TRB FROM WASHINGTON

Fine Lines

The most frustrating part of the interminable debate about the "war
on drugs" is the word "drugs." Strictly speaking, after all, there is
no war on drugs in this country; there is a war on some drugs.

America boasts a vast legitimate pharmaceutical industry, and
personal expenditures on its products go up every year. Very, very
few of us go even a week without taking some kind of drug, be it an
over-the-counter cold medicine, a doctor-prescribed medication, or a
self-medicated legal substance--a cigarette, a shot of tequila, a
double espresso, a McFlurry. And the variety and sophistication of
these substances are growing as fast as their use. Do you remember
the day when you could simply ask for a cup of coffee and no further
elaboration was required?

The salient question behind the "drug" war, then, is not simply the
usual libertarian-authoritarian conundrum.

It's much simpler: What is the criterion that makes one drug the
object of a "war" in which millions are incarcerated for illegal use
and another drug the object of a vast marketing machine through which
millions are regularly sold to and hooked?

The more you think about the question, the more elusive the answer
becomes. Once upon a time, medicine was relatively unsophisticated.
The few medicinal drugs there were saved lives or cured obvious
debilitating illnesses; the few recreational drugs there were gave
people pleasure or excitement or oblivion and were regulated on an ad
hoc but vaguely sane basis.

In a puritanical culture, drugs that were extremely pleasurable,
physically harmful, and highly addictive--opium, cocaine,
heroin--were banned.

Drugs that were mildly pleasurable, slightly unhealthy, and less
addictive--caffeine, nicotine, alcohol--were milked for profit and
tax revenues.

Few pretended this scheme was entirely coherent--permitting
addictive, destructive booze while banning nonaddictive, benign pot
made no real sense--but it seemed a practical balance between the
right to personal pleasure and the need for social calm. The one
attempt to be coherent, Prohibition, proved the dangers of consistent
logic in social policy.

And then technology had its way. It seems to me that the last decade
or so has largely invalidated whatever sanity lay behind this
practicable scheme.

Our deeper understanding of the chemical effect of even a candy bar
has made us think about everything we consume in pharmacological
terms. (You can partly thank the Food and Drug Administration's
labeling for that.) And our ability to take pharmaceutical substances
and alter them in minuscule ways has further blurred the distinction
between "good" and "bad" chemicals.

The result is a hopelessly contradictory scheme in which fat-drenched
hamburgers--partly responsible for heart disease, our leading cause
of death--are celebrated, while marijuana, consumed with little harm
by millions, is stigmatized to the point of incarceration.

And these are the easy cases.

Further up the chemical-sophistication ladder, the ironies only multiply.

Take the designer drug Ecstasy. "E" is now classed in the same group
of illegal drugs as heroin.

But as recently as the 1980s it was completely legal; Merck patented
it in 1914. E works by flooding the brain for a few hours with
serotonin, the "happy" chemical, a substance our body naturally
produces but in much smaller and more consistent amounts.

Now compare Prozac. Prozac and its sister and successor drugs help
regulate the production of serotonin for people with suppressed or
unstable serotonin levels.

The effect of such drugs is far less intense than that of
Ecstasy--and the method by which serotonin is released and moderated
is far subtler. But the substance being manipulated is the same.
Indeed, people who regularly take Prozac tend to find that E barely
affects their mood at all. Their serotonin problem is already fixed.

Yes, there are differences in degree here, and some in kind.
Long-term, persistent use of Ecstasy has been correlated with
depression. But long-term use of Prozac may affect the structural
composition of the brain as well. Neither is clearly dangerous unless
taken in massive doses.

Both are designed to make people "happier." What rationale is there
in making one drug illegal and marketing the other to literally
millions every year?

Similarly, Starbucks profits by marketing coffee, a legal substance
that addictively wires people for hours on end. Health-food stores
sell stronger versions of speed in the form of pills and even
chocolate. There are no laws preventing anyone from drinking ten
double espressos or downing several packets of No-Doz. But one sniff
of a much more concentrated methamphetamine--which might actually be
less damaging to your body--can land you in jail. Similarly, you can
get a dose of Xanax from your doctor and feel extremely mellow within
half an hour; or you can take two puffs of pot and be a felon.
Likewise, you can buy a drug from a vitamin
store--androstenedione--to boost your own production of testosterone,
or you can get a packet of testosterone gel on the black market (as
thousands of teenage jocks do) and risk a criminal record.

A growing number of "medicinal" drugs also have high "recreational"
street value: painkillers like Vicodin, downers like Valium, uppers
like Ritalin, and anesthetics like Ketamine.

My point is not that there is no sense at all in these distinctions.
Clearly, crystal meth is more potent, more addictive, and easier to
take than ten triple espressos.

Clearly, excessive steroid use can wreck people's livers in ways that
even massive use of legal androstenedione won't. But we're dealing
here with degree as much as kind. And as the sophistication of
pharmaceuticals develops exponentially each year, the lines we draw
between legal and illegal, between stigmatized and accepted, will
become more and more arbitrary.

In exactly the same way, the very definition of "health" is up for
grabs. Do most people take Prozac for their mental health or their
sense of well-being? Is there a moral difference between taking Xanax
to get some sleep and smoking a joint?

If someone wants to take modest amounts of anabolic steroids to look
good and feel sexy, why should that be illegal when a legal,
multibillion-dollar industry is aimed at achieving the same effects
with the stone-age technology of swallowing creatine, eating steak,
and pushing pieces of iron up and down? Similarly, human growth
hormone was developed to accelerate the growth of stunted children.

It's now popular among retiring baby-boomers who enjoy its
rejuvenating effects on their bodies and minds.

But the boomers often have to fake weight loss and impotence to get
it legally. Why shouldn't retirees have access to it--not because
they have an actual physical ailment but because they want to enjoy
to the fullest what's left of their lives?

Isn't aging the ultimate physical ailment?

I wish I knew the answer to these questions; to me they seem the ones
we need to confront.

The war on soft drugs is built on such logical sand that it cannot be
sustained forever--just as the once-clear distinction between health
and pleasure is now disintegrating, and only our residual cultural
puritanism is propping it up. In a country dedicated to the pursuit
of happiness, where happiness is reducible to a chemical, surely the
"war on drugs" will not be the only casualty of this development.