III. Public Health Consequences Of Current Drug Policy

The Task Force views substance abuse as, first and foremost, a public health issue. Accordingly, it appears that problems of substance abuse would be more appropriately and effectively addressed within our health care delivery systems, rather than by our law enforcement agencies, courts and correctional institutions.

The emphasis on a "penal" model of drug control results in reduced funding for drug treatment facilities. This is an unfortunate irony, since, as concluded by RAND researchers in a 1994 report, a dollar's worth of drug treatment is worth seven dollars spent on the most successful law-enforcement efforts to curb the use of cocaine. (19)

Moreover, the fear of arrest, stigmatization and even removal of their children from homes, (20) discourages substance abusers from taking advantage of those health care and counseling facilities which are available. (21) Pregnant women who are substance abusers are deterred from seeking adequate prenatal care, resulting in unhealthier children. A single positive drug test result during pregnancy can trigger mandatory reporting requirements. Therefore, the current policy of criminalization of drug use amplifies potential health hazards of substance abuse, and inhibits access to treatment, even for non-drug use related health care.

Since possession and sale of any controlled substance is illegal, dangerous drugs (which despite criminalization are still widely available on the black market) are completely unregulated. Under a scheme of criminalization, regulatory control is ceded to underworld figures, including violent, predatory and often ruthless criminals. This total lack of quality control of illicit drugs on the market results in more dangerous, adulterated drugs being produced and consumed, which, in turn, causes more disease and death from the use of controlled substances than would occur if the production and distribution of these drugs were regulated by, for instance, U.S. Food and Drug Administration safety regulations, warnings and other labeling requirements. (22)

The "zero tolerance" approach to the "drug problem," with its primary emphasis on law enforcement and penal sanctions, results in an absence of any quality control for illegal drugs widely consumed throughout the nation, and a lack of information concerning safer drug use. This presents further serious health costs brought on by current drug policy, which ignores the reality that some degree of drug use in our society is inevitable. This lack of public education and safety regulations dramatically, and unnecessarily, increases the health risks involved in the consumption of those drugs presently designated as illegal.

Accordingly, it appears that present drug control laws themselves, have directly led to an increase in the health risks associated with drug use and substance abuse. In addition to those dangers posed by lack of quality control and safety regulations governing illegal drugs, drug paraphernalia laws, together with a failure to promote needle exchange programs, have resulted in the preventable spread of AIDS and other similarly transmitted diseases to users, their partners and children. (23)

Moreover, easier interdiction of marijuana, (with a larger mass than other controlled substances), causes greater relative availability of "harder," stronger, more dangerous drugs (e.g., cocaine and heroin), which are easier to conceal, transport and distribute. Additionally, increased dangers to our youth and others who may consume "soft" drugs, (e.g., marijuana and hashish), result from failure of current policy to separate out the markets for "hard" drugs from those for "soft" drugs. Therefore, since consumption of all of these drugs is illegal, (and distributed in the same "black-market"), those who only purchase and smoke marijuana, for instance, are inevitably forced to come in contact with a more dangerous criminal element in order to obtain this relatively harmless substance. (24)

Violence associated with the illicit drug trade creates substantial public health problems, in the form of injuries and death. These health problems arise from effects of drug prohibition rather than substance abuse per se. Evidence suggests that gunshot wounds (due to "drug-trade related" violence) are more prevalent than overdoses ("drug-induced" injuries) in inner city hospital emergency rooms of major metropolitan areas. (25) Moreover, in addition to the empirical evidence, our nation's experience with alcohol prohibition suggests the validity of these observations. Once prohibition ended, so did the violence associated with black market alcohol distribution. (26)

"Drug prohibition" also causes an increased demand for more potent legal substances, like alcohol, which is decidedly more harmful than certain controlled substances, most notably, marijuana. (27) Moreover, current drug policy is found to be, in ways, arbitrary and inconsistent, since it has been proven that among the most dangerous commonly consumed drugs are tobacco and alcohol, both of which are legal. (28)

Finally, current drug policy discourages research into potentially therapeutic effects of psychotropic drugs, (29) e.g. "medical marijuana," which is known to alleviate the suffering of cancer patients and to be therapeutically beneficial in treatment of certain other diseases. (30)