DOPEY, BOOZY, SMOKY--AND STUPID

Thirty-five years into the "war on drugs", the United States still has
a huge drug abuse problem, with several million problem users of
illicit drugs and about 15 million problem users of alcohol.

Illicit drug-dealing industries take in about $50 billion per year.
Much of the retail drug trade is flagrant, involving either open-air
activity or identified, dedicated drug houses.

Flagrant dealing creates violence and disorder, wrecking both the
neighborhoods where it goes on and the lives of the dealers.

Chronic heavy users of expensive illicit drugs steal and deal to
finance their habits.

Drug injection spreads HIV and hepatitis-C.

On top of all that, we have a highly intrusive and semi-militarized
drug enforcement effort that is often only marginally constitutional
and sometimes more than marginally indecent.[1]. For accounts of the
"epidemic of isolated incidents" in which innocent people have been
killed or injured when their homes were wrongly subjected to
SWAT-style searches, see Radley Balko, Overkill: The Rise of
Paramilitary Police Raids in America (Cato Institute, 2006). That
enforcement effort keeps about 500,000 Americans behind bars at any
one time for drug law violations, about 25 percent of the total U.S.
prison and jail population. A larger proportion of U.S. residents is
doing time for drug law violations than is behind bars for all
offenses put together in any country to which we'd like to be compared.

These are depressing facts that cry out for a radical reform to solve
the drug problem once and for all. But the first step toward achieving
less awful results is accepting that there is no one "solution" to the
drug problem, for essentially three reasons.

First, the potential for drug abuse is built into the human
brain.

Left to their own devices, and subject to the sway of fashion and the
blandishments of advertising, many people will wind up ruining their
lives and the lives of those around them by falling under the spell of
one drug or another.

Second, any laws--prohibitions, regulations or taxes--stringent enough
to substantially reduce the number of addicts will be defied and
evaded, and those who use drugs in defiance of the laws will generally
wind up poorer, sicker and more likely to be criminally active than
they would otherwise have been. Third, drug law enforcement must be
intrusive if it is to be effective, and enterprises created for the
expressed purpose of breaking the law naturally tend toward violence
because they cannot rely on courts to settle disputes or police to
protect them from robbery or extortion.

Any set of policies will therefore leave us with some level of
substance abuse--with attendant costs to the abusers themselves, their
families, their neighbors, their co-workers and the public--and some
level of damage from illicit markets and law enforcement efforts. Thus
the "drug problem" cannot be abolished either by "winning the war on
drugs" or by "ending prohibition." In practice the choice among
policies is a choice of which set of problems we want to have.

But the absence of a silver bullet to slay the drug werewolf does not
mean we are helpless.

Though perfection is beyond reach, improvement is not. Policies that
pursued sensible ends with cost-effective means could vastly shrink
the extent of drug abuse, the damage of that abuse, and the fiscal and
human costs of enforcement efforts.

More prudent policies would leave us with much less drug abuse, much
less crime, and many fewer people in prison than we have today.

The reforms needed to achieve these ambitious goals are radical rather
than incremental. But they are not simple, or all of a piece, or in
any one of the directions defined by current arguments around American
dinner tables, on American editorial pages or in American legislative
chambers.

The conventional division of drug programs into enforcement,
prevention and treatment conceals more than it reveals. So does the
standard political line between punitive drug policy "hawks" and
service-oriented drug policy "doves." Neither side is consistently
right; some potential improvements in drug policy are hawkish, some
are dovish, and some are neither. [2]. This topic deserves a book
rather than an essay, and, as it happens, a fairly good book has
recently been published: David Boyum and Peter Reuter, An Analytic
Assessment of U.S. Drug Policy (American Enterprise Institute, 2006).
To see why, let's start with the facts.

THE FACTS

Some of the claims below are deliberately controversial, but only in
terms of common public discourse.

They are not controversial in a scientific sense.

Basics

Most drug use is harmless, and much of it is beneficial--at least if
harmless pleasure and relaxation count as benefits.

But drug abuse is a real problem all the same because some drug
users--typically a fairly small minority among consumers of any given
drug--lose control of their behavior when under the influence and do
foolish or wicked things. Another overlapping and even smaller group
loses control over drug-taking itself.

Loss of control in these two forms marks out substance abuse, a
diagnosable disease, from non-problem drug use, which may be
unconventional but is not pathological.

For most people who fall into its grip, drug abuse is relatively
transient. But some drug abusers have a chronic, relapsing form of
that disorder: "addiction." Drug addicts, though a minority of a
minority among drug users, constitute the bulk of the drug problem due
to the frequency of their misbehavior (both under the influence of
drugs and in search of money to acquire drugs), the volume of their
drug purchases, and the violence and disorder of the illicit markets
they support.

