Chapter four toward a coherent social policy

Those charged with formulating drug policy face a dilemma. Drug use is a behavior usually occurring in private and sharing much in common with personal decisions traditionally governed by individual choice. The preference for self-determination and personal autonomy is one of the basic principles of our public philosophy and the key stone to our entire social organization. At the same time, a free society, like any other, must protect the health, safety and welfare of the whole. Since this responsibility entails a certain amount of social engineering, there is always tension between the desire for personal freedom and the need for collective restraint.
For the Most part, this country has proceeded on the assumption that the citizen's sense of personal responsibility will act as a sufficient check on individual discretion and that a certain amount of irresponsible behavior is more tolerable than serious abridgments of our liberties. Conflict arises when the level of irresponsibility increases or threatens to increase beyond the point of tolerance.
American drug policy, following the prevailing view that drug use undermines individual responsibility and self-control, has tended to emphasize prevention of collective harm rather than individual freedom of choice. To some extent, however, an unfortunate polarization of perspective has made the dilemma appear sharper than it really is. On one hand, use of most psychoactive substances has been viewed as inconsistent with personal responsibility and self-control; yet, mature, stable persons could use many of these drugs in a structured, moderate manner without individual or collective harm. On the other hand, some critics have asserted that society should base its policies purely on the assumption that individuals will behave responsibly ; yet, history demonstrates that widespread exposure of a populace to psychoactive substances frequently exacts a heavy social cost. Í A significant portion of those groups most vulnerable to excessive and irresponsible use will be drawn to the drug, magnifying the harmful impact of the drug's availability.
The policy maker must try to understand and reconcile these opposing points of view, combining the valid elements from each. Much of the debate regarding drug policy has been strident and unsatisfying precisely because participants tend to approach the fundamental issues from different perspectives. For example, many social scientists, attorneys and pharmacologists emphasize the harmlessness of the bhavior of the majority of experimental or recreational users who neier go on to intensified or compulsive use, while many physicians, particularly psychiatrists, educators and spiritual leaders focus on the drug casualties with whom they must deal more, than anyone eke. The Commission does not believe that the two viewpoints are neessarily mutually exclusive, as long as neither is taken as a complte analysis of the problem. ,
The issue of perspective, which is really a problem of descriptim, leads to an issue of philosophy, which is a problem of prescription, As we noted in Chapter One, the decision whether or not to use drugs is fundamentally a question of values. The question is: whose values should determine the answer?
The American value system prizes self-reliance, productivity and community involvement. From this perspective, resort to drugs for unnecessary purposes poses undesirable risks, whatever immediate benefits the individual user may perceive. Ideally, then, use of psychoactive substances in this society would be restricted to a very few purposes. There are some, of course, who do not entirely subscribe to this ideal while others profess the ideal and live by it as well. In reality, however, most Americans aspire but do not measure up to the standard. The use of different drugs and motivations for use may vary, but reliance on chemical substances is a common feature, of American life.
So a second dilemma is posed. Should public policy toward drug use reflect the prevailing morality of aspiration or the realities of individual and group behavior? This issue is most important when policy toward one substance, for example marihuana, invokes the moral ideal, while policy toward another, alcohol, accommodates the way most people behave. Such uneven application of principle explains why some critics believe that present drug policy is no more than an assertion of majority preference.
While the details of social policy need not be the same. for all substances, the Commission believes that differences must be justified in terms of one general set of principles. An apparent double standard compromises the integrity of social institutions and interferes with efforts to deal with the consequences of excessive drug use.
The Commission also believes that semantics must not blur the basic philosophical dilemma: when policy restricts individual choice for the common interest, the decision should be stated unequivocally. A determination that society suffers more from an existing restrictive policy than from the use of a particular drug should be stated with equal candor.

THE PROCESS
The Commission has attempted to formulate a set of general principles, as well as a process for applying them. The policy-making process we have employed consists of five steps :
•    Definition of the problem.
•    Definition of goals and premises.
•    Determination of conditions under which specific psychoactive substances should be available within the society (the "availability" decision).
•    Determination of circumstances under which society should intervene in the life of an individual who has chosen to consume a substance outside the prescribed channels of availability (the "consumption-intervention" decision).
•    Allocation of responsibility for implementing policy among various institutions, public and private, formal and informal.
These determinations can also be framed as' a series of questions, none of which can be answered solely on the basis of empirical data and observation. On some issues, the data will weigh most heavily; on others, the answers will depend primarily on value judgments and philosophical perspectives. For this reason, we have not tried to skirt the difficult questions of philosophy and perspective raised earlier. They are examined at every point in the policy-making process where they are relevant.
Particularly in the last three steps in the policy-making process, decision-making cannot be determined logically. First, we are dealing with a limited, inadequate base of information, a factor which increases the weight of intangible considerations. Second, drug policy cannot be isolated from the overall social context : the effects of drug policy on the entire society, the impact of change on institutionalized belief systems and parallel social developments, all are part of the analysis of the problem. Even if prohibition of alcohol was judged logically and philosophically desirable, for example, it could not be achieved in a manner tolerable to the majority of our citizens. Even if a longterm societal goal were to reduce circumstantial drug use, this kind of drug-using behavior may be so closely tied to current economic and social developments that any present attempt to deal with it separately would be counterproductive.
Concern about the larger context in which drugs are used is particularly important when policy decisions, and perhaps policy-making premises as well, require rethinking. New policies which offend deep-seated beliefs may convey messages other than those intended, exacting a heavier social cost than temporary perpetuation of error. Thus, even if a policy of regulated availability might be otherwise appropriate for marihuana, the Commission believes that such an approach would inevitably signify approval of the drug, exacerbate conflict and frustrate the overall objective of deemphasizing marihuana as a problem and discouraging its use.
In this Chapter, the Commission recommends a course of action for immediate implementation. Accordingly, we have taken into account the impact of policy making as well as the impact of drug use. The recommendations, if followed, will establish new priorities, reorganize the present institutional response and reorient policy to the realities of the problem. We hope that adoption of these recommendations will replace the present confusion with a coherent response, focusing on drug-using behavior rather than on drugs themselves and minimizing rather than aggravating the adverse consequences of use.
We recognize that the number of policy options is limited at the present time. In the future, we hope that these proposals will facilitate the process of informing popular attitudes toward drugs and, where necessary, change them, so that the long-term response may be selected from the widest possible range of alternatives.
We emphasize again that information alone does not tell the policy-maker what to do. However, he cannot stand pat by pleading an inadequate data base. Absence of complete knowledge may dictate caution, but not immobility. Knowledge is always incomplete and always expanding. Recogizing this, policy makers must make decisions from the existing information base, then reconsider previous decisions when new and better information becomes available.
So that reconsideration is possible, the Commission is anxious to ensure that the mechanisms and policies now employed do not become permanent features of this society's response to drug use. All aspects of present policy must be continually reevaluated in terms of their costs and benefits to society. Eventually, these policies must be replaced or modified to fit more consistently with new information, new operating premises and the changing roles of societal institutions.

GOALS AND PREMISES

Our society seeks to create and maintain conditions in which each of its members may develop his or her potentialities to the fullest extent. A premium is placed on individual choice in finding self-fulfillment. Whether or not this goal is attainable, however, depends upon the capacity of citizens not to abuse their freedom and upon their willingness to act responsibly toward others and toward society as a whole. Responsible behavior, through individual choice, is both the guarantor and the objective of a free society.

Drugs and Social Responsibility
Use of drugs, in itself, is not an irresponsible act. Medical uses are often important in restoring physical and mental health. Sacramental use in connection with bona fide religious ceremonies may enhance rather than impair the celebrant's spiritual well-being.
In therapeutic and religious settings, the purposes of drug use are defined precisely by specified persons who, through tradition and training, have the expertise and authority to structure the experience and minimize the risk. In contrast, when the individual defines his own need, whether it be pleasure, relaxation, escape or an effort to expand awareness, there are no external limits on his drug use. Although most individuals can be expected to structure their drug taking, the risk of irresponsibility and adverse individual and social consequences increases with self-defined use.
While the use of drugs for self-defined or group-defined purposes is not inherently irresponsible, neither is it purely a matter of personal choice. The potential public impact of drug-induced behavior and drug dependence is great enough that society cannot afford to be neutral. On the other hand, the fact that all drug taking poses some risk does not mean that all use poses the same risks, and official policy should not pretend that it does.

Irresponsible Use
The primary goal of drug policy must be to minimize irresponsible drug-using behavior. The Commission finds that the use of drugs is clearly irresponsible :
• when the manner or circumstances of use pose a threat to the safety or welfare of others;
•    when the pattern of use substantially impedes or risks the im pairment of the individual's social and economic functioning; am
•    when the pattern of use reduces the individual's options for self fulfillment by impairing his faculties or retarding his develop ment.

Discouragement and Social Tolerance
A secondary aim of public policy must be to discourage the use o: drugs for self-defined purposes, or at least to remove those institutiona and social pressures which motivate an individual toward such. AsE Policy should incorporate the ideal of drug-free living in the contex of establishing those conditions in which each individual is free ti realize his or her potentialities. In this sense, society should encourage individual choices of means of fulfillment which do not present undue risks to the individual's own welfare or the welfare of others.
This discouragement policy reflects the Commission's judgment tha drug policy should not lose sight of social ideals. Recognizing, how ever, that most of us do perceive advantages in drug use from time tE time, the Commission emphasizes that policies and programs also mus be rooted in reality. A policy of discouragement must also be temperei with a degree of understanding for those who do use drugs.

