatively ineffective, increasingly costly, and highly counterproductive in all sorts of ways that many Americans are only beginning to appreciate. Nowhere is this more true than in the urban ghettos, where the war on drugs has failed to reduce the availability of illicit drugs or the incidence of drug abuse and offers no prospect of doing so in the future. At the same time, these neighborhoods and their residents have suffered the negative consequences of drug prohibition more severely than any others. Not unlike Chicago under Al Capone, they must live with the violence and corruption generated by prohibition, the diversion of law enforcement resources, the distortion of economic and social incentives for their youth, the overdoses that result from unregulated drugs, the AIDS that spreads more rapidly because clean syringes are not legally or readily available, and the incarceration of unprecedented numbers of young men and women. Those who contend that legalization would mean writing off impoverished inner-city neighborhoods ignore the remarkable extent to which drug prohibition has both failed and devastated the urban ghettos. Drug legalization offers no panacea, particularly if it is not accompanied by more fundamental changes in the norms and leadership of urban societies. But there is no question that it can alleviate many urban ills at relatively little risk.

Second, there are good reasons to believe that a nonprohibitionist regime would not result in dramatic increases in drug abuse. Public opinion polls reveal that few Americans believe they would use drugs that are now illicit if they were legally available. Important implications, moreover, can be derived from the observation that we already live in a society in which all sorts of psychoactive substances are cheaply and readily available to both adults and children. Legalizaton would make more drugs more available than they are today, but it would not present a situation dramatically different from that which currently exists. The same sorts of norms and interests that prevent most Americans from misusing drugs today would persist. And even many of those who do misuse illicit drugs would be no worse off, and in many ways better off, under an alternative regime. Some Americans would suffer from the abolition of drug prohibition, but all the evidence suggests that their numbers would be modest. We possess, in short, substantial evidence of a fundamental societal resilience in the face of widespread drug availability.

Third, there are also good reasons to anticipate positive shifts in drug consumption patterns if we move in the direction of nonprohibitionist controls. The current drug control regime favors certain legal and illegal drugs over others that may well present fewer dangers to both consumers and society generally. Under a legalization regime, alcohol and tobacco would no longer be artificially favored by their legal status. Crack cocaine would no longer benefit from the perverse dynamics of the illicit market. And traffickers and consumers would no longer be obliged to favor more compact and potent drugs over bulkier but more benign substances simply because the former were less detectable. Both illicit drug abusers and responsible consumers, particularly among the poor, would have better access to drugs that are safer than those that are most available now. Drug legalization might thus result in more consumption of a wider array of substances than is currently the case but with dramatically fewer negative consequences.

Fourth, those who take seriously such values as tolerance, privacy, individual freedom, and individual responsibility have little choice but to seek out alternatives to the current system. These values are fundamentally at odds with a prohibition regime that criminalizes the possession of small amounts of any drug for personal consumption. They are seriously threatened, moreover, by a war on drugs that promotes notions of zero tolerance toward drug users, that pursues its objective of a drug-free society with few restraints, that encourages neighbors and family members to inform on one another, and that incarcerates hundreds of thousands of Americans for engaging in vice activities that were entirely legal less than a century ago.

In proposing a mail-order distribution system based on a right of access, I have tried to offer a model that strikes at the heart of what is most problematic about drug prohibition. I realize that such a model is easily mocked by those with little interest in thinking seriously about alternatives to drug prohibition. My intended audience are the progressive prohibitionists and legalizers of all stripes interested in developing the discourse about alternatives to drug prohibition. I believe the model offers an effective means of eliminating or reducing the worst consequences of drug prohibition. It represents the best compromise I can envision between individual rights and communitarian interests. It provides for both a skeletal framework at the federal level and substantial flexibility for local option at the state and local level. It allows for substantial latitude in implementing public health measures and campaigns designed to reduce drug abuse. And it offers a system that can be fairly easily superimposed on the current prohibition system. The model does not, to be sure, represent a panacea. It raises as many questions as it answers. Like any other model, it has its vulnerabilities and it is susceptible to abuse by those determined to take advantage of it. Its potential effectiveness depends, moreover, on the extent to which it is filled out with sensible and humane drug control policies at state and local levels of government. But it does compare favorably, I believe, with both the American prohibition system and the supermarket model preferred by extreme libertarians. It presents greater risks than the conventional, prohibition-bound harm reduction model one finds in parts of Europe and Australia, but it also offers far more potential to transform drug consumption patterns in both the urban ghettos and the population at large in safer directions.