Users with substance abuse disorders account for around 80 percent of
the volume in the market for an addictive drug.

Not all drugs are equally risky or abusable.

But since different drugs are abused in different ways and have
different harm profiles, there is no single measure of "harmfulness"
or "addictiveness" by which drugs can be ranked.

Moreover, the overall damage caused by a drug does not depend on its
neurochemistry alone; the composition of the user base and the social
context and customs around its use also matter. Alcohol, for example,
constitutes a major violence-and-disorder problem in Britain, but not
in Italy.

And alcohol is a drug, one that ranks high along most dimensions of
risk. Among intoxicants (that is, excluding caffeine and nicotine),
alcohol abuse accounts for more than three-quarters of total substance
abuse in the United States, and for more death, illness, crime,
violence and arrests than all illicit drugs combined.

A drug abuse control policy that ignores alcohol is as defective as a
naval policy that ignores the Pacific.

Some pairs of drugs are substitutes for one another, so that making
one more available will reduce consumption of the other. (Brands of
beer compete; beer competes with wine; heroin competes with morphine.)
On the other hand, some pairs of drugs are complements, so that making
one more available will increase consumption of the other (any
depressant is likely complementary with any stimulant, as illustrated
both by rum-and-Coke and by the heroin-and-cocaine combination known
as a "speedball"). We know much less about these relationships than we
should; it isn't even clear whether making beer more expensive and
less available to adolescents would reduce their cannabis use or
increase it (and vice versa).

Drug addicts face a strong psychic compulsion to continue to use their
favorite drugs, although most of them also have a desire to escape
from their addiction.

But "compulsive" isn't the same as "involuntary": Addicts can and do
respond to the conditions and consequences of their behavior.

They tend to cut back on drug use and increase their efforts to quit
in the face of higher prices, and they respond to rewards for
abstaining and punishments for using, as long as the rewards and
punishments are swift and predictable.

Laws and Law Enforcement

Taxes, regulations and prohibitions can reduce drug consumption and
abuse, but always at the cost of making the remaining consumption more
damaging than it would otherwise be. Any rule restrictive enough to
matter needs to be enforced, and enforcement is always costly and
damaging to those punished.

All illicit markets are bad; just how bad depends on the size of the
market, the flagrancy of the distribution mechanism, and the social
mix of users and dealers.

At relatively low cost, regulation and prohibition can be effective in
preventing the emergence of new problem drug markets, and sometimes in
keeping drugs already entrenched in some areas from extending their
geographic reach.

But once a drug has an established mass market, more enforcement
cannot greatly shrink the problem; existing customers will seek out
new suppliers, and imprisoned dealers, seized drugs and even
dismantled organizations are replaced.

Moreover, the effectiveness of enforcement tends to fall over time as
the illicit industries learn to adapt.

We have 15 times as many drug dealers in prison today as we had in
1980, yet the prices of cocaine and heroin have fallen by more than 80
percent.

Aggressive enforcement against mass drug markets generates mass
imprisonment. Imprisonment is necessarily horrible, and most
imprisonment in the United States is worse than necessary.

Dealers emerging from prison have limited economic opportunities
outside the drug trade, forcing down drug-dealing wages and thus drug
prices; that seems to have happened with crack.

Some drug dealers commit non-drug crimes of such severity as to
justify imprisonment to prevent future victims.

However, the average incarcerated dealer commits fewer predatory
crimes than the average non-drug prisoner, so filling cells with
dealers while prison space is scarce tends on balance to increase the
rate of property and violent crime.

Prevention

Drug-use prevention efforts are very cost-effective because they're
very cheap.

But they aren't very effective; even the best programs, combining
school-based and community-based efforts, reduce the rate of
initiation by no more than a quarter, with no assurance that spending
more would produce bigger effects.

Most of those initiations are postponed rather than avoided entirely,
and there is no direct evidence that deferring drug initiation reduces
future addiction.

The DARE program, by far the most widespread, is also demonstrably the
least effective, with an impact on student drug use indistinguishable
from zero after dozens of evaluations.

Treatment

The mantra, "Drug abuse is a chronic, relapsing condition", is true of
only a minority of substance abusers.

That group seems typical to casual observers only because its members
fill the jails and the treatment programs.

Most substance abuse disorders resolve "spontaneously"; that is,
without formal treatment. (Of those who have met diagnostic criteria
for substance abuse disorder during their lifetimes, fewer than a
quarter still do, and only a tiny proportion of those who have
recovered have ever been treated professionally.)

Those victims of substance abuse disorders whose attempts to quit or
moderate their drug use fail will usually benefit from professional
help if they seek it and persist in it. But most people who "need"
treatment in the sense that they meet the clinical criteria for
substance abuse disorder do not want treatment enough to enter and
remain in treatment, even if it is available.