Responsible Decision Making
Society must trust its emotionally mature citizens to make intelli• gent decisions regarding drug use. In the context of the overall dis couragement policy, institutions should motivate and assist the in dividual to make responsible choices. Institutional energies should be directed toward altering the context within which the individual': decision is made. For example, public policy can reduce or stop dru€ use by relieving some of the environmental pressures that motivate people to use them. In particular, policy makers should focus on thosE social, economic and cultural factors which make certain population: vulnerable to intensified or compulsive drug use.
A policy which emphasizes discrimination in institutional response as well as individual responsibility and prudent decision making, iE more likely than a purely negative policy to foster coherent public attitudes toward drug use. By including alcohol use and self -medica tion with psychoactive substances as well as "street use," drug polic3 can promote development of sounder beliefs toward those behaviors removing the need to hide behind semantic walls and specious distinc tions. Further, an emphasis on prudent decision-making will also alert physicians, clergy, pharmacists, psychologists, teachers and others tc whom individuals look for information and support, to the importance of their assisting the individual in understanding his needs and his personal responsibility for his decisions and their consequences.
This approach places the responsibility where it belongs: on the individual and those institutions closest to him and not on the drugs or on the government. Indeed, policy should demythologize the drugs themselves as part of a general attempt to focus public attention on human needs and on the urgency of developing satisfactory non-drug alternatives. When drugs are regarded less often as villains, they are also less likely to be regarded as panaceas.

Risks and Perceived Advantages
Drug policy must stop dealing with only one side of an equation, the risks of drug use. In order to facilitate responsible decision-making in moving closer to the proclaimed ideal, social institutions must deal directly with the perceived attractions of drug use. With youthful users in particular, there can be no credible dialogue about drugs without admitting that there are at least two sides to the issue to be discussed.
Cigarette and alcohol policy suggests strongly that emphasis on risks has a minimal impact on the behavior of those otherwise likely to use drugs. Instead, institutions should address beliefs about the needs which drugs are perceived to fill and should attempt to influence the meaning they have on individual and group behavior. The individual, in turn, must face his actual motivation for use, with a view toward finding alternative outlets for self-expression and alternative means of altering his mood.

Designing a Differential Response to Drug Use
Policy must reflect complexity of drug-using behavior, including differences in the drugs themselves; in their interactions with the personality of the user; in the amounts, frequency and settings of use; and in the meanings and functions of drug use to the individual and the society. The tendency to regard drug use as a unitary phenomenon has been a major reason for current confusion and for ineffective individual and corporate action. To illustrate the need for a differentiated response, we will refer to the general patterns of drug-using behavior described in Chapter Two.
Youthful experimentation, for example, raises special concerns. This population is substantially more likely than adults to engage in irresponsible and unstructured drug-using behavior. Youth is generally a time of experimentation, as well as a time when peer groups exert an especially powerful influence on individual behavior. Consequently, in discouraging experimentation with drugs, society must concentrate on persuading the young that the experimental motivation, so healthy in other respects, is undesirable where drugs are concerned. In doing so, efforts must be made to act as much as possible through the peer group to reinforce the desired, non-using behavior. As a corollary, social institutions must attempt to anticipate new forms of drug experimentation, intensifying formal discouragement efforts when sudden changes in drug use patterns increase the danger of disruptive, unstructured behavior.
Recreational use is a low-risk behavior as long as it is appropriately ritualized to minimize adverse social consequences. However, policy should seek to discourage all self-defined use by removing various social incentives to recreational use (such as minimum drink requirements and the symbolic attributes of marihuana). Individuals must also assess the value of drug use, including alcohol, as a recreational behavior in their own lives.
Almost by definition, the risk of circumstantial drug use is low on the scale: the major concern is that a drug-taking response to a given situation may become recurrent. Institutions should encourage individuals to deal directly with underlying conditions or to seek non-drug coping mechanisms. At the same time, policy makers must recognize that circumstantial drug use is increasing significantly, and that, at best, the institutional response can only partially restrain it.
The major thrust of policy should be to minimize the incidence and consequences of intensified and compulsive use. Such behavior poses significant risks to the individual and to the society and often signifies underlying problems of personal and social adjustment. These risks are maximized, of course, when the drug-using behavior dominates the individual's life style and when absence of the drug precipitates serious behavioral disruption. Concerted effort, including, where appropriate, paternalistic intervention by society, should be devoted to identifying those in need of assistance and to providing the necessary health and social services.

I THE AVAILABILITY DECISION

Having defined both the Ps roblem and the overall social policy objectives in terms of behavior, rather than in terms of specific drugs, the policy-making process in its third step must determine the condiuse and the individual's right to autonomy because restrictions on available. This part of the process does not involve a direct conflict between society's right to protect itself from the consequences of widespread use and the individual's right to autonomy because restrictions on availability do not intrude into the realm of private behavior, but merely circumscribe the individual's options. Accordingly, society may legitimately emphasize control, since the difficulty of retreating from widespread availability, once established, argues for a cautious approach. Policy makers may legitimately speculate about the aggregate consequences of use and should not be deterred from restrictive control by the inadequacy of available information regarding the effects of a particular substance.

MODELS OF AVAILABILITY
On one public policy issue regarding drug use, there can be little dispute : if drugs are not available, people will not use them. The converse may not always be true, but the Commission notes that the incidence of use of potent psychoactive substances does appear to bear a general relationship to how readily available they are.
Through its legal system, a nation can attempt to eliminate the availability of a particular drug, or to channel its distribution in specified ways. Once the legal market has been established, a multitude of variables, including the customary habits of the population and economic incentives for illegal trafficking, will determine whether the drug is available only within that market. Therefore, the major question about decisions to restrict availability through law is not whether it will have an effect on supply of the substance, which it surely will, but rather how much effect it will have.
There are four alternative models of availability for psychoactive substances. The first involves no special controls at all : the substance is treated in the same way as other market commodities. Under the second approach, the substance is subject to special controls, but remains lawfully available for self-defined purposes. The third model limits availability to specific purposc s ; generally, to medical and research uses only. Under the fourth t pproach, the substance is not legally available at all, except perhaps for narrowly-circumscribed use in research (MCGrew, 1973).
Within the three models of controlled availability, the level of control may range from minimum to strict according to the types of restrictions imposed and the rigor with which they are applied Among the most common restrictions are :
•    requirements that supply be limited to certain designated users or uses (ranging from requirements which define the approved uses very broadly to those which define them very narrowly)
•    prohibitions on supply for disapproved uses, with penalties ranging from mild civil sanctions to severe criminal penalties
•    restrictions on the amount that may be distributed to a user, or on the times and places at which users may obtain the drug
•    requirements that users obtain special authorization (for example, prescriptions) from a specifically identified class of persons (for example, physicians) in order to acquire the drug lawfully
•    controls on the quality and potency of the substance
•    requirements that records of transactions be kept and submitted to periodic inspection
•    requirements that manufacturers, importers, distributors and dispensers take certain security precautions to prevent diversion of drugs to illegitimate uses
•    requirements that all manufacturers, importers and distributors obtain special licenses
•    restrictions on the amount of drug that may be manufactured, imported or sold, inventoried, or dispensed by individual licensees, or by all, within a given time period
•    limitations on the number of manufacturers or distributors within a designated area
•    excise taxes, including taxes designed to raise revenue, taxes designed to discourage use by creating an artificially high price and taxes designed to make the cost of the drug in lawful supply channels prohibitive.

THE CALCULUS: AN OVERVIEW

Relative Social Cost
The availability decision, since it deals with supply, is necessarily drug specific ; consequently, the decisional process starts with the relative social cost of particular substances. In Chapter Three, we defined social cost as the aggregate impact on the public safety, health and welfare of drug-induced behavior and drug dependence. Actual social cost refers to this impact within the present social context, including present conditions of availability. Maximum social cost refers to the projected impact under conditions of unrestrained availability.1
The cost associated with a particular drug defines generally what it is worth to society to prevent or reduce its use by means of control. Wherever any significant social cost is attributable to use of a substance, there is at least tentative justification for restricting its availability; the higher the cost, the greater the justification. Similarly, unless significant social cost follows from use of a given drug, there is no rational basis for precluding its availability for self-defined purposes.
If the properties of specific drugs were the only determinant of availability decisions, controls would be most restrictive for alcohol, opiates and cocaine and relatively less restrictive for marihuana and the hallucinogens. But more is involved. In addition to the relative social cost of various substances, the policy maker must examine the efficacy of various control devices in channelling use toward approved purposes, the cost of the controls and finally, the importance of the availability decision as a symbol of control.

Efficacy of Controls
The effectiveness of particular control devices in reducing availability of substances for disapproved uses involves two factors : how well controls prevent legitimately produced substances from being diverted into unintended channels and how well they prevent illegal production and distribution. Controls have generally succeeded in the first task, which is to ensure that lawfully produced drugs go to lawful uses, though sometimes they have had the undesirable effect of inhibiting distribution for approved purposes (McGrew, 1973).
Success of controls in forbidding illegal production and supply has been more problematic. Drug trafficking laws are difficult to enforce for a number of reasons. First, there are practical and legal obstacles to the detection and proof of any drug-related crime, deriving from the lack of complaining witnesses to the offense. Second, most psychoactive drugs can be obtained abroad or produced domestically with relative ease, while they can be detected only with great difficulty even when transported in economically profitable quantities (General Accounting Office, 1972). Third, it is not easy for law enforcement agents to penetrate the illegal market (Moore, 1970) . Part of the distribution network may lie in foreign countries, whose authorities are reluctant or unable to cooperate; even in this country, populations in some areas where dependence is high are not always willing to assist enforcement agencies. Finally, and most important, is the economic attractiveness of the trade in illicit drugs. Rewards for dealing are a function of drug demand, and as long as there is a demand for substances outside the prescribed channels of availability, society will never lack persons to supply it.