Intellectual ruminations about supermarket models, mail- order distribution systems, and a right of access to psychoactive drugs seem far removed from current political debates over drug control policy in the United States. There are, nonetheless, good reasons to develop the intellectual capital associated with the analysis of alternative drug control regimes. First, scholars are obliged to pursue their intellectual inquiries unencumbered by the blinders imposed by current prejudices and political realities. To limit the questions that one asks and the answers that one ventures to those sanctioned by officialdom is to forsake our moral and intellectual obligations to both our profession and our society. Future generations are ill served if today's scholars uniformly submit to the intellectual conservatism that so dominates social science and public policy analysis. Second, many of the assumptions that underlie both the current war on drugs and the prohibition system itself have not been systematically examined for a long time. Even those who desire no substantial revisions in drug control policies can benefit from such an appraisal. Third, no one knows what the future will bring. New drugs and new ways of altering one's state of consciousness will surely emerge. The challenges of regulating psychoactive drugs are certain to increase. And the pharmacological Calvinism that dominates contemporary American public opinion and policy analysis can only persist for so long.

Cost-benefit analysis can, and should, play an important role in the debate over the future of drug control policy, if only because it provides us with the closest thing to an objective framework of analysis for clarifying our objectives and assessing our options. Ultimately, however, the debate over drug policy is really a debate over competing moral visions of society. I see no merit, and much evil, in calls for zero tolerance and a drug-free society. I also see nothing immoral, I must admit, about the consumption of psycho-active drugs by those who do no harm to others and who fulfill the obligations they have assumed to others. The challenge, from my perspective, is one of designing and promoting a drug control policy that combines a healthy respect for individual freedom and responsibility with a strong sense of compassion. These values do not trump all others all of the time. But it is important that they be not forgotten or pushed to the side whenever the fearful specter of DRUGS is uttered.

Acknowledgments

I am grateful to the members of the Princeton Working Group on the Future of Drug Use and Alternatives to Drug Prohibition for their participation in the project, and to the Smart Family Foundation for its financial support of the working group. I am also indebted to the Ford Foundation and the Robert C. Linnell Foundation for their research support. I am grateful for comments on previous drafts of this paper from Michael Aldrich, Virginia Berndge, John Dilulio, Ernest Drucker, David Hawks, Sylvia Law, Stanton Peele, Craig Reinarman, Sasha Shulgin, Kenneth Wamer, and Alex Wodak.

Endnots

(1) The relationship between the current debate over drug legalization and prior debates is analyzed in Ronald Bayer, "Introduction: The Great Policy Debate-- What Means This Thing Called Decriminalization?," Milbank Quarterly 69 (3) (1991): 341-63.

(2) See the following articles by Ethan A. Nadelmann, "Drug Prohibition in the United States: Costs, Consequences and Alternatives," Science 245 (1 September 1989): 939-47; "U. S. Drug Policy: A Bad Export," Foreign Policy 70 (Spring 1988): 1-39; and "The Case for Legalization," The Public Interest 92 (Summer 1988): 3-31. Also see James Ostrowski, "The Moral and Practical Case for Drug kgalization," Hofstra Law Review 18 (3) (Spring 1990): 607-702; Richard Lawrence Miller, The Case for Legalizing Drugs (New York: Praeger, 1991); Amold S. Trebach, The Great Drug War (New York: Macmillan, 1987); Steven Wisotsky, Breaking the Impasse in the War on Drugs (Westport, Conn.: Greenwood Press,1986); and the collections of articles in Melvyn B. Krauss and Edward P. Lazear, eds., Searching for Alternatives: ,Drug-Control Policy in the United States (Stanford, Calif.: Hoover Institution Press, 1991); in David Boaz, ed., The Crisis in Drug Prohibition (Washington, D.C.: CATO Institute, 1990); in Ronald Hamowy, ed., Dealing with Drugs: Consequences of Government Control (kxington, Mass.: Lexington Books, 1987); in Amold S. Trebach and Kevin B. Zeese, eds., the three-volume Drug Prohibition and the Conscience of Nations (Washington, D.C.: Drug Policy Foundation,1990), The Great Issues of Drug Policy (1990), and New Frontiers in Drug Policy (1991); and in Bruce K. Alexander, Peaceful Measures: Canada's Way Out of the ' War on Drugs' (University of Toronto Press, 1990).

(3) Recent effort to analyze nonprohibitionist drug policy options include Doug Bandow, "Dealing with Legalization," The American Prospect 8 (Winter 1992): 82-91; and Chester Nelson Mitchdl, The Drug Solution (Ottawa: Carleton University Press, 1990). A proposed research agenda can be found in Ethan Nadelmann, "Beyond Drug Prohibition: Evaluating the Alternatives," in Krauss and Lazear, eds., 241-50.

(4) See Franklin E. Zimring and Gordon Hawkins, The Search for Rational Drug Control (New York: Cambridge University Press,1992),82-110; and Mark A. R. Kleiman and Aaron J. Saiger, "Drug Legalization: The Importance of Asking the Right Question," Hofstra Law Review 18 (3) (Spring 1990): 527-66.

(5) See, generally, Pat O'Hare, Russell Newcombe, Alan Matthews, Ernst C. Buning, and Emest Drucker, eds., The Reduction of Drug Related Harm (London: Routledge, 1991); Peter McDermott and Pat O'Hare, eds., Reducing Drug- Related Harm: New Developments in Theory and Practice (London: Whurr Publishers, 1992); and Nick Heather, Alex Wodak, Ethan Nadelmann, and Pat O'Hare, eds., Psychoactive Drugs and Harm Reduction: From Faith to Science (London: Whurr Publishers, 1993). Also see John Strang and Gerry V. Stimson, eds., AIDS and Drug Misuse: The Challenge for Policy and Practice in the 1 990s (New York: Routledge, 1990).

(6) See Govert Frank van de Wijngaart, "A Social History of Drug Use in the Netherlands: Policy Outcomes and Implications," Journal of Drug Issues 18 (1988): 481-95.

(7) See the first National Drug Control Strategy issued by the Office of National Drug Control Policy, Executive Office of the President, in September 1989 (Washing-ton, D.C.: US Government Pnnting Office, 1989), 11.

(8) See Zimring and Hawkins, The Search for Rational Drug Control, 4-21, for a fine analysis of the report and its ideological assumptions.

(9) See Gerald L. Klerrnan, "Psychotropic Hedonism vs. Pharmacological Calvinism," Hastings Center Report 2 (4) (September 1972): 1-3.

(10) See Thomas Szasz, Our Right to Drugs: The Case for a Free Market (Greenwood Press, 1992); David Boaz, "The Consequences of Prohibition," in Boaz, ed., The Crisis in Drug Prohibition; and the speech delivered by Milton Friedman to the Fifth International Conference on Drug Policy Reform, Washington, D.C., 16 November 1991.

(11) See David A. J. Richards, Sex, Drugs, Death, and the Law: An Essay on Hutnan Rights and Overcriminalization (Totowa, N.J.: Rowman and Littlefield, 1982), 157-214.