The gap between clinically determined treatment need and treatment
actually delivered is a function of inadequate demand for treatment as
well as inadequate supply.

Those who undergo treatment under legal coercion do as well
statistically as though who do so voluntarily. In practice, there is
no sharp line between voluntary and involuntary treatment, because
those who aren't coerced by the criminal justice system often enter
treatment under other pressures: from their families, for example, or
their employers.

Conversely, legal coercion to undergo treatment is often more nominal
than real: Three-quarters of drug-involved offenders "diverted" from
punishment to treatment either fail to appear for treatment at all, or
drop out of treatment before completion--and few are punished for it.

Many of those who need treatment--that is, those who cannot get better
on their own--cannot readily be "cured", and that fact is the origin
of the "chronic, relapsing condition" theory.

But treatment can easily pay for itself by reducing, even temporarily,
the level of drug abuse and the resulting harms.

In that sense, the slogan "treatment works" is accurate: Those who
enter and remain in treatment (voluntarily or otherwise) nearly always
improve their condition and their behavior to some extent, and those
who enter and remain for a year or more have a good chance of
remaining better off and better behaved, even if not entirely
abstinent, for some time after treatment ends.

Tobacco

Nicotine in the form of cigarettes is unusually addictive; most
smokers are dependent and suffer significant health damage as a
result. People who start smoking tend to grossly underestimate their
vulnerability to nicotine addiction, or they wouldn't start.

Nine out of ten current smokers want to quit, have tried
unsuccessfully to quit, and wish they'd never started.

Pipe and cigar smoking and the use of smokeless tobacco (chewing
tobacco and snuff) are much less addictive and much less damaging to
health than cigarette smoking.

Nicotine use could be made safer by moving users away from cigarettes,
by reducing the toxic content of tobacco products (for example,
formaldehyde and benzene), or by vaporizing the active agents in
tobacco with external heat rather than by burning the leaves, thus
delivering nicotine to the lung without the accompanying cloud of hot,
toxic gases and particulates.

Hallucinogens

Hallucinogens ("psychedelics") have a unique risk/benefit profile.
Addiction is extremely rare, but users, especially young users, risk
injury from accidents and lasting damage from frightening subjective
experiences.

The excesses of the 1960s discredited hallucinogens and largely put an
end to what seemed like a promising field of research.

But former hallucinogen users are far more prone than former users of
other kinds of illicit drugs to report that their lives have been
lastingly enhanced by their experiences. Recent studies show that
these drugs may have clinical potential in reducing the fear of death
among terminal patients and in the treatment of some psychiatric
problems, including post-traumatic stress disorder.

There are also hints that the use of hallucinogens in very low doses
might enhance creative work in the arts, the professions, mathematics
and the sciences.

Some hallucinogens have been used for religious/spiritual purposes for
centuries, if not millennia; the kerkyon, the sacred beverage used in
the Eleusinian Mysteries, seems to have contained ergot, a precursor
of LSD. A recent experiment at Johns Hopkins University showed that
psilocybin, the active agent in "magic mushrooms", when given under
controlled conditions can safely and fairly reliably produce effects
indistinguishable from classical mystical experiences, with apparently
persistent positive effects on mood and behavior. The Native American
Church, which claims a quarter of a million members, has had special
legal permission to use mescaline-bearing peyote buttons in its
services for more than half a century, and no apparent harm has resulted.

The Supreme Court, interpreting the Religious Freedom Restoration Act,
has now ruled that other churches using other chemicals may do so
lawfully if the religious motive is genuine and the practices
reasonably safe.

These facts having now been set out, five principles might reasonably
guide our policy choices.

First, the overarching goal of policy should be to minimize the damage
done to drug users and to others from the risks of the drugs
themselves (toxicity, intoxicated behavior and addiction) and from
control measures and efforts to evade them.

That implies a second principle: No harm, no foul. Mere use of an
abusable drug does not constitute a problem demanding public
intervention. "Drug users" are not the enemy, and a achieving a
"drug-free society" is not only impossible but unnecessary to achieve
the purposes for which the drug laws were enacted.

Third, one size does not fit all: Drugs, users, markets and dealers
all differ, and policies need to be as differentiated as the
situations they address.

Fourth, all drug control policies, including enforcement, should be
subjected to cost-benefit tests: We should act only when we can do
more good than harm, not merely to express our righteousness. Since
lawbreakers and their families are human beings, their suffering
counts, too: Arrests and prison terms are costs, not benefits, of
policy. Policymakers should learn from their mistakes and abandon
unsuccessful efforts, which means that organizational learning must be
built into organizational design.

In drug policy as in most other policy arenas, feedback is the
breakfast of champions.