Cost of Controls
The utility of controls, of course, rests not only on their effectiveness but also on their cost. Most easily quantified are the operating costs : salaries of administrative and enforcement personnel, agency overhead and equipment costs, expense of prosecution and imprisonment. Other costs are not as readily measured, but they are no less important. For example, controls which prevent diversion of drugs to illicit uses may also interfere with legitimate use, depriving both individuals and society of a benefit.
Drug trafficking laws have other intangible costs, too. When supply for certain uses is prohibited, the illegal market which usually emerges increases the price of the commodity. To the extent that persons are dependent on the prohibited substance and cannot secure it legitimately, property crimes may increase as a direct result of restrictions on availability. Also, the purity and potency of illegally produced drugs are unregulated and unpredictable, aggravating the public health problems attending their use.
One important cost of control has, until now, largely been ignored. If a system of controls succeeds in substantially restricting supply of a particular drug and in frustrating the demand for it, some of that demand may shift to other drugs. There is no net gain if one drug is controlled successfully, only to cause a corresponding rise in the use of another, with equal or more serious costs. Further, there is no net gain when lawful production is restricted, but replaced with unlawful supply at substantially the same level.

The Social Context of the Availability Decision
The Commission points out again that no decision about drugs can be made in a vacuum. The policy maker must keep constantly in mind that all his projected actions will affect one another and that all will operate within a much larger complex of problems and policies. This is equally true with respect to the last major factor in the availability decisional process : the social context within which the decision is made.
In many instances the availability decision is purely anticipatory. One of the important contributions of the Comprehensive Drug Abuse Prevention and Control Act of 1970 (Controlled Substances Act) was to establish a mechanism for making availability decisions before widespread use of a. drug and public reaction to it become established. Whenever a decision is being made for a substance already available and being used for self-defined purposes, an additional factor enters the decision-making process; the meaning which the drug has developed for the using and non-using populations.
At the present time, classification of a drug for availability purposes may carry a symbolic value not directly related to either social cost or to utility of control. A decision to loosen controls can connote approval of use, or suggest that the drug in question is not harmful, thereby encouraging experimentation with it. Conversely, tightening controls beyond a given level may be necessary to lend coherence to a social policy which otherwise appears inconsistent.
By referring to these effects as symbolic, the Commission does not discount their importance. On the contrary, we recognize that in any decision for the immediate future these benefits, like the more concrete ones, must be given full weight. Eventually, however, symbolism and fact must join; if they do not, the symbols will lose their meaning, at least for some segments of the population. For this reason, a particular scheme of control should not be retained indefinitely for its symbolic value alone; where other factors point toward less control, concern for the cultural impact of removing restraint will justify retention only long enough to ease the transition.

THE PRESENT SYSTEM
The analysis we have described does not work with mathematical precision. Some of the elements are not even quantifiable in theory, and for many of those that are, there is not sufficient information from which to calculate. Nonetheless, the process accurately describes and properly relates the relevant factors, and a deliberately preventive bias in the balancing compensates for the lack of information.
Following this approach, the Commission concludes that the present system should be retained, with several adjustments in the control of certain drugs. This decision does not mean that perpetuation of the present system will assure achievement of our policy goals. It signifies only that present controls on availability do seem to result in a net benefit for society : a reduction in social cost of drug use that outweighs the cost of control itself.
There are two caveats even to this limited endorsement. First, in reaching our recommendations, the Commission employed the rule that where the present state of knowledge left an issue in serious doubt, the doubt would be resolved in favor of retaining a restrictive approach. At the availability level, the burden of proof must rest on those who recommend new and untested solutions, particularly measures which might entail widespread availability of a potent psychoactive drug. The corollary to this rule, however, is that the present system of controls must allow sufficient leeway for the research and experimentation which will expand our knowledge and enable policy makers to reach more informed decisions in the future. Ignorance of the road ahead may excuse a slow and cautious advance, but when the present situation is unsatisfactory, it cannot excuse standing still.
The second caveat is that, with respect to some drugs, considerable weight had to be given to the symbolic value of control. As we have pointed out, this serves only as a temporary justification. If more direct approaches to the problem of use do not succeed in reducing demand for certain drugs, society in the future must consider alternative methods of regulating their availability.

At present, society controls availability of drugs in a wide variety of ways. (See Table IV-1) For many substances, a previous availability decision can be justified retroactively; for others it cannot. Prior to the Controlled Substances Act, however, it is fair to say that these decisions were reached in an ad hoc manner.

Availability Not Limited As To Purpose of Consumption
There are two major psychoactive substances which are under control but not restricted as to purpose of use: tobacco and alcohol.2 Tobacco is controlled only at a minimal level ; warning labels are required, purity is verified and production is supervised for purposes of collecting excise taxes. Distribution to minors is prohibited, although this restriction is rarely enforced. Controls on alcohol are at moderate to minimal level, depending on jurisdiction and type of beverage. Time and place of retail distribution are often restricted, distribution to minors is prohibited, and interstate movement may be regulated. There are no current examples of drugs 'whose availability, while strictly controlled, is not restricted as to purpose of use; it should be noted, however, that some have proposed such a system for marihuana.

Availability Limited As To Purpose of Consumption
Most psychoactive substances are so controlled that they are lawfully available only for certain purposes. With the one minor exception of peyote, which is available to the Native American Church for sacramental uses, this means availability is limited to medical and research uses.
Under the purpose-restricted model of availability, drugs controlled at a minimal level are available for a wide range of therapeutic needs, broadly defined and often determined by the individual user himself. For some drugs, prescriptions are not required to obtain the drug, but the user must sometimes indicate that purchase is for medical use. For other minimally controlled drugs, prescriptions are required, although they may be secured with very little difficulty because of generalized medical indications for their use. There are also controls on the purity and potency of these drugs and, occasionally, on the quantity that may be sold to individual consumers. Drugs that are restricted as to purpose and subject to minimal control are generally not covered by federal and state controlled substances laws,3 but a few, mainly cough syrups and antidiarrhetics containing codeine and opium, are listed under Schedule V of these laws.
Moderately controlled drugs remain available for therapeutic purposes, but these purposes tend to be more precisely defined ; and the propriety of use is always determined by someone other than the user. Prescriptions are uniformly required to obtain the drug, and distributors are required' by law to maintain inventory accounting and take precautions against diversion of drugs for illicit use. Security controls are also imposed on manufacturers, and the potency of the drugs is regulated. There may also be limitations on the amounts that may be dispensed to individual users within a given period of time. Drugs restricted as to purpose and presently controlled at a moderate level include barbiturates, certain non-barbiturate sedatives and some stimulants and analgesics. They are regulated under Schedules III and IV of the controlled substances laws.
Under strict controls, psychoactive substances are available for very limited and narrowly defined therapeutic and research purposes. Manufacture and importation are limited by quota, and tight security controls are imposed on the entire distribution system. A non-refillable prescription is required to obtain the drug, and, in some cases, the drug may be administered only at particular places. Quantities dispensed are also regulated. Strictly controlled psychoactive substances include morphine, methadone, cocaine, amphetamines and some amphetamine-like stimulants. They are listed in Schedule II of the controlled substances laws.

Substances Not Available for Consumption
Availability of a few psychoactive drugs is extremely restricted; they are available only for research under strict controls, which must be specified in the research protocol. Both protocol and researchers must be approved by the government, Cannabis drugs, hallucinogens and certain opiates, such as heroin, are the most important substances controlled in this manner. They are listed in Schedule I of the controlled substances laws.

SPECIFIC RECOMMENDATIONS

In recommending retention of the present system of controlling availability, the Commission does not endorse the decisional process which established these controls or ratify the historical precedents which shaped them. While we recognize that history has a legitimate role in our decisions, prior decisions cannot be conclusive. Accordingly, the Commission does not propose continuation of the present controls without change.

Opiates
Because heroin has a severe dependence liability and capacity for inducing compulsive use, and because it is particularly attractive to highly vulnerable populations, its social cost is considerably out of proportion to the numbers of its users. This reason, coupled with strong symbolism attaching to the use of this drug within affected communities, justifies the highest possible restrictions on availability. Accordingly, the Commission favors retention of the present restrictions on the availability of heroin and other opiates.
Controls have thus far been very effective in preventing diversion of lawful supplies of the medically used opiates ; for example, morphine, Dilaudid and Demerol (McGrew, 1973). The Commission recognizes, however, that the availability of illicit heroin has, to a large degree, reduced the demand for diversion of lawfully-produced substitutes.
Diversion of methadone supplied through maintenance programs has proved more of a problem. As a result, maintenance programs have been confronted with the conflict between the therapist's need for flexibility in treatment and law enforcement's need for rigid control over availability. To avoid destroying program effectiveness, the Commission recommends that federal and state regulations concerning maintenance programs emphasize treatment flexibility, coupled with reasonable controls to curtail diversion.
The present system has been less effective in preventing importation and distribution of heroin than it has been in suppressing diversion of the legal opiates. While the Commission believes that new enforcement strategies may prove promising, as will be pointed out later in this Chapter, it seems unrealistic to expect substantial reductions in unlawful supply unless major traffickers decide to stop smuggling the drug into this country. It is fair to assume that they will not stop such activities until the demand disappears.
The best hope for reducing the social costs of heroin dependence lies in the prevention and treatment areas. If a concentrated social effort to reduce demand does not have a significant impact over the next few years, policy makers should consider the other models of availability, since present controls operate at considerable cost and with only modest results. At the present time, however, the Commission strongly advises against any change in present controls on availability of heroin. We will have more to say on this subject in connection with treatment and research.

