Working within the System

by Steven Jonas

Steven Jonas, M.D., is a professor at the Department of Preventive Medicine, School of Medicine, State University of New York at Stony Brook, 11794-8036.

Although the drug problem is an economic, political and social one, at its center it is a health problem. This is so because, among some users at least, the use of drugs produces abnormal and destruc-tive physical and mental changes in the body, with resultant negative al-terations in behavior as well. Further, it is a public health problem because the use of drugs by certain individuals has profound effects on the health of others, and drug use is susceptible to control by public health measures.

Now, if we look at the drug problem and drug policy from the public health point of view, additional defects in current policy can be identified. First and foremost, current policy, simply a variant of one that has been in place for 80 years or so, does not solve the drug problem. It just does not work. It is true that the use of the currently illegal drugs has declined in recent years, at least among certain populations. How-ever, little if any of that decline can be attributed to present policy, aimed as it is primarily at the supply side.

Interdiction of drugs and imprison-ment of dealers and users has gone up significantly. But the supply of the major current illegal drug, cocaine, is more plentiful, cheaper and purer than ever before. The drug trafficking crime problem is worse, not better. And in any case, the overall use in society of both currently illegal and legal drugs, has declined at about the same rate. This fact alone makes it clear that illegalization is not a sufficient cause of the decline.

From the public health point of view, current policy actually exacer-bates the drug problem by virtually ignoring the recreational, mood-alter-ing drugs that are the most harmful overall to the public's health: tobacco and alcohol.

The drug problem is further exacerbated by an artificial dichotomy — "good" drugs vs. "bad" drugs — cre-ated by cur-rent policy. This OK-not-OK business has no phar-macological, toxicological or epidemiological basis.

The drug problem is compounded by the drug trafficking problem, which happens largely to be a creation of current policy. The policy ignores the fact that most drug-action-related crime is caused by the effects of alcohol. It focuses on drugs as the "baddies," rather than on the negative behaviors they produce in some people. It adopts as its goal the unrealistic, and indeed unde-sirable, "Drug-Free Society," making it difficult to deliver a consistent mes-sage about drug use.

Current policy completely ignores the existence and the role of the Ameri-can Drug Culture. It is this culture that glorifies and heavily promotes the use of recreational, mood-altering drugs, sells over-the-counter pharmaceuticals as instant problem solvers for what-ever ails you, endorses the unnecessar-y and wasteful use of vitamin pills as a painless, effortless way to a better you, and fosters a system of medical prac-tice that is heavily drug-dependent.

What is to be done

From the public health perspec-tive, and, I think, from the perspective of most legalizers as well, simple legali-zation, without a comprehensive pro-gram to deal with the drug problem, is not the answer. While simple legaliza-tion of the currently illegal drugs would solve much of the drug trafficking problem, it would do nothing to solve the drug problem, especially that major part of it that is caused by tobacco and alcohol.

A solution is available: a compre-hensive, public-health-based drug use and abuse reduction and control pro-gram that builds upon successes that have already been achieved in this and other countries. The goal of this pro-gram would be to reduce the use and abuse of all the recreational, mood-altering drugs in order to provide for their safe, pleasurable use, consistent with centuries-old human experience, while minimizing their harmful effects on individuals, the family and society as a whole. The adoption of this goal would recognize that given the current level of alcohol and tobacco use, to say nothing of the safe use of many drugs other than cigarettes by many of their users, a "drug-free society" is neither achievable nor desirable.

The program would have the fol-lowing components:

1. A rational system based on science and medicine would replace the current legal/illegal drug classification sys-tem, which is based on history and politics. The four major criteria of this new system wouldbe addictive potential, short-term dangers, long-term hazards and the personal benefits (if any) of the drugs them selves.

2. Based on the British system, which has been very successful in re-ducing the alcoholic cirrhosis of the liver mortality rate, there would be controls on the places and hours of availability and a rational price struc-ture and credible tax policy for all the legal recreational drugs.

3. Making a clear assault on the Drug Culture, there would be a na-tional politicaVeducational campaign to diminish its importance and impact on our society. As part of this, there would be an advertising policy that puts some constraints on pro-recreational drug use advertising, consistent with First Amendment protections for freedom of speech. Prohibiting or tax-ing pro-drug use advertising are ap-proaches that are constitutional since the Supreme Court has upheld restrictions on commercial speech. A dollar tax on each advertising dollar spent would both reduce the amount of ad-vertising and raise a significant amount of money for the program.

4. Building on the successes already achieved in this country with the decline in use of cigarettes and alcohol, there would be a comprehensive, pub-lic education, anti-drug use campaign, covering all drugs.

5. Building on the experience of large-scale programs currently under-way, a national, comprehensive, school education program dealing with all of the recreational drugs in a unified manner would be established.

6. As required by those addicted to any of the recreational, mood-altering drugs, comprehensive treatment, re-habilitation and job-training programs would be made available.

7. For tens of thousands of workers and farmers who would be put out of work in this country by a significant decline in the currently legal recrea-tional drug trade, there would be sub-sidies, relocation assistance and re-training opportunities.

8. Created anew and expanded as
needed would be the programs of na-tional domestic spending necessary to deal with the root causes of drug use in those central city neighborhoods that are so scarred by both legal and illegal drug use and the war on drugs.

9. Until the use and abuse of all recreational, mood-altering drugs is significantly reduced, current law en-forcement efforts would be continued. However, this program would provide for no increase in those efforts, cancel-ing any plans to build more jails, to employ the military in interdiction, to erode further the Fourth Amendment protections, to increase penalties for use, and so forth. It could very well include an expansion in the federal court system so that current case cal-endars can become unclogged and civil cases can begin moving again. And, it almost certainly would reverse current policy that inhibits legal representa-tion of drug crime defendants.

For the long term, the law enforce-ment effort would be focused on dealing with the anti-social behaviors associ-ated with the abuse of all recreational drugs, and the violation of statutes governing the promotion, distribution and sale of all the recreational drugs to minors. Because it is in youth when most recreational drug use begins, the latter is especially important as a public health measure.

Political features

This program is non-ideological and outcome-oriented. Using the arguments of the reform movement to attack cur-rent policy, it then goes on to offer a practical, public health-based plan to deal with the true drug problem. By deferring any decisions on legalization, it changes the focus of the present argument on the pros and cons of that approach to a focus on what can and does work, and what cannot and does not work, in dealing with drugs. It will permit us to begin focusing on those drug problems, which, from the public health point of view, are by far the most serious: the ones caused by alcohol and tobacco.

This plan implies that the only way that legalization can be contemplated is if the public health program is implemented first. Unlike legalization, this program cannot be labeled "soft on drugs." First of all, it directly focuses on the use of all drugs, something present policy does not do. It is aimed directly at drugs, their effects, their promotion and the causes of their use, rather than at the users themselves. Second of all, at the beginning it contemplates no reduction in current law enforcement efforts. Its major political downside is that it requires a major assault on the tobacco and alcohol industries.

Also, it might be opposed, privately of course, by the institution that has the most at stake in maintaining ille-galization: the drug cartel. Since this plan might pave the way for legaliza-tion, the cartel might very well oppose it. The means for doing so would be the same as the one that it most likely uses at present: the funding of the political campaigns of strong opponents of pres-ent policy. However, supporters of a policy that will significantly reduce the harmful use of the recreational, mood-altering drugs should not be deterred from engaging in it just because a po-litical battle is difficult.

Finally, supporters of the public health approach must find encourage-ment in the Richard Dennis/Drug Pol-icy Foundation poll, the results of which were released Feb 27. In that survey, 70 percent of respondents felt that the federal government was providing too little support for drug treatment pro-grams and drug education. Only 13 percent felt that imprisoning drug users was an effective use of tax dollars in combatting the drug problem. Overall, the results of the survey indicate that the majority of the American people are unhappy about the extent of the drug problem in the United States. But they also indicate that the American people would support new approaches to dealing with the problem, approaches that are not dependent on the criminal justice system. The public health ap-proach certainly fits that bill.