Fifth, in discussing programmatic innovations we should focus on
programs that can be scaled up sufficiently to put a substantial dent
in major problems.

With drug abusers numbered in the millions, programs that affect only
thousands are barely worth thinking about unless they show growth potential.

A PRACTICAL AGENDA

What would actual policies based on the forgoing facts and principles
look like? Here is a "to do" list to get us started:

Don't fill prisons with ordinary dealers.

While prohibition clearly reduces drug abuse (otherwise there wouldn't
be several times as many abusers of alcohol as of all illicit drugs
combined), and some level of enforcement is necessary to make
prohibition a reality, increasing enforcement efforts against
mass-marketed drugs cannot significantly raise the prices of those
drugs or make them much harder to acquire. If we had only 200,000
dealers behind bars rather than 500,000, the drug markets would not be
noticeably larger, and they might be less violent. Given the fiscal
and human costs of incarceration, and the opportunity cost of locking
up a drug dealer in a cell that might otherwise hold a burglar or a
rapist, the current level of drug-related incarceration is hard to
justify.

We can reduce that level with arrest-minimizing enforcement strategies
and by a discriminating moderation in drug sentencing.

Lock up dealers based on nastiness, not on volume.

All drug dealers supply drugs; only some use violence, or operate
flagrantly, or employ juveniles as apprentice dealers.

The current system of enforcement, which bases targeting and
sentencing primarily on drug volume, should be replaced with a system
focused on conduct.

If we target and severely sentence the nastiest dealers rather than
the biggest ones, we can greatly reduce the amount of gunfire, the
damage drug dealing does to the neighborhoods around it, and the
attractive nuisance the drug trade offers to teenagers.

As a practical matter, too, we cannot create adequate differential
disincentives for the most destructive forms of dealing solely by
ramping up sanctions for those who engage in them. If we're already
locking up ordinary drug dealers forever, locking up the nastier ones
forever and a day won't create much competitive disadvantage for
violence-prone or juvenile-employing organizations. The base level of
sanctions needs to be reduced to make differentiated sentencing effective.

Pressure drug-using offenders to stop. The relatively small number of
offenders (no more than three million all together) who are frequent,
high-dose users of cocaine, heroin and methamphetamine accounts for a
large proportion both of theft and of the money spent on illicit
drugs. Getting a handle on their behavior is inseparable from getting
a handle on street crime and the drug markets.

Yet current policies for dealing with such offenders ignore everything
we know both about addiction and deterrence. Ordering drug-using
probationers and parolees to enter drug treatment might be effective
if we could make the order stick, but it would still be a profligate
use of treatment resources.

Instead of coercing treatment, we could coerce abstinence directly,
insisting that probationers and parolees abstain from the use of
illicit drugs.

Not every drug-using offender has a diagnosable substance abuse
disorder, and insisting (as drug courts do) that every offender have a
treatment-needs assessment and a personalized treatment plan sops up
scarce capacity, sometimes to the point that poor drug users can't get
treated without getting arrested first.

Whether we demand treatment attendance or abstinence, the hard problem
is to make that nominal requirement effective in a population with
poor self-control and no great reluctance to break the law. Probation
and parole agencies tend to rely excessively on severity at the
expense of certainty and immediacy; while most instances of cocaine
use by probationers or parolees either go undetected or lead to no
sanction beyond a verbal rebuke, some unlucky offenders face
revocation of probation or parole and months or even years behind bars.

Instead, we should make the consequences of non-compliance and the
rewards of compliance quicker and more reliable.

Frequent testing, with automatic and formulaic sanctions for using or
missing a test, greatly reduces drug use, and therefore crime, even
among chronic user-offenders. Probation or parole revocation--putting
the offender behind bars for months, or even years--should be reserved
for those who commit serious new crimes or abscond from supervision.
The sanction for continuing to use drugs should be no more than a few
days in jail. If that threat is made credible, it will generally
induce compliance. (Hawaii's HOPE probation program, based on the
"coerced abstinence" model, has reduced the rate of positive drug
tests among its clients by 80 percent or more.) Delivering a
relatively mild sanction swiftly and consistently is both more
effective and less cruel than only occasionally and randomly lowering
the boom.

Because rewards are even more potent than punishments, we should also
figure out ways of rewarding drug-involved offenders for abstinence.
Modest financial incentives greatly reduce cocaine and methamphetamine
use in the context of voluntary drug treatment; the trick is to adapt
that approach to managing offenders, perhaps by giving a partial
remission of fines and fees for each "clean" drug test.

The benefits of mounting a coerced abstinence program nationally would
vastly outstrip its costs, and outstrip the benefits of any other
program that could be mounted against drugs and crime using comparable
resources.