Cocaine
Cocaine, like heroin, is a drug with high dependence liability and appeals to the same vulnerable populations attracted to heroin use and intravenous amphetamine use (Woods and Downs, 1973). Although the actual social cost stemming from cocaine is not yet substantial, there is some evidence that illicit supply and use of cocaine is increasing. Our National Survey figures support this hypothesis, as do recent seizure statistics. Law enforcement officials in several major cities also share the impression that cocaine use is a growing problem.
Within the domestic distribution system, controls against diversion of unlawful cocaine have been very effective. Yet, paradoxically, much of the cocaine smuggled into the country for illicit use may originate from our own lawful production. In 1970, for example, the United States accounted for 88% of the reported world imports of coca leaves, and presumably processed most of the world's lawful cocaine. From the imported raw material, the United States produced 1,033 kilograms of cocaine and exported 725 kilograms. During that year, 379 kilograms were distributed in connection with this country's legitimate use, thereby reducing the total domestic inventories to 248 kilograms. Those countries to whom we exported cocaine apparently reexported a substantial amount of it, resulting in an even greater distribution (International Narcotics Control Board, 1971). It is not implausible that some of the cocaine shipped out of the United States was diverted overseas and smuggled back into this country for illegal distribution.
In the Commission's opinion, on the basis of formal statements from the American Medical Association's Department of Drugs and from the American Association of Opthamology, cocaine no longer has significant medical uses not easily served by other substances.
The Commission recommends that the American Medical Association survey the medical profession to determine what, if any, unique therapeutic benefits cocaine has. At the same time, the United States, working through the United Nations and the World Health Organization, should encourage worldwide discussions on the therapeutic uses of cocaine and on its dangers.
The Commission further recommends that the federal government, taking into account the AMA survey and the results of the international deliberations, reduce legitimate cocaine production in this country (including import of coca leaves for purposes of extracting cocaine) to the minimum quantities needed for domestic research and medical uses. If no unique therapeutic use of the drug remains, the government should eliminate manufacture altogether. In addition, the United States should work through diplomatic channels to persuade other countries not to manufacture cocaine for export.
Because control of cocaine availability is already strict, the symbolic value of tighter restraint will be slight. Accordingly, the Commission warns against over-dramatizing a change in control and thereby advertising the drug to vulnerable populations not yet familiar with it.

Amphetamines
Until recently, amphetamines were subject only to moderate control, and they were easily obtainable within the medical system for a number of uses which could have been served by substances with less risk potential. Amphetamines were often prescribed for patients who were overweight or suffering mild depression or fatigue. They were also available, through "backyard pharmacies" and loose prescription practices, to persons who felt their daily lives required periodic stimulation. A substantial quantity of these drugs, recently estimated to have been around 20% of lawful production, found its way into illegal distribution channels and could be purchased on the street (Ingersoll, 1972) .
Amphetamines have high reinforcement potential, and their repetitive use can lead to seriously disruptive behavior patterns. Moreover, when taken as a replacement for normal sleep and proper nutrition, they can cause serious organic damage. Yet, under the previous system of controls, both the public and the medical profession seemed to underestimate the risks of amphetamine use.
New controls have reduced lawful production of amphetamine drugs to approximately one-tenth their previous level. Though unlawfully-produced amphetamines may have replaced diverted drugs in the illicit market, introducing new problems of adulteration and black market prices, rescheduling amphetamines has probably realized a net social gain by reducing their over-prescribing. The Commission urges that the present controls on amphetamines be retained.'

Barbiturates
Overuse of barbiturates is America's hidden drug problem, corn-parable perhaps to the scope of hidden opiate dependence around the turn of the century. Medical supervision of the use of these drugs has too often been lax, resulting in abundant availability of barbiturates within the medical distribution system. In 1970, barbiturates (and the considerably lesser used barbiturate substitutes) accounted for over 25% of the total prescriptions issued for psychoactive drugs. Only the minor tranquilizers, with 38.8%, were higher. Forty million barbiturate prescriptions were issued in 1971-22 million of them for refills of old prescriptions (Brecher, 1972 ; Aston, 1973) .
Because of their sedative powers barbiturates have long been important therapeutic agents, but their use, if not closely supervised, can lead to serious problems. Heavy repeated doses result in sustained stupor, and sudden withdrawal from chronic use can be hazardous. Moreover, the danger of an overdose is greater with barbiturates than with any other psychoactive substance. This danger is aggravated when the barbiturate user also drinks, since alcohol and barbiturates potentiate each other's effects on the central nervous system (Aston, 1973)
In addition to the hidden medical use problem, the Commission has found a significant increase in street use of barbiturates in recent years, particularly among adolescents, though accurate statistics do not exist. Because of both the medical and street problems with barbiturates, a strong argument has emerged that these drugs should be moved to Schedule II control, as the amphetamines have been.
The Commission agrees that something must be done quickly about the misuse of barbiturates, but we have grave doubts whether rescheduling the drugs, as was done with the amphetamines, will be effective. In the first place, rescheduling is unlikely to have a substantial effe .t on street use. There is no conclusive evidence that street drugs are being diverted from the manufacturing and wholesaling levels. In his testimony before the Commission; in Washingon, D.C., on July 19, 1972, John E. Ingersoll, Director of the Federal Bureau of Narcotics and Dangerous Drugs stated :
We have, for many years, attached greatest importance to the amphetamine and barbiturate drugs in the belief that they constitute the principal targets of diversion. Various statements have been made by both private and government authorities that as much as 50% of the total drug production of these substances is diverted into illicit channels.
On the basis of the single scientifically based study which had been made, this appears to have been an exaggeration. Dr. Joseph Greenwood of our Bureau's scientific staff began the first systematic collection and analysis of data for these drugs relating to their distribution for calendar year 1967 ; and that was prior to the existence of the number of regulatory controls which now exist.
This study ... has provided some rational basis for our assessments. In accordance with its findings, approximately 20% of the total amphetamine production was unaccounted for and, therefore, presumed to have been diverted.
In contrast, approximately 3.1% of the barbiturates production was unaccounted for. But here, the equation is somewhat more complex. If we select only the figure which represents the conversion of barbiturate compounds into medical dosage forms, we find the percentage of unaccountability rises to 6.5%.
We may observe, in this connection, that barbiturate compounds as a class are far more diversified than are amphetamines, and many have virtually no history of abuse whatsoever.
Available data indicate that thefts at the retail level and "diversion" from the home medicine chests may account for some of the barbiturates on the streets; how much is unclear (Ingersoll, 1972). Rescheduling might curtail youthful experimentation with barbiturates from the family medicine cabinet; otherwise, it should have little effect on street use.
Since the quotas required by Schedule II are a function of medicinal use they will also have no substantive impact on medical availability of barbiturates. Most important, imposing higher controls upon barbiturates would significantly raise their price to lawful users, and could interfere with their legitimate medical uses. For example, barbiturates remain the medical drug of choice for chronic insomnia, a condition which, left untreated, causes a general deterioration in physical and mental health. In addition, they are commonly used to reduce anxiety in cases of peptic ulcer and high blood pressure. Drugs that might substitute for barbiturates are often less effective and present the same kinds of risks. Moreover, the volume of legitimate mediml use of barbiturate compounds is so great that rescheduling will place a serious burden on the control mechanism, inevitably weakening administration of controls on the other Schedule II substances (Mc3rrew, 1973).
The only effective step to reduce the hidden barbiturate problem is levelopment of restraints on prescription practices within the medical )rofession itself. This can be accomplished either by tightening conrols and moving the barbiturates into Schedule II or by the American Medical Association's taking the lead and creating prescription guideines. Either action is likely to impress upon physician and patient he risk potential of these drugs and close the gap between perceived .angers of medical drugs and those of illicit drugs.
This decision was one of the most difficult which the Commission faced. The great harm which misuse of short-acting barbiturates now causes weighed very heavily with us. At the same time, recognizing the negative implications of applying stringent Schedule II controls over widely used therapeutic agents, such as the barbiturates, as compared with the less medically used amphetamines, coupled with our preference for voluntary private action whenever that can effectively serve in place of formal governmental intervention, argued for an initially less restrictive alternative. After long and hard deliberation, the Commission does not recommend that any of the barbiturate drugs, including the short-acting barbiturates, be placed in Schedule II of the Federal Controlled Substances Act at this time. Instead, the Commission recommends that the AMA immediately design and furnish to physicians guidelines on the prescribing of barbiturates and actively encourage state medical societies and individual practitioners to respect these guidelines.
If, after a reasonable period of time, such guidelines prove ineffec • tive then the responsible federal agencies should consider increasing control over the prescribing of these drugs. The Commission cautions, however, that any prospective controls should be enforced cautiously so as not to hinder legitimate therapeutic uses. The public should be informed about the relative ineffectiveness of such controls on the illicit production of barbiturates and on the street use of those substances.

Non-Barbiturate Sedatives
For the most part, the social cost of the non-barbiturate sedatives is significantly lower than that of the other CNS depressants. However, there is one important exception—methaqualone—which is not even classified as a controlled substance and, therefore, is subject only to a minimal level of control. The risk potential of methaqualone is roughly equivalent to that of the short-acting barbiturates. Moreover, recent evidence indicates that illicit use of this too easily obtained substance is increasingly common among adolescents and has become a significant problem in a number of locations (Pascarelli, 1973). Since, unlike the barbiturates, methaqualone does not have large-scale medical uses, the Commission recommends that it be placed in Schedule II, along with the amphetamines.
The other barbiturate substitutes are already included in Schedules III and IV of the Controlled Substances laws. None of them poses a problem of irresponsible use at the present time, and the Commission advises no change in the control of their availability.

Minor Tranquilizers
One class of depressants, the so-called minor tranquilizers, is controlled only minimally through restrictions which apply to all prescription drugs. The Bureau of Narcotics and Dangerous Drugs, though, has recently completed administrative action to include two of these substances—chloriazepoxide (Librium) and diazepam ( Valium)—in Schedule IV. Since this decision is now under court review, the Commission will not express an opinion as to the proper outcome of that case.
We will note, however, our findings with respect to these drugs. At present, they are the most widely prescribed psychoactive substances in the world, utilized for a wide spectrum of legitimate medical purposes and generating a combined total of $200 million in retail sales each year. Despite the fact that these drugs are sometimes found on the streets and that approximately 6% of the adults and 3% of the youth have used them for self-defined purposes (Abelson, et a1.,1973), their important medical uses and low dependence liability point away from overly rigid control.
At the same time, the Commission feels the use of these drugs deserves policy-making attention, because of their prevalence in circumstantial drug use. One of our major concerns about this particular kind of drug-taking behavior is the possibility that it may become a conditioned response to personal anxieties. If the discouragement policy is to be taken seriously, the medical system must cease to encourage any automatic association in the public mind between a pill and peace of mind. Neither the public nor the medical profession should treat any effective psychoactive substance as harmless or routine.
While we defer to the judiciary on whether chloriazepoxide and diazepam should be controlled under the Federal Controlled Substances Act, we do think that the review of their status was timely and necessary. Accordingly, the Commission recommends that the appropriate federal agencies conduct studies on all other ethical hypno-sedative drugs not presently covered by the Controlled Substances Act to determine whether or not further controls are required.

Hallucinogens
The availability decision with regard to the hallucinogenic drugs, such as LSD, DMT and DET, involves a delicate balancing of concerns. On the one hand, these drugs have a low dependence liability, and their widespread use would not involve a social cost as heavy as that associated with use of the CNS depressants or stimulants. On the other hand, while hallucinogens, with a few minor exceptions, have no recognized medical utility, 5% of the adult population and 5% of the youth have run the already identified psychological risks inherent in the hallucinogen experience (Abelson, et al., 1973) ; and much more remains to be learned about the effects of these substances.
Without belaboring the issue, the Commission believes that the same considerations which argue against institutionalization of availability of marihuana apply more strongly to the hallucinogens. Only within the last decade have these drugs been used on any significant scale in American society, and their use tends to be age-specific and transitory. Data presented in Chapter Two suggest that the incidence of experimentation may have already peaked, indicating the same transience which may characterize the marihuana phenomenon.
Finally, the combination of scientific uncertainty about the effects of these drugs, together with the inability of present availability models to structure the use experience, dictate caution. If a non-medical availability model were chosen for these drugs, it would have to differ substantially from the present alcohol scheme. An appropriate third-party expert would be needed to determine whether the potential consumer could handle the experience and to structure it for him. As we suggested in our first Report, possible regulatory mechanisms for channelling the availability of psychoactive drugs for self-defined purposes have not yet received adequate study. Until this area is given detailed and thorough scrutiny, institutionalization of any more psychoactive substances would not be in the public interest.

Marihuana
As promised in our first Report, the Commission has reviewed all of its findings and recommendations during this past year. We reaffirm our conclusions and recommendations .5 The risk potential of marihuanà is quite low compared to the potent psychoactive substances, and even its widespread consumption does not involve the social cost now associated with most of the stimulants and depressants (Jones, 1973 ; Tinklenberg, 1971) . Nonetheless, the Commission remains persuaded that availability of this drug should not be institutionalized at this time.
The Commission's 1972 National Survey data suggest that the incidence and prevalence of marihuana use may indeed be peaking. Uncertainty about long-term effects of heavy use continues. Lastly, it is painfully clear from the debate over our recommendations that the absence of a criminal penalty for private use is presently equated in too many minds with approval, regardless of a continued prohibition on availability. The Commission regrets that marihuana's symbolism remains so powerful, obstructing the emergence of a rational policy.

Alcohol
Society at present pays a heavy price for the widespread availability of alcohol. The social costs of long-term, heavy use are much higher than any other drug "problem" we have.
The Commission does not believe that it is realistic to reconsider prohibition of availability for self-defined purposes. This country's earlier experiment with such controls amply demonstrated that they are ineffective and extremely costly. Impracticality of strict control, however, does not argue for a system of controls so lax and haphazard that heavy use is in no way discouraged and in some cases even encouraged. Without reviving Prohibition, society can demonstrate to users that alcohol is not an ordinary commodity but, rather, is a powerful psychoactive drug.
The Commission recommends that the National Institute on Alcohol Abuse and Alcoholism devote susbtantial effort to the development of better non-prohibitory means of controlling the availability of alcohol. In particular, society should alter availability controls to minimize the social costs of alcohol use.

IMPLEMENTING RESTRICTIONS ON AVAILABILITY

Throughout most of the history of this country's regulation of psychoactive drugs, certain cycles have been evident. First, restricting lawful production and distribution of a particular drug is emphasized. When this has been achieved, the government has either ignored the situation for a time or turned its attention directly to the user. Law enforcement agencies, particularly federal agencies, have steadily tried to disrupt illegal manufacture and distribution, but until very recently their efforts, both in size and in result, played a small part in drug policy. International drug regulation has shown the same pattern : the Single Convention on Narcotic Drugs and the proposed Convention on Psychotropic Drugs deal with the restriction of licit production and manufacture. Under the aegis of the United Nations Commission on Narcotic Drugs, there have been arrangements for exchange of information on illegal trafficking and occasions of bilateral and multilateral cooperation ; but international treaties have had no major or
continuing impact on illegal trafficking.
In addition, the enforcement of availability controls, like the level of social response in general, has oscillated with the degree of public concern at a given point in time. Control agencies have tended to operate at two speeds, crisis and complacency, making long-term strategies difficult to achieve or predict. Enforcement has also followed public sentiment in determining what drug to control most actively. Agencies have gone through periods of emphasis on heroin, marihuana, heroin again, amphetamines, hallucinogens, marihuana again, and now heroin a third time, with cocaine and barbiturates thrown in for good measure.
The current period of intense control, however, is different from earlier ones in two important ways. First, it has involved virtually all of the psychoactive drugs (except alcohol) in rapid progression : hallucinogen use by college youth simultaneously with marihuana use by virtually all segments of the population ; street amphetamine use, including intravenous use ; heroin use ; and barbiturate use among youth. Cocaine consumption may also be increasing, although that drug has rarely been the subject of serious concern since the early 192025 6 (Woods and Downs,1973) .
The current response also differs in the emphasis placed on enforcement of availability proscriptions. In earlier periods of elevated public concern, policy makers almost invariably responded to the problem of supply by tightening controls on lawful distribution and increasing the penalties for illegal trafficking. Law enforcement agencies may have received funds for a few additional investigative personnel, but apparently controls were assumed to be self-effectuating.
Now, the Government has begun to increase the vigor of law enforcement rather than concentrating entirely on the rigor of the laws. Enforcement resources have multiplied several-fold. In five years, Federal expenditures for law enforcement have gone from a total of $20.5 million to over $225 million. The Bureau of Narcotics and Dangerous Drugs alone has more than quadrupled its budget since 1969. (See Table IV-2)
Agencies have also developed new strategies of enforcement and recruited high-calibre personnel. Projects are underway to enhance cooperation between state and federal control agencies and between agencies in this country and in others.
The Commission commends this new approach. It will test, for the first time, the efficacy of availability controls in reducing use, because for the first time enforcement agencies have resources adequate to their assigned tasks. At the same time, we are concerned that expectations for the current effort are too high. The assumptions that underlie the present approach need closer examination.


Official spokesmen often say now that control of supply is the key to the problem of use, a conclusion they seem to reach from the observation that if drugs are not available, they cannot be used Like most tautologies, this one is not really helpful. It assumes that the desired restriction of availability can be completely achieved, that increasing enforcement effort reduces supply proportionally and that at some point law enforcement can eliminate the illicit supply altogether.
To support these assumptions, rising statistics of drug arrest and drug seizures are often cited. In 1971, for example, there were an estimated 500,000 arrests for violations of state and federal drug laws, approximately a 400% increase since 1967 (Federal Bureau of Investigation, 1972). Seizures, naturally, increased too. In 1971, federal agencies removed from the illicit market over 1,500 pounds of heroin, triple the amount of the year before (Bureau of Narcotics and Dangerous Drugs, 1972) .
These figures are dramatic, but they do not really tell what is happening. Increased numbers of arrests may simply mean more violators, rather than more effective enforcement. Similarly, the quantities of drugs seized may reflect only the size of the illegal market. It is possible, in fact, that law enforcement efforts are not even keeping up with the illicit trade. The volume of illegal drugs sold and used may be increasing even faster than the number of arrests and seizures. Drug availability on the illicit market, according to most law enforcement officials, has not appreciably declined.
Because gross enforcement statistics by themselves show nothing, we have not included them here. The Commission did, however, conduct extensive studies of drug arrests during 1971, both at the federal level and in six major urban jurisdictions.' These research projects were designed to probe the actual meaning of drug arrest statistics, going as far behind them as the available data would permit. Detailed reports of the results of our studies are contained in the Appendix to this Report.
Even this research was not able to determine whether, as some have put it, law enforcement is "winning the war on drugs." The studies did show that, at the local enforcement level, about 80% of the arrests were for consumption offenses, not trafficking offenses, and that few trafficking arrests involved more than small amounts (Johnson and Bogomolny, 1973). Moreover, the data indicated that local enforcement entailed little or no investigation; most of the arrests seemed to result from spontaneous encounters between offenders and the police. This is not surprising in light of limited law enforcement resources and the difficulty of investigating drug cases. It does suggest, though, that local law enforcement is only keeping pace with the growing traffic in and use of illicit drugs.
One reason for the lack of better quality cases at the local level is the insufficiency of funds ("buy money") necessary to purchase drugs from illicit dealers. One of the common methods of apprehending large scale traffickers is to make larger and larger drug purchases while insisting upon dealing with persons higher up the ladder as the size of the purchase increases. In this fashion, penetration of the selling organization and ascension within its ranks is achieved.
This method is often used by federal law enforcement, which has greater resources available to it. For lack of these resources, it is not often utilized by state and local authorities, except in New York state, where it has met with some success. On occasion, and within its own fiscal capabilities, BNDD has supplied "buy money" to local authorities. BNDD makes an admirable effort, but it cannot provide the funds required to capitalize on all local investigative opportunities on a nationwide basis.
Therefore, the Commission recommends that the federal government make available to state and local law enforcement, through the Law Enforcement Assistance Administration, substantial amounts of "buy money" to enable them to make better quality cases and reach the higher echelons of the illicit drug traffic.
At the federal level, the drug arrest data, though still ambiguous, was somewhat more encouraging. Arrests by the Bureau of Narcotics and Dangerous Drugs are almost always investigative, and the vast majority of arrests were for trafficking offenses. The study showed that BNDD was and is, as it has claimed, concentrating on heroin and cocaine trafficking and having considerable success in obtaining convictions. Nonetheless, many of the cases resulted in relatively small seizures of drugs, suggesting that even the resources of the federal government are hard pressed to overcome illegal trafficking.
The Commission believes that law enforcement, particularly at the federal and state level, should concentrate on trafficking rather than use and that the traditional approach to drug possession offenses must change. Yet, we caution against the facile argument that law enforcement agencies, relieved of enforcing possession laws, will then succeed in quashing illicit supply.
Because the drug dealer and his user-victim share a community of interest, drug trafficking offenses are highly resistant to traditional law enforcement techniques. Techniques that do work against it are more expensive, more time-consuming and more likely to conflict with other societal values. At best, law enforcement can reduce the illegal supply of drugs, partly by eliminating some of the drugs and some of the dealers, partly by imposing additional costs on suppliers and thereby increasing the price to users. Yet, even this limited result involves substantial cost, not only in terms of resources spent on enforcement but also in terms of the disadvantages of having an illegal drug market charging relatively high prices for its commodity.
Under certain conditions, perhaps, law enforcement alone might eliminate the illicit market in drugs. To achieve this, though, would require, at the least, multifold increases in manpower, a suspension of Fourth Amendment restraints on police searches, seizures and wiretaps, wide-scale pretrial detention, abolition of the exclusionary rule and broader controls so extensive that they would substantially hinder foreign commerce. Despite the country's passion to stop illegal drug use, not one of these measures would be acceptable. For this reason, the public must recognize that the police cannot be blamed for the availability of prohibited drugs.
The remaining hope of eliminating the illegal market is to join vigorous enforcement of the trafficking laws with some effective program of reducing demand for drugs. Possession laws may have reduced demand some, but they have not been able to deter large numbers of persons from using, especially in the case of marihuana. The fact remains that neither the problem of supply nor the problem of demand can be solved by criminal laws. Long-term strategies must be devised for dealing with prevention as well as enforcement.
For example, the Commission considered why, with heroin use so widely condemned, an illicit heroin market flourishes. A study of this question called our attention to an economic fact of life in the inner city which may in part explain this phenomenon—the underground welfare system. The obvious negative aspects of heroin dependence for the community are offset to some extent by unexpected benefits. The need to steal creates a second illicit market, in which persons in the lower socio-economic strata of our society can purchase stolen goods, such as televisions, radios, food, clothing, automobile tires, at reduced prices. The compulsive drive of a large heroin-dependent population assures a constant supply of goods.
While a stolen goods market existed before widespread heroin use, and certainly would continue after use subsides, the extent of the current heroin problem has increased both the size of the market and the certainty of its supply. While the underground system is deplorable, society must recognize that it exists and seek to replace it with something better. Disregard of a phenomenon upon which, rightly or wrongly, a segment of our society relies could create problems in other social areas which seem logically unrelated to heroin dependence.
The Commission does believe that increased and improved enforcement of availability restrictions is a necessary part of dealing with the drug use problem. In the following pages, we have set forth a number of specific recommendations to enhance present efforts. The Commission urges policy makers and public agencies, however, not to overstate the possible outcome. The public must appreciate what enforcement can do and what it cannot; no program or policy should be advertised as a panacea.

The Role of International Agreements

The present system of international drug treaties and conventions is not self-enforcing; how well international controls work depends solely on how well each member nation enforces them in its own territory. With agricultural products, such as the opium poppy, the coca bush and the cannabis plant, the difficulties of keeping drug products out of illicit channels are great, regardless of whether or not a government registers and supervises its domestic growers pursuant to international law. In countries whose economies are primitive and whose central governments often have little actual power in the hinterlands, control of supply becomes impossible.
In our visits to 36 countries, the Commission observed that in some nations, the production of opium, coca leaves and cannabis, though illegal, is an integral part of the domestic economy. Moreover, for parts of these populations, smuggling is a way of life, and the official bribe is simply a cost of doing business. Where such conditions exist, multi-national or bi-national efforts to eradicate illicit cultivation, transshipment and exportation will have limited utility.
As one of our consultants noted in discussing opium controls, "It is obvious that problems of this kind cannot be solved by treaty provisions nor by national laws controlling or prohibiting opium production" (Lande, 1973). He felt the same way with respect to coca leaves:
The cultivation of the coca bush and the production of coca leaves are nowhere effectively controlled. Clandestine manufacturers of cocaine have no difficulty whatsoever in obtaining the coca leaves which they need (Lande, 1973).
With marihuana, there is no hope whatsoever of extinguishing cultivation. The plant grows wild almost everywhere and is cultivated in many countries for non-medical purposes (for example, India) and industrial uses ( for example, in 1970, European countries cultivated 94,000 hectares, yielding 82,800 metric tons of hemp fiber). "It is submitted that it would be unduly optimistic to assume that one could in the foreseeable future suppress the illicit traffic by a universally accepted and applied international regime adequate for this purpose" (Lande, 1973).
In reality, the present system of international controls, principally the Single Convention on Narcotic Drugs, deals most effectively not with the illicit traffic, but with the lawful production and manufacture of these substances. This aspect of international control depends more on economics than on prohibitions and appears to work reasonably well. Yet, many public spokesmen give the impression that treaties such as the Single Convention suppress illicit trafficking. Such misrepresentations should cease since they raise false expectations and detract from the actual value of international agreements.
The Commission supports continued multilateral international efforts to control the production and manufacture of drugs, such as opium, cocaine and cannabis; however, we believe that strengthened bilateral agreements with individual source nations will prove more useful in reducing the illicit traffic. In this regard, the Commission recommends that the State Department, in conjunction with the Department of Justice, immediately undertake a comprehensive review of existing extradition treaties dealing with drug offenses with a view toward expanding the scope of extraditable offenses and facilitating the extradition process. Drug traffickers must not be able to flee to "safe" countries and avoid prosecution for acts committed here. Recently, the State and Justice Departments have succeeded in bringing several major traffickers to this country for prosecution, but more needs to be done. The Commission feels this is a high priority item, requiring vigorous diplomatic efforts.
The Commission further recommends that the United States encourage law enforcement agencies in all concerned countries to increase both formal and informal exchanges of information concerning drug traffic and traffickers. At the present time, investigative agencies share information only on a case-specific basis. The Office of National Narcotics Intelligence of the Department of Justice should encourage all foreign law enforcement agencies to share information routinely, perhaps on a regional basis.
In terms of day-to-day enforcement policy by the United States in other countries, lines of responsibility should be more clearly defined. Since enforcement efforts may have ramifications in other spheres, including commerce, finance and agriculture, the State Department should coordinate all enforcement activity by BNDD, Customs, AID and other agencies on foreign soil. The ambassador should have final authority over day-to-day tactical decisions which have diplomatic overtones, while Washington should define overall enforcement strategy.
In framing enforcement strategies overseas, federal enforcement officials should recognize that no eradication program will successfully eliminte opium, cocaine or marihuana. At best, the United States may reduce somewhat the supply of drugs entering the international illicit market and, therefore, reduce the supply entering this country. Some law enforcement resources may be profitably spent in improving police and drug enforcement capabilities in indigenous drug-producing countries in order to reduce the amount of drugs entering the international traffic and, therefore, finding their way into our domestic market. The interception of a pound of heroin in Thailand or a pound of cocaine in Peru is simply a more cost-effective way of reducing the illicit supply for our country than by trying to seize that same pound after it has been cut and "retailed" to users in New York City or Chicago.
As another example, Colombia, with a coastline on two oceans, is a natural transit point for illicit drugs originating in South America destined for the United States. Yet, Colombia's Customs Service has only 12 patrol boats, six of which are not operational, five more of which have only one of two motors operational. From a cost-effectiveness standpoint, increasing the Colombian capability to intercept the drugs in Colombian waters might well repay the cost to this country by eliminating the need to find the same drugs after their arrival in New Orleans, Miami or New York.
Additionally, the Commission observed in its travel overseas the intense interest on the part of foreign police agencies for more drug law enforcement training assistance. Presently such training is being conducted by the Federal Bureau of Narcotics and Dangerous Drugs. Since it benefits the overall national drug enforcement effort to offer such technical assistance, the Commission feels that the training being performed by BNDD is useful and should be continued and, if possible, expanded.
A major deficiency in the present system of international regulation is that little attention is given to measures which might be taken, internationally, to reduce demand for psychoactive substances. That the United Nations Commission on Narcotic Drugs is comprised primarily of representatives of law enforcement agencies reflects its supply-only orientation. The Commission feels that problems of drug use prevention and education, treatment and rehabilitation also merit discussion and consideration at the international level. The Commission recommends that the membership of the Commission on Narcotic Drugs be expanded to permit representatives of the health authorities of member nations equal participation in its deliberations and decisions. In this regard, the Commission further recommends that the United States, in cooperation with the United Nations, convene a worldwide conference to consider the issues surrounding prevention of demand for drugs.
If international controls do too little in some areas, they do too much in others, intruding upon national sovereignty. The international control system should not dictate how participating nations deal with the use of drugs within their own borders. Too often treaties and conventions have been consciously utilized as a method of foreclosing policy options at home and circumventing the usual and proper legislative processes. In the future, treaties and conventions should not contain provisions which infringe upon national sovereignty in this manner, and such provisions in present agreements should be removed.
In particular, the Commission recommends that the Single Convention and the proposed Psychotropic Convention be redrafted to make clear that each nation is free to determine for itself which domestic uses for controlled substances it will allow, provided only that each nation prevent diversion, prohibit exportation and production for exportation for illegal use in other countries.
The current restriction on availability of controlled drugs to medical and scientific purposes should be replaced by a broader provision which would permit each nation to define what kinds of domestic use are legitimate. Provided every national regulatory scheme prevents diversion and exportation for illicit uses to other nations, international obligations should be considered satisfied.
To maintain the current medical use limitation is to prepetuate a charade, for even now each nation can define its lawful uses as "medical," though others do not concur in its judgment. For example, Great Britain has employed opiate maintenance as a form of medical treatment for many years while the United States consistently rejected t on several grounds, including its putative inconsistency with the single Convention. Now, this country has adopted a methadone mainenance system, which it has also defined as a "medical use."
Further, the Single Convention recognizes the validity of nonmedical use of drugs by exceptions which permit use of certain substances for recreational purposes. For example, bang/i, a cannabis beverage, is lawful in India, as is mate de coca, or coca leaf tea, in Bolivia and Peru ; as long as these products are not diverted or exported into other countries, where similar use is illicit, the international community accepts such uses.
It is particularly important that international controls not interfere with legitimate scientific and medical research. Certain drugs, for example, have become difficult to obtain for research purposes ; recently representatives of several countries complained they were unable to secure enough legitimate opium to satisfy their scientific needs. The Commission urges that the international system of controls promote needed research and establish an environment in which the responsible researcher can function unimpaired by needless restrictions.
Measured by these principles, the Psychotropic Convention, adopted in Geneva in March 1972, has a number of important defects and should not be ratified in its present form. First, the new Convention goes beyond the Single Convention in placing undue restrictions on legitimate research. Second, it would demean the role of the World Health Organization by providing that the International Commission on Narcotic Drugs could completely ignore the advice of the World Health Organization in scheduling decisions; this is again contrary to the structure of the Single Convention which allows the Commission on Narcotic Drugs to accept or reject the World Health Organization's recommendations but not to adopt courses of action contrary to them. Third, and most important, the Convention would interfere improperly with United States domestic law, imposing record-keeping requirements contrary to those in the Comprehensive Drug Abuse Prevention and Control Act of 1970 and possibly placing drugs under domestic control without the approval of the Secretary of Health, Education, and Welfare.
The Commission strongly recommends that the United States not ratify the Psychotropic Convention in its present form. If, however, for diplomatic or other reasons, the United States government does adopt the Convention, the Commission urges that the instrument of ratification include the following declarations:
• That it is the understanding of the United States that scheduling decisions adopted by the Commission on Narcotic Drugs and ratified by the membership are not effective within the United States until and unless the procedures established by Section 201 of the Comprehensive Drug Abuse Prevention and Control Act (PL 91-513) are complied with and the Secretary of Health, Education, and Welfare and the Attorney General of the United States agree that the substance is subject to control.
•    That it is the understanding of the United States that the provisions of the Convention do not affect the manner in which the United States restricts availability of substances included in the Convention to medical and scientific purposes.
•    That it is the understanding of the United States that the definition of punishable offenses in Article XXII, paragraph 1, sub-paragraph (a) does not include possession of substances in Schedule I for personal consumption.
•    That it is the understanding of the United States that in Article VII, paragraph (a), the word "establishments" contained in the phrase "in medical and scientific establishments which are directly under the control of their government or specifically approved by them," includes the offices of physicians licensed to practice under the law of the United States.
The Commission also feels that the Department of Health, Education and Welfare has so far played too insignificant a role in the international drug control system. Too often, the Department's only contribution has been to comment on actions proposed by agencies directly participating, the Bureau of Narcotics and Dangerous Drugs and recently, the Department of State. We encourage the Department of Health, Education, and Welfare to develop the necessary legal expertise in the area to exercise a meaningful and coordinate role with the other departments involved.
Finally, the Commission recommends that the United States take the necessary steps to remove cannabis from the Single Convention on Narcotic Drugs (1961),, since this drug does not pose the same social and public health problems associated with the opiates and coca leaf products. Moreover, if the Psychotropic Convention is adopted, retention of the natural plant products of cannabis in the Single Convention, while its synthesized and concentrated active ingredient, tetrahydrocannabinol, is controlled under another system, would be an anomaly. Accordingly, the Commission further recommends that the proposed Psychotropic Convention be revised to include all cannabis substances, but not under Schedule I, since cannabis products are used for medicinal or self-medicating purposes in many parts of the world.

Federal Enforcement Policy

In the federal system of control, one agency, the Bureau of Narcotics and Dangerous Drugs 8 is primarily responsible both for regulating lawful production and distribution of controlled psychoactive drugs and for enforcing laws against illegal trafficking. These two activities, though related in purpose and hopefully in effect, are by nature distinct; they employ different . kinds of techniques and require different kinds of skills. Regulation involves inspection and auditing; since it deals with lawful enterprises, there is considerable cooperation from the businesses regulated. Enforcement of trafficking laws, on the other hand, is criminal investigation work of the most difficult type. It involves covert operations, often carried out at considerable risk to the agent. Absolutely no cooperation can be expected from the other side.
Practically, then, the two functions should be operationally separate from each other and organized according to different principles. For example, the regulatory function can be set up in regional and district offices, since the geographical distribution of lawful drug manufacturers and and suppliers does not vary greatly over a long period of time. A criminal investigation, on the other hand, may lead all over the country, requiring greater mobility and flexibility in the investigating unit.
President Nixon, in his July 14, 1969, drug message to the Congress, proposed mobile criminal investigative strike forces. The Commission supports this. approach but would broaden it to include all criminal investigative units and would closely coordinate the investigative units of BNDD with the prosecutorial arm of the Department
of Justice. The Commission recommends that the criminal investigation activities at the federal level not have regional offices, as BNDD and Customs now do, but instead deploy strike forces, not tied to any one region, which are able to follow the illicit distribution networks wherever they lead. These units could react quickly to changing trafficking patterns, drawing the necessary administrative support from the regulatory regional office in the area where they were working. Further, the coordination of investigative and prosecutorial strategies should enhance federal efforts against major traffickers. It should be noted that this approach is presently in effect, to a limited extent, in the Office of Drug Abuse Law Enforcement.
The Commission also recommends that federal investigative agencies concentrate primarily on the top of the illegal distribution network: importation, exportation and large volume foreign and domestic traffic. This part of the trafficking enterprise is national and international in scope, and state agencies are incapable of dealing with it : only the federal government has the breadth of jurisdiction and resources necessary to the task. As mentioned earlier, intensified overseas activities, including mutual exchanges of information, supportive training and financial assistance to other national police agencies, would be helpful in this effort. Enforcement should emphasize the interception of illegal heroin and cocaine, since these two drugs carry the heaviest potential social costs. If trafficking in illegally-produced amphetamines and barbiturates were to increase significantly, it should also receive special attention.
To deal more effectively with the higher levels of the illegal distribution system, the Commission recommends that federal law enforcement develop long-range strategies. The degree to which an investigation can penetrate the illegal market depends directly on how long it remains undercover before surfacing to make arrests and obtain convictions. Investigations of several months or even several years appear necessary simply to reach the middle level of the illicit distribution chain; the extreme precautions which surround high level drug dealing will make progress further up the chain even more time-consuming. In some cases, agents will have to stay undercover for periods as long as three to five years if they hope to infiltrate major illicit drug networks. The Commission is convinced that more major trafficking cases will be developed if a commitment to such long-range strategies is made.
The Commission also urges development of innovative legal mechanisms and approaches to deal with drug trafficking. One of our consultants, for example, proposes that the civil injunction, so often employed in civil rights and antitrust actions, might also be effective against illicit drug dealers (Flittie, 1973) . He points out the difficulty 4f proving a criminal case against a major trafficker and argues that civil sanctions, which require less conclusive evidence, could deter illicit supply equally as well. Innovative ideas should receive serious stte}ntion from policy makers, and, if promising and constitutionally permissible, they should be tried.
The Commission recommends that the federal regulatory effort on preventing diversion at the manufacturing and wholesale levels, leaving to the states primary responsibility for supervising retail pharmacies, hospitals and physicians. This division of tasks between state and federal agencies parallels that in the area of criminal investigation and reflects the superior capacity of the federal government to deal with national and international enterprises, while the states, given federal financial assistance, can better police the local levels of distribution.
The most important factor in the success of any enforcement agency is the calibre and training of its personnel. The Commission recommends that recruitment of qualified investigative agents be given high priority and that the screening of such recruits include testing to insure suitability for this type of enforcement. The greatest need is for young, college-educated personnel, both men and women, who have a broad understanding of the social context of drug use. The Commission also recommends that federal law enforcement personnel receive more intensive training and that career agents periodically take refresher courses to keep them abreast of current trends. Plans which would send federal criminal investigators back to training courses for extended periods of time to prepare them for higher supervisory or management positions, similar to Department of Defense career officer training programs, could serve as models for a continuing education and training program for law enforcement personnel.
With regard to career development, the Commission notes the unfortunate tendency to promote first rate criminal investigators into supervisory positions simply because of their past performance as investigators. Too often, this only exchanges a good investigator for a mediocre administrator. The Commission recommends that agencies encourage skilled criminal investigators to remain in the field, giving them equal promotion opportunities within the investigative area.
One especially unfortunate personnel problem in criminal drug investigation is the danger of corruption. Agents inevitably become closely acquainted with many of the subjects of their investigations; they are also aware of the immense profits made in this form of commerce. Often, too, their job is frustrating and thankless : convictions are difficult to obtain and frequently their efforts seem futile. Few federal agents actually succumb, but even the suspicion of corruption can be severely damaging to a law enforcement agency. To minimize both dangers, the Commission recommends that a separate unit be established to maintain internal security among federal drug law enforcement agencies. This unit should be distinct from all other law enforcement activities and report directly to the Attorney General of the United States.
The Commission also recommends creation of a separate evaluation unit, distinct from both criminal and regulatory investigative units, to monitor performance of all operational units. In order to facilitate evaluation, case reporting for all drug investigation should be standardized and digested in a form amenable to critical analysis. The Commission reaffirms its recommendations in the first Report that all federal law enforcement agencies, especially the Bureau of Narcotics and Dangerous Drugs and the Bureau of Customs, use uniform reporting forms to the maximum extent possible, so that the information can be combined, studied, and shared. Both agencies have susbtantially improved the form and substance of their records during the past year, but reporting requirements are still incomplete, particularly with respect to reporting circumstances of detection and arrest.
The Commission also recommends that the federal government provide state and local agencies technical and funding assistance necessary for the development of a national uniform reporting system on drug arrests and case dispositions which can provide reliable, valid and comparable data. The Commission found serious discrepancies between drug arrest statistics reported by some police departments to the Federal Bureau of Investigation for inclusion in the Uniform Crime Reports and the statistics in the same departments' own records. (Apparently, police departments are still confused about the exact meaning of the UCR drug categories.) More surprising, sections within a single police department sometimes report different sets of drug arrest statistics.
With respect to the drug trafficking laws themselves, the Commission recommends retention of the trafficking offenses and penalty structure presently in force under the 1970 Comprehensive Drug Abuse Prevention and Control Act. The Commission notes that some officials have proposed a return to mandatory minimum penalties, which were abandoned for the most part in the 1970 Act. In our view, this would return the drug use prevention effort to relying on fierce words in statute books, in place of constructive action. Laying aside the question whether any definable class of offenders invariably deserves such cruel punishment, the Commission feels that no criminal law, regardless how severe, will deter unless its enforce- ment is speedy and fairly certain. With effective enforcement, on the other hand, even relatively short prison sentences have a strong prac- tical deterrent effect.
Moreover, many who have studied this country's earlier experience with minimum mandatory sentencing provisions believe they can actu+ ally impede enforcement, if applied literally. Because they burden the judicial system with increased numbers of jury trials (defendants being understandably reluctant to plead guilty to offenses with minimum mandatory sentences), and because they may frequently result in palpable injustices, both courts and prosecutors apparently tried on many occasions to avoid their impact (King, 1972).
Statistics on Federal drug defendants and the disposition of their cases during the period 1945-1972 gives some credence to these criticisms.9 Congress first introduced minimum mandatory sentences for second and subsequent offenses in the "Boggs Act" in 1951. Five years later, Congress increased the minimums, and made them mandatory for all but first offense possession. The Comprehensive Drug Abuse Prevention and Control Act of 1970 finally repealed the minimum mandatory provisions for offenses occurring after April 30, 1971, with one narrow exception for "continuing criminal enterprises."
The federal defendant statistics suggest that the harsher penalties did cause changes in case dispositions, but not always the ones anticipated. For example, after passage of both the 1951 and 1956 Acts, there was only a slight decrease in the number of defendants receiving fines or probationary sentences. In fact, despite minimum mandatory provisions, the number of non-incarcerative sentences began to rise in the early and middle 1960's. Long sentences for drug offenses (five years and over) did increase noticeably after 1951 and 1956. In the period 1952 to 1956, though, sentences of less than a year and a day diminished, while after 1956 the proportion of defendants receiving sentences of one to five years decreased. This suggests that the main effect of the laws was to ensure that defendants who would have gone to prison anyway spent longer periods of time there.
Since repeal of the mandatory minimum provisions, the number of federal drug offenders (excluding those charged solely with marihuana offenses) who have received sentences of five years and more has actually grown though the proportion has diminished. In both absolute numbers and percentages, the number of defendants (again excluding marihuana defendants) who received three to five year sentences has increased.
Most important, perhaps, is the apparent effect of penalty changes on plea bargaining. After the 1951 legislation, the number of drug defendants pleading guilty or nolo contendre lessened significantly, roughly doubling the number of jury trials required. Since that time, the proportion of defendants pleading seems to have remained relatively constant, unaffected either by the 1956 Act or by the repeal of minimum mandatory sentences in 1971. These data would seem to contradict those who argue that harsh sentences encourage plea bargaining. Those who feel that drug offenders should not be allowed to plea bargain, but must suffer the full rigors of the law, should take note that presently about three-quarters of federal drug cases are resolved by pleas. If all of these cases went to trial, the federal judiciary would require a tremendous increase in personnel and funds.
The Commission, of course, shares the feeling that major drug traffickers should be punished strictly. It is for this reason that the Commission supports the continuing criminal enterprise minimum mandatory sentencing provision of the federal law, which deals with serious trafficking offenses. However, the Commission is opposed to the imposition of minimum mandatory sentencing at the federal and state levels for routine sale cases and for any possession cases. We feel that effective punishment can be meted out under flexible sentencing provisions which expedite minor cases, avoid injustices, and help to secure for enforcement the all important element of speed. Rapid and sure enforcement of the laws would be far more effective in deterring the illegal drug trade than an occasional life sentence and would be much less costly.10

State Enforcement Policy

The Commission recommends that state enforcement, in order to complement the federal effort, concentrate on the lower levels of both licit and illicit distribution networks. State criminal investigative agencies should focus on middle-level illicit trafficking within the states. State regulatory agencies, to ensure compliance with laws and regulations, should concentrate on inspecting pharmacies, hospitals, physicians and researchers. Both regulatory and investigatory state agencies should work on the problem of pharmacy drug thefts, developing standards to minimize this serious problem.
Our recommendations for well-trained investigatory personnel and for external checks on corruption apply with equal strength to state enforcement agencies. The Commission recommends that each state with a substantial trafficking problem have a separate unit, responsible to the state attorney general and charged with the responsibility of investigating any evidence of corruption in law enforcement agencies. This unit should also monitor police agencies on a regular basis as a preventive measure and should possess broad subpoena powers and exercise a state-wide jurisdiction. As an additional check on corruption, most agents should rotate through state and local drug units routinely to avoid excessive exposure, perhaps serving on a drug squad no more than two of any six years.
The Commission recommends that state and local enforcement agencies also actively recruit younger men and women into their drug investigation units, in order to broaden and update the agencies' perspective. Recruits should be carefully screened and receive extensive training. Federal agencies should continue to provide technical and financial training assistance to state and local police.
The Commission further recommends that every state systematically review and evaluate the operation of its boards of pharmacy and medicine, to ensure that they are adequately enforcing the provisions of state and federal law. Professionals who knowingly or repeatedly violate state drug regulations and laws should lose their licenses to practice, in addition to being prosecuted under criminal statutes. The Commission also recommends that each state establish an advisory medical body to act as liaison between the state medical society and law enforcement officials, giving advice and assistance on matters within their area of medical expertise.
Official interference with law enforcement is a recurring problem at the state and local levels. As long as drug use and its prevention are highly publicized, elected officials will feel compelled to press for more "action," especially on the part of law enforcement. By responding to this kind of pressure, law enforcement agencies often waste their resources and interrupt effective operations. Drug law enforcement, at its operational level, must be apolitical. Public officials with no special competence in law enforcement must resist the temptation to interfere and allow those agencies responsible for enforcing the laws an opportunity to employ their special expertise and skills.
Finally, the Commission reaffirms the need for uniform state criminal and regulatory drug laws. States which have not already done so should adopt the Uniform Controlled Substances Act, with the modifications suggested in our Reports. In addition, the Commission recommends that each state review its penalty structure for trafficking offenses and determine whether the penalties are commensurate with the relative severity of the offenses. The Commission endorses the criminal provisions in the 1970 Federal Controlled Substances Act and recommends that the states use them as a model for their own trafficking penalties.

1 We remind the reader that we excluded from the social cost analysis the non-behavioral risks of drug use. The adverse effects on individual health, which generally attend repeated use of some drugs, are not matters of societal self-protection. Some health risks may he matters of self-protection, such as communicable diseases and risks which the individual would not choose to run were he aware of them. However, the public interest in precluding, as opposed to informing, individual choice to use a particular substance is substantially different when the drug, whatever its risk potential or dependence liability, exerts no significant impact on behavior.

2 The solvents and inhalants—glue, lacquer thinner, ether and nitrous oxide—are widely available for non-drug purposes, and, therefore, are not usually restricted in terms of "consumption." Some states and municipalities, however, regulate sale of these substances to minors. Massachusetts, for example, requires minors purchasing glue to write their name in a register kept by the seller for police inspection. Denver, Colorado prohibits by ordinance sale of glue to a person under 18, except with parental consent or unless the glue is sold together with a model kit.
I Schedule I of controlled substances laws.
2 Schedule II ot controlled substances laws.
Schedules Ill and IV of controlled substances laws.
4 Schedule V of controlled substances laws or unscheduled and controlled only as prescription drugs.
e The level of control of medical preparations of the opiates varies according to strength of solution. The table indicates the level of control for the most common formulation of these substances.
e These substances are controlled as to purity and potency and are subject to labeling requirements.

8 Comprehensive Drug Abuse Prevention and Control Act of 1970, PI. 91-513, 84 Stat. 1236, and the Uniform Controlled Substances Act, approved and recommended for enactment in all states, National Conference of Commissioners on Uniform State Laws, August 1-7, 1970. The Uniform Act has been adopted in 38 states.

`The Commission also endorses plans of the Food and Drug Administration to order injectible methamphetamine off the market, together with amphetamine-sedative combinations. The FDA found that the injectible form is unsafe and that the combinations, marketed as anoretic (appetite depressant) drugs, were ineffective Food and Drug Administration, 1973).

The recommendations of our first Report. Marihuana: A Signal of Misunderstanding, are set out at the end of this Report.

6 One brief cocaine "crisis" apparently occurred in Chicago, after World War II, but the principal worry then was that cocaine use was leading to the use of heroin.

° The six urban jurisdictions were New York (Manhattan), Los Angeles, Chicago, Miami. Dallas and Washington, D.C.

8 Later in this Chapter. we will have further recommendations concerning the bureaucratic organization of the entire federal drug effort, including federal law enforcement efforts.

°These statistics are reprinted in the Appendix to this Report.

1° Commissioners Javits and Hughes believe that the Commission should not foreclose at the state and federal level minimum mandatory sentencing provisions in serious trafficking cases or in cases involving the commission of violent crimes in order to increase the deterrent potential of our criminal law.