(12) See, generally, the collection of articles in Thomas H. Murray, Willard Gaylin, and Ruth Macklin, eds., Feeling Good and Doing Better: Ethics and Nontherapeutic Drug Use (Clifton, N.J.: Humana Press, 1984), in particular the concluding article by Ruth Macklin, "Drugs, Models, and Moral Prinaples," 187-213. Also see James B. Bakalar and Lester Grinspoon, Drug Control in a Free Society (New York: Cambridge University Press,1984), and Douglas Husak, Drugs and Rights (New York: Cambridge University Press, 1992).

(13) As John Kaplan wrote in 1988, "It is true that if the number of those dependent upon cocaine merely doubled, we would arguably be well ahead of the game, considering the large costs imposed by treating those users as criminals. But what if there were a fiftyfold increase in the number of those dependent on cocaine? We simply cannot guarantee that such a situation would not come to pass; since we cannot do so, it is the height of irresponsibility to advocate risking the future of the nation." See John Kaplan, "Taking Drugs Senously," The Public Interest 92 (Summer 1988): 32-50. Avram Goldstein and Harold Kalant assert more confidently: "There is no reason to doubt that the increased costs to society [of drug legalization] would rival those now attributable to alcohol." See Avram Goldstein and Harold Kalant, "Drug Policy: Stnking the Right Balance," Science 249 (28 September 1990): 1513-21.

(14) See Andrew Weil, The Natural Mind: An Investigation of Drugs and the Higher Consciousness (Boston: Houghton Mifflin, 1972, revised edition 1986), 29. Weil credits Timothy Leary and Richard Alpert with first recognizing the importance of these two variables. The significance of "set and setting" is examined at length in Norman E. Zinberg, Drug, Set, and Setting: the Basis for Controlled Intoxicant Use (New Haven, Conn.: Yale University Press, 1984).

(15) See, for instance, Lawrence O. Gostin, "Compulsory Treatment for Drug-Depen-dent Persons: Justifications for a Public Health Approach to Drug Dependency," Milbank Quarterly 69 (4) (1991): 561-93.

(16) See Nathan S. Kline, "The Future of Drugs and Drugs of the Future," Journal of Social Issues 27 (3) (1971): 73-87; Wayne O. Evans and Nathan S. Kline, eds., Psychotropic Drugs in the Year 2000 (Springfield, lil.: Charles C. Thomas,1971); Alexander Shulgin and Ann Shulgin, PIHKAL: A Chemical Love Story (Berkeley, Calif.: Transform Press, 1991); Ronald K. Siegel, Intoxication: Life in Pursuit of Artificial Paradise (New York: E. P. Dutton, 1989), 298-317; and Henry B. Clark, Altering Behavior: The Ethics of Controlled Experience (Newbury Park, Calif.: SAGE Publications, l 987). A particularly bleak and pessimistic perspective is provided in Morton A. Kaplan, "2042: A Choice of Futures-- A Nightmare," The World & I(January 1992): 108-115.

(17) Note that the "needle park" experiment in Zurich, Switzerland, from 1990 to 1992 shared little in common with the sort of "supermarket" model developed here. Production and distribution of drugs remained illegal, the place of sale was strictly limited to one small park, and the entire scheme was developed within a fairly strict prohibitionist context. Much the same is true of the "open air" illicit drug markets in many urban ghettos. See Arnold S. Trebach, "Lessons from Needle Park," The Washington Post, 17 March 1992.

(18) See David T. Courtwright, Dark Paradise: Opiate Addiction in America before 1940 (Cambridge, Mass.: Harvard University Press, 1982); and see Ethan A. Nadelmann, "Historical Perspectives on Drug Prohibition and its Alternatives," American Heritage (forthcoming).

(19) See, for instance, Michael R. Aldrich, "Legalize the Lesser to Minimize the Greater: Modern Applications of Ancient Wisdom," Journal of Drug Issues 20 (1990): S43-53.

(20) Controlled consumption of heroin is examined in Zinberg, Drug, Set and Setting. Controlled consumption of cocaine is examined in Dan Waldorf, Craig Reinar-man, and Sheila Murphy, Cocaine Changes: the Experience of Using and Quitting (Philadelphia: Temple University Press, 1991), and in Peter Cohen, Cocaine Use in Amsterdam in Non Deviant Subsultures (Amsterdam: Instituut voor Sociale Geografie, Universiteit van Amsterdam, 1989).

(21) See Stanton Peele, Diseasing of America: Addiction Treatment Out of Control (Lexington, Mass.: Lexington Books,1989), who further observes that most drug abusers eventually quit or curtail their destructive behavior without resort to conventional treatment programs. Also see Charles E. Faupel, Shooting Dope: Career Patterns of Hard-Core Heroin Users (Gainesville: University of Florida Press, 1991).

(22) US Department of Justice, Bureau of Justice Statistics, Sourcebook of Criminal Justice Statistics--1990 (Washington, D.C.: US Govemment Printing Office, 1991), 347; and US National Institute on Drug Abuse, National Household Survey on Drug Abuse: Highlights 1988 (Washington, D.C.: Department of Health and Human Services, Alcohol, Drug Abuse and Mental Health Adminis-tration, 1990), 8.

(23) The Gallup Poll Monthly, Nos. 288 and 303, reprinted in Sourcebook of Criminal Justice Statistics--1990, 347.

(24) Ibid.

(25) National Household Survey on Drug Abuse: Highlights 1988, 44.

(26) Ibid., 8, 45-50

(27) Ibid., 17-22.

(28) In a nationwide poll commissioned by Richard Dennis and the Drug Policy Foundation, 4 percent of the 1401 respondents said that they would be "very likely" to try marijuana if it were legal, 6 percent said they would be "somewhat likely," 8 percent said "not very likely," and 81 percent said "not at all likely." Asked the same question about the legalization of cocaine, 2 percent said they would be "very likely" or "somewhat likely," 4 percent said "not very likely," and 93 percent said "not at all likely." Similarly, in the annual survey of American high school students conducted by the Monitoring the Future Project at the University of Michigan, 73 percent of respondents said they would not use marijuana even if it were legal, 11 percent said they would use it about as often as they do now, or less, 7 percent said they might try it, and only 3 percent said they would use it more often than at present. See Lloyd D. Johnston, Patnck O'Malley, and Jerald G. Bachman, Drug Use Among American High School Seniors, College Students and Young Adults, 1975-1990 (Rockville, Md.: National Institute on Drug Abuse, 1991), 141-42.

(29) See Richard H. Blum & Associates, Society and Drugs (San Francisco: Jossey-Bass, 1969), 25-44.

(30) See National Research Council, National Academy of Sciences, Evaluating AIDS Prevention Programs (Washington, D.C.: National Academy Press, 1988); and the report by the National Commission on AIDS, The Twin Epidemics of Substance Abuse and HIV (Washington, D.C., 1991).

(31) See Thomas Szasz, Ceremonial Chemistry: The Ritual Persecution of Drugs, Addicts, and Pushers (Anchor Books, 1975).

(32) See Stanton Peele, The Meaning of Addiction: Compulsive Experience and Its Interpretation (Lexington, Mass.: Lexington Books, 1985); and John Booth Davies, The Myth of Addiction (Philadelphia, Pa.: Harwood Academic Publish-ers, 1992).

(33) The Australian policy is analyzed in Robin Room, "The Dialectic of Drinking in Australian Life: From the Rum Corps to the Wine Column," Australian Drug and Alcohol Review 7 (1988): 413-37. The British policy is assessed in Arthur Shadwell, Drink in 1914-1922: A Lesson in Control (London: Longmans, Green & Co., 1923). The impact of Prohibition on alcohol consumption and alcohol -related ills in the United States is assessed in John P. Morgan, "Prohibition is Perverse Policy: What Was True in 1933 Is True Now," in Krauss and Lazear, eds., Searching for Alternatives, 405-23; Mark Thornton, The Economics of Prohibition (Salt Lake City: University of Utah Press,1992); and Jeffrey A. Miron and Jeffrey Zweibel, "Alcohol Consumption during Prohibition," American Economic Review 81 (Z) (1991): 242-47. More generally, see Ethan A. Nadel-mann, "Response to Letters," Science 246 (1989): 1102-1103; and Harry G. Levine and Craig Reinarman, "From Prohibition to Regulation: Lessons from Alcohol Policy for Drug Policy," Milbank Quarterly 69 (3) (1991): 461-94.

(34) Early twentieth-century models of alcohol control, many of which allowed adults to import alcoholic beverages into "dry" locales, are analyzed in Raymond B. Fosdick and Albert L. Scott, Toward Liquor Control (New York: Harper & Brothers,1933); Leonard V. Harrison and Elizabeth Laine, After Repeal: A Study of Liquor Control Administration (New York: Harper & Brothers, 1936); and Reginald E. Hose, Prohibition or Control: Canada's Experience with the Liquor Problem, 1921-1927 (New York: Longmans, Green & Co., 1928). The modi-fication in F.D.A. policy is discussed in James H. Johnson, How to Buy Almost Any Drug Legally Without a Prescription (New York: Avon Books, 1990).

(35) See, for instance, David Dixon, From Prohibition to Regulation: Bookmaking, Anti-Gambling, and the Law (Oxford: Clarendon Press, 1991).

(36) US Department of Justice, Bureau of Justice Statistics, "Drugs and Jail Inmates, 1989" (August 1991), 1, 9.

(37) See Mark H. Haller, "Bootleggers as Businessmen: From City Slums to City Builders," in David E. Kyvig, ed., Law, Alcohol, and Order: Perspectives on National Prohibition (Westport, Conn.: Greenwood Press, 1985), 139-57.

(38) See D. M. Warburton, "Internal Pollution," Journal of Biosocial Science 10 (1978): 309-19, and Ruth Cooperstock "Current Trends in Prescribed Psycho-tropic Drug Use," in Research Advances in Alcohol and Drug Problems 3 ( 1976): 297-316.

(39) Some of these issues are considered in John P. Morgan and Doreen V. Kagan, eds., Society and Medication: Conflicting Signals for Prescribers and Patients (Lexing-ton, Mass.: Lexington Books, 1983).

(40) But also see Chester N. Mitchell, "Deregulating Mandatory Medical Prescription," American Journal of Law and Medicine 12 (2) (1986): 207-39.

(41) See Peter Temin, Taking Your Medicine: Drug Regulation in the United States (Cambridge, Mass.: Harvard University Press, 1980), and Peter Temin, "The Origin of Compulsory Drug Prescriptions," Journal of Law and Economics 22 (April 1979): 91-105.

(42) See Sam Peltzman, "The Health Effects of Mandatory Prescriptions," Journal of Law and Economics 30 (October 1987): 207-38, and Sam Peltzman, "By Prescnption Only . . . or Occasionally?" AEI Journal on Government and Society (3/4) (1987): 23-28.

(43) Peter Temin, "Costs and Benefits in Switching Drugs from Rx to OTC," Journal of Health Economics 2 (1983): 187-205.

(44) See the excellent drug education text by Andrew Weil and Winifred Rosen, Chocolate to Morphine: Understanding Mind- Active Drugs (Boston: Houghton Mifflin, 1983). Also see David F. Duncan, "Drug Abuse Prevention in Post-Legalization America: What Could It Be Like?" The Journal of Primary Preven-tion 12 (4): 317-22; I. Clements, J. Cohen, and J. Kay, Taking Drugs Seriously: A Manual of Harm Reduction Education on Drugs (Liverpool: Healthwise, 1990); David F. Duncan and Robert S. Gold, Drugs and the Whole Person (New York: Macmillan, 1985); and Ruth C. Engs, Responsible Drug and Alcohol Use (New York: Macmillan, 1979).

(45) The efficacy of antismoking campaigns is discussed in Kenneth E. Warner, "The Effects of the Anti-Smoking Campaign On Cigarette Consumption," American Journal of Public Health 67 (1977): 645-50; and, by the same author, "Effects of the Anti-Smoking Campaign: An Update," American Journal of Public Health 79 (1989): 144-51. Also see Martin Raw, Patti White, and Ann McNeill, Cleanng the Air: A Guide for Action on Tobacco (London: British Medical Association, 1990). The Partnership's advertisements are evaluated favorably in the Commit-tee on the Value of Advertising, What We've Learned About Advertising from The Media-Advertising Partnership for A Drug-Free America (New York: American Association of Advertising Agencies, 1990). More critical analysis is provided in Richard Blow, "How to Decode the Hidden Agenda of the Partner-ship's Madison Avenue Propagandists," Washington City Paper 11 (49) (6-12 December 1991): 29-35; Cynthia Cotts, "Hard Sell in the Drug War," The Nation 254 (9) (9 March 199Z): 300-302; and Lynn Zimmer, "The Partnership for a Drug-Free Amenca and the Politics of Fear," paper delivered to the Fifth International Conference on Drug Policy Reform, Washington, D.C.,15 Novem-ber 1991.

(46) See "How to Launch a Nationwide Drug Menace," in Edward M. Brecher and the Editors of Consumer Reports, Licit and Illicit Drugs (Boston: Little, Brown and Co., 1972).

(47) See "The Promise of Prozac," Newsweek, 26 March 1990; Fran Schumer, "Bye-Bye, Blues: A New Wonder Drug for Depression," New York, 18 December 1989- and the more balanced "Beating Depression," U.S. News and World Report, 5 March 1990.

(48) See F. Earle Barcus and Susan M. Jankowski, "Drugs and the Mass Media," Annals of the American Academy of Political and Social Science 417 (197S): 86-100, Patrick T. MacDonald and Rhoda Estep, "Prime Time Drug Depic-tions," Contemporary Drug Problems 12 (1985): 419-37; William Braden, "LSD and the Press," in B. Aaronson and H. Osmond, eds., Psychedelics (New York: Doubleday,1970); Jock Young, "Drugs and the Mass Media," Drugs and Society 1 (November 1971): 14-l8, and Craig Reinarman and Harry G. Levine, "Crack in Context: Politics and Media in the Making of a Drug Scare," Contemporary Drug Problems 16 (1989): 535-77.

(49) 478 U.S. 328, 92 L. Ed. 266, 106 S. Ct. 2968 (1986).

(50) See Sylvia A. Law, "Addiction, Autonomy and Advertising," Iowa Law Review 54 (1992); and Peter Hirsch, "Advertising and the First Amendment," in Trebach and Zeese, eds., New Frontiers in Drug Policy, 404-407.

(51) See Joe B. Tye, Kenneth E. Warner, and Stanton A. Glantz, "Tobacco Advertising and Consumption: Evidence of a Causal Relationship," Journal of Public Health Policy 8 (1987): 492-508. The debate over tobacco advertising is aired in Advertising of Tobacco Products: Hearings before the Subcommittee on Health and the Environment of the Committee on Energy and Commerce, House of Representatives, 99th Cong., 2 Sess. (1986) (Serial No. 99-167). The debate over alcohol advertising is aired in Alcohol Advertising: Hearing Before The Subcommittee on Children, Family, Drugs and Alcoholism of the Committee on Labor and Human Resources, United States Senate, 99th Cong., 1st Sess. (1985) (S. Hrg. 99-16), and Beer and Wine Advertising: Impact of Electronic Media: Hearing Before the Subcommittee on Telecommunications, Consumer Protec-tion, and Finance of the Committee on Energy and Commerce, House of Representanves, 99th Cong., 1st Sess. (1985) (Serial No. 99-16).

(52) See Alison Masson and Paul H. Rubin, "Plugs for Drugs," Regulation (September/ October 1986), 37-53, which argues for fewer restrictions on prescription drug advertising.