At a guess, a national program costing $5 billion (compared to the
total Federal-state-local drug enforcement budget of around $40
billion per year) could reduce the dollar volume in the hard-drug
markets by 30 percent, and the savings from incarcerating fewer
addicts and fewer dealers would probably more than repay that
investment, giving us all the other benefits for free. The
administrative and political barriers to such a program are
formidable, but the Hawaiian experience suggests that they are not
insurmountable. The challenge is to get multiple agencies (probation
officers, court clerks, judges, police and jailers) to work together
well enough to generate swift and predictable consequences, and to do
so at mass scale.

Break up flagrant drug markets using low-arrest crackdowns. Flagrant
drug dealing, whether in open-air markets or dedicated drug houses,
creates crime, violence and disorder, all of which are deadly to
neighborhood life. Even if breaking up such markets doesn't do much to
reduce drug abuse, it does protect the neighborhood. An open drug
market is the ultimate "broken window."

Massive and protracted crackdowns work, but at intolerable expense in
police and court resources.

But the same effects can be achieved by using explicit and credible
threats of arrest and prosecution instead. High Point, North Carolina,
broke up a twenty-year-old crack market by identifying and developing
cases against all of the active dealers, calling all of them in for a
meeting to tell them that dealing must stop at once, and that anyone
who persisted could and would be sent to prison based on evidence
already in hand. Any one dealer could have been easily replaced, but
when all of them stopped at once the market ground to a halt--and
anyone who tried to move into the vacuum made himself a sitting duck
for law enforcement.

Once the dealers quit, the buyers stopped coming.

That forced transactions into more discreet--and less socially
destructive--channels such as hand-to-hand transactions in bars or
clubs or telephone orders with home delivery.

The hard part wasn't making the cases and delivering the threats, but
identifying the dealers, mobilizing community support for the effort,
and lining up social-service providers to offer the involuntarily
retired dealers the help they needed to make law-abiding lives for
themselves. Winston-Salem, North Carolina, and Newburgh, New York,
have had similar success; Kansas City is on deck. That low-arrest
crackdowns work is no longer in serious doubt; whether police,
prosecutors, and local government leaders will accept the closure of
the markets as success, rather than demanding large numbers of arrests
and convictions as a mark of "being tough on drugs", remains an open
question.

Deny alcohol to problem drinkers.

When someone gets caught drinking and driving, we take away his
license: his driving license, that is. The "license" to drink--legal
permission to buy and consume alcohol in unlimited quantities--is
presumed to be irrevocable. But why? We know that someone who drinks
and drives is a bad citizen when drunk, but not that he is a bad
driver when sober.

If someone is convicted of drunken driving, or drunken assault, or
drunken vandalism, or repeatedly of drunk and disorderly conduct--if,
that is, someone demonstrates that he is either a menace or a major
public nuisance when drunk--then why not revoke his (or, much more
rarely, her) drinking license.[3]. In a typical American jurisdiction,
something like a tenth of one percent of the population consisting of
chronic drunk and disorderly arrestees accounts for about 15 percent
of all arrests.

Of course, the "personal prohibition" imagined here, like the current
age restriction, would have to be enforced by sellers of alcoholic
beverages, who would have to verify that each buyer has not been
banned from drinking, just as they now have to verify that each buyer
is of legal age to drink.

Obviously, such a ban could not be perfectly enforced.

But reducing the frequency and flagrancy of drinking behavior by
problem drunks somewhat is far better than not reducing it at all. A
ban on drinking by bad drinkers (unlike the current ban on drinking by
those under 21) would have an obvious moral basis.

Evading it, for example by buying liquor for someone on the "Do Not
Drink" list, would be clearly wrong and worth punishing. Moreover,
offenders would not easily be able to drink in bars, restaurants or
other public places, which means they would be less likely to drink
and then drive or cause public disturbances.

Raise the tax on alcohol, especially beer. The average excise tax
(Federal plus state) on a can of beer is about a dime. The average
damage done by that can of beer to people other than its drinker is
closer to a dollar.

Those costs consist mostly of crimes, accidents and the health care
costs redistributed through insurance--and the one-dollar figure
doesn't count the costs to the families and friends of drinkers.

Of course, not all drinks are created equal; a dollar per can would be
too high a tax on the great majority of drinkers whose drinking does
no harm, and too low on the dangerous minority.

But in the words of an old Chivas Regal advertisement, "If the extra
money matters to you, you're drinking too much." (Note that the
optimal tax level would fall if we denied alcohol to bad drunks.)

Raising taxes is also among the best ways to reduce heavy drinking by
teenagers, for whom price is often a major consideration.

Eliminate the minimum drinking age. There is good evidence that age
restrictions reduce underage alcohol abuse and drunk driving.

That is true even taking into account the inducement for kids to drink
created by making drinking a badge of adulthood and the difficulty of
teaching responsible drinking practices to teenagers who are forbidden
to drink at all.

But against the benefits we must weigh the costs of making the vast
majority of adolescents into lawbreakers. Nearly nine high-school
seniors in ten report drinking.

Criminalizing statistically normal behavior trivializes lawbreaking by
enacting a law that almost everyone breaks, and breaks without
apparent harm: Most teenage drinkers, like most adult drinkers, don't
have a drinking problem. The current drinking age has also normalized
the acquisition and use of false identification documents, which seems
like a bad idea in the age of terror.

The increased teenage drinking that would result from eliminating the
age restriction could be offset by a tax increase, leaving us better
off all around.

Few of my fellow drug policy analysts agree on this point, so few
politicians are likely to vote for such a change.

Nonetheless, these three proposed alcohol-policy reforms--higher
taxes, personal prohibition for problem drunks, and eliminating the
age restriction--would substantially reduce the social costs of the
drinking problem.

Prevent drug dealing among kids. Efforts to prevent adolescents from
using drugs command widespread support.

But next to no attention is paid to the problem of preventing
adolescents from dealing drugs. Dealing is a much riskier activity,
yet one that still enjoys a certain glamour in some neighborhoods.
That glamour could be dulled by introducing some facts about what most
dealers actually earn (less than minimum wage) and how likely they are
to get shot, jailed or addicted. Even a modest degree of success would
be well worth the effort.

Say more than "No." The current set of messages in most school-based
prevention programs--that all drug use is abuse and that cannabis is
as dangerous as any other drug--has three big defects.

The first is that the messages are false, and lying to schoolchildren
is bad. The second is that when the kids figure out that the messages
are false--and they do--they won't believe warnings against harder
drugs (or other warnings from the government). The third is that once
you've told kids that all drug use is abuse, it's hard to go back and
tell them how to keep watch over the circumstances and patterns of
their own drug-taking to avoid the transition from non-problem use to
abuse. Today, even responsible drinking is a taboo topic.

It's time for the prevention effort to grow up.

Don't rely on DARE. Drug Abuse Resistance Education, where police come
into fifth-grade classrooms, makes kids friendlier toward cops and
vice versa, which is all to the good. But it has never been shown to
reduce drug use. As a result, the current dominance of DARE means that
our drug prevention dollars are preventing less drug use than they
might.

Encourage less risky forms of nicotine use. Cigarette smoking, now the
overwhelmingly dominant form of nicotine use, is also the form most
dangerous to smokers and obnoxious to others.

If it were not politically impossible, there would a strong argument
for banning cigarette sales to new users, with maintenance supplies
for current users.

In the meantime, we should encourage less risky forms of nicotine use.
The problem isn't the nicotine, it's the dying--400,000 Americans
every year. The nicotine phobia of the public health community isn't
hard to understand, but basing policy on that phobia does severe
damage to public health.

Let pot-smokers grow their own. Marijuana is an outlier among
currently illicit drugs.

Its risks are markedly smaller, its consumption is enormously more
widespread, and it leads to more arrests than all the others
combined--mostly for misdemeanor possession. It is also the one
illicit drug that consumers could practically produce themselves.
Current cannabis laws criminalize millions of otherwise law-abiding
individuals and create a multibillion-dollar illicit market.

Not that cannabis is harmless.

While its "capture rate" to abuse and dependency is substantially
smaller than comparable rates for alcohol, cocaine, methamphetamine
and heroin, and while the damage from abuse and dependency are usually
much less drastic, the rate of capture is still high enough, and the
consequences bad enough, to constitute a substantial problem,
especially given that the median age of cannabis initiation is now
about 15.

Full commercial legalization of cannabis, on the model now applied to
alcohol, would vastly increase the cannabis-abuse problem by giving
the marketing geniuses who have done such a fine job persuading
children to smoke tobacco, drink to excess and supersize themselves
with junk food another vice to foster.

However, if current laws were changed to make it illegal to sell
cannabis or to exchange it for anything of value, but not to grow it,
possess it, use it or give it away, the costs of the current control
regime could be sharply reduced without greatly increasing the size of
the marijuana consumption problem.

Such a law could not effectively prevent private sales any more than a
ban on gambling can prevent private poker games. Its goal would be to
prevent mass marketing.

In the short-to-medium term such a policy would have only a slight
impact on use. The biggest effect would be on those who now cease
marijuana use as they enter the workforce but might instead keep using
the drug. In the long term, there would probably be modest growth in
cannabis use due to decreased social stigma and employment risk; how
much of that growth in use would be among people who subsequently got
into trouble with the drug is harder to guess.

On the other hand, kids who are heavy pot-smokers would no longer be
tempted to become dealers.

A modest increase in pot-smoking would be a small price to pay for
eliminating a huge illicit market, along with several hundred thousand
arrests each year and the tens of thousands of prison and jail terms
meted out for dealing.

Encourage problem drug users to quit without formal
treatment.

Some problem drug users need treatment; others do not. Making it
widely known that most people with substance abuse problems can
recover without professional help would increase the rate of
"spontaneous" attempts to quit. Those who try often enough (five
failures before success is the average for those trying to quit
smoking) are likely to succeed.

It won't work for everyone, but not trying is the only approach
certain to fail.

Police lockups, jails and hospital emergency rooms would be good
places to screen for abuse, urge abusers to quit on their own if they
can, and refer those who can't to treatment.

Those places all see many people with substance abuse disorder at a
time when the bad consequences of frequent intoxication are especially
salient in their minds. Those opportunities remain largely
unexploited.

The other obvious occasion for screening and brief intervention is the
annual physical exam; physicians have great credibility in talking
about the issue, and have a professional license to ask intrusive questions.

But most physicians are not trained in, or compensated for, drug
screening and intervention, and the lack of reliable privacy for
medical records makes some patients reluctant to answer frankly.

Change would require efforts by medical schools, professional
societies, managers of health care organizations and the agencies that
finance health care.

Expand opiate maintenance. Increasing the capacity of the
opiate-maintenance treatment system, which is now grossly
over-regulated, could shrink both drug abuse and crime.

Drug treatment works for people who stick with it. Most don't, but
opiate maintenance--treatment with methadone, and the newer and in
some ways superior agents buprenorphine and LAAM (l-alpha-acetyl
methadol)--has a huge advantage over other addiction treatments: Its
clients keep coming back. (There's no equivalent treatment for
stimulant abuse; given the way stimulants work, there probably can't
be.)

We currently have about a million problem opiate users in the United
States. Perhaps three-quarters would accept maintenance therapy if it
were easily available.

Only 100,000 now receive it. One reason is that most judges and
probation departments still insist on sending opiate-using offenders
to "drug free" therapies.

That's a mistake; the data from California's Proposition 36
drug-diversion program shows that heroin-using offenders assigned to
maintenance programs commit dramatically fewer crimes.

Work on immunotherapies. Imagine stimulating the immune system of a
cigarette smoker or a crack user to recognize molecules of nicotine or
cocaine as foreign bodies and sop them up in the bloodstream before
they reach the brain.

It appears that such treatments, consisting of a single injection
every month or every few months, are technically feasible for at least
some drugs, including nicotine and cocaine. The social benefits of
perfecting them and bringing them to market are much larger than the
profits a manufacturer could hope to earn.

Immunotherapies should therefore be high priority for public
drug-research dollars, especially compared to the expensive and so far
largely futile search for drugs to ease the craving that comes from
quitting cocaine. (Note that these treatments are technically
"vaccines", but their use is therapeutic, not prophylactic. Mass
immunization makes no sense in this context.)

Get drug enforcement out of the way of pain relief.

Physicians and their regulators are naturally concerned about the risk
of iatrogenic (treatment-induced) drug dependency. Consequently, they
have tended to be sparing in their use of opiate and opioid pain
relievers, even when the pain involved is extreme and the patient's
short life expectancy, as in the case of terminal cancer patients,
makes addiction a largely notional problem.

Better professional education has made more recent cohorts of
physicians less afraid of over-prescribing painkillers than their
older colleagues, but the upsurge of prescription-analgesic abuse
(especially of hydrocodone [Vicodin] and oxycodone [Percodan,
Oxycontin]) has generated a backlash.

Tight controls and cautious prescribing can reduce medical misuse and
recreational use of prescribed drugs and the diversion of
pharmaceuticals into illicit markets.

A crackdown on Internet pharmacies offering on-line "prescriptions" is
fully justified.

But the tighter the regulation, the greater the cost and inconvenience
imposed on manufacturers, physicians, pharmacists and patients.

Cost and inconvenience will not only annoy those groups, it will also
increase the amount of untreated pain.

Current policies are scaring physicians away from treating pain
aggressively. Many doctors and medical groups now simply refuse to
write prescriptions for any substance in Schedule II, the most tightly
regulated group of prescription drugs, including the most potent
opiate and opioid pain-relievers and the potent amphetamine
stimulants. The opiate-and-stimulant combination the textbooks
recommend for treating chronic pain is almost never given in practice
for fear (a fear well in excess of the actual risk) of disciplinary
action and criminal investigation for a physician prescribing "uppers
and downers" together.

It's time to loosen up.

Create a regulatory framework for performance-enhancing chemicals.
Advances in pharmacology are producing a new wave of molecules capable
not merely of curing disease, but of enhancing normal performance
across a range of activities: athletic, erotic, cognitive and creative.

The borderline between drugs that are necessary to treat real ailments
and those that are elective for enhancing performance is already hazy
and is bound to become even more indistinct.

Most drug abuse control policy is directed at chemicals people take
for fun. (Abuse of anabolic steroids in sports is notoriously
widespread, but the number of criminal prosecutions since anabolic
steroids were made controlled substances has been tiny, perhaps
because steroid abuse doesn't involve intoxication and is associated
with athletic striving rather than the hedonistic "drug culture.") But
we will increasingly confront chemicals people take to perform better.

Insofar as reasonably safe drugs can be developed that lastingly boost
memory or other cognitive capacities, it's not obvious that they ought
to be forbidden, or that they should need to be brought in under the
guise of treatments for cognitive impairments, as Viagra was brought
in to treat erectile dysfunction only to be transformed into an
enhancer of normal sexual performance. But let's not fool ourselves
about the nature of competitive pressure.

To people playing winner-take-all games in schools, workplaces and
sports arenas, any effective performance enhancer that becomes legal
will become virtually mandatory for those who don't want to be
outstripped by their competitors. Such chemicals are likely to have
long-term side-effects, and we're virtually certain not to know much
about those effects for decades.

That makes the regulation of performance-enhancing chemicals a hard
problem, and one that can't safely be left to bioethicists alone.

Figure out what hallucinogens are good for, and don't let the drug
laws interfere with religious freedom.

In light of new scientific evidence, it's time to forget some of the
(false) lessons learned from the paisley-and-Day-Glo "psychedelic"
episode and bring the potential benefits of responsible hallucinogen
use back into the realm of scientific and policy respectability. If
hallucinogens have potential for therapy or performance enhancement,
why stifle it? If sincere religious seekers want to accept modest
risks of injury by taking potentially dangerous chemicals to induce
mystical visions, why forbid them?

Stop sacrificing foreign policy and human rights objectives to drug
control. Nothing that happens in Colombia or Afghanistan will greatly
influence the size of the U.S. drug problem.

Drug crops are so plentiful, so cheap and so little restricted by
geography that no plausible set of crop-eradication efforts abroad
could make any significant difference to the availability of drugs in
the United States. And if we can't make raw drug crops scarce, we
shouldn't weaken the taboo against biowarfare in trying.

Even if aerial-spraying campaigns posed no threat to food crops, we'd
never convince the world of that.

Given the stakes for us in the current contest between the government
in Kabul and the resurgent Taliban for control of Afghanistan, it is
absurd for us to insist that President Karzai make large political
sacrifices in an inevitably futile attempt to suppress poppy
production and opium and heroin exports.

Regardless of what level of crackdown on the poppy crop Karzai finds
advantageous to winning his civil war--or even if he were to decide to
legalize and tax poppy production or even heroin refining--he should
have the full backing of the United States. But our government
continues to talk (and perhaps act) as if the poppy-production issue
matters one way or the other. Given the choice between a Taliban-run
Afghanistan and not enforcing the Single Convention on Narcotic Drugs,
we should not hesitate a moment in letting the convention go.

As the National Academy of Sciences pointed out a few years ago, one
fundamental problem with our current approach to drug abuse is that we
don't know nearly as much as we need to make sound policy.

On reason is that the overwhelming bulk of the activity in drug abuse
control consists of law enforcement, but almost all of the research
money comes from the health side.

The National Institute on Drug Abuse (NIDA), with its billion-dollar
annual budget, is part of the National Institutes of Health, making it
a biomedical research agency.

Drug abuse, however, is only partly a biomedical problem.

NIDA has no interest in studying the drug markets or drug enforcement,
but that's where much of the policy action is. More heavy users and
more data are to be found by sampling arrestees than by surveying the
general population, but we continue to spend tens of millions of
dollars a year on a household survey while the very useful Arrestee
Drug Abuse Monitoring (ADAM) program was axed by the National
Institute of Justice because, at only $7 million a year, it
represented a quarter of the tiny part of the NIJ budget not already
earmarked by the Congress.

Conflict between good and interesting science and the needs of
policymaking is typical, not anomalous.

Good science is often largely irrelevant to immediate policy;
conversely, no one is going to win a Nobel Prize for figuring out how
to reduce the violence in street drug markets.

Learning more about the brain will surely pay off in the long run, but
there is an overwhelming immediate need for more policy-relevant research.

If there's ever the political will to base drug policy on evidence
rather than prejudice, the first step must be to get serious about
gathering real evidence.

Supervising the national drug policy research agenda, and thinking
about how to create less disastrous national drug policies, ought to
be part of the job of the Office of National Drug Control Policy (the
"drug czar" operation). But instead, that office has been mostly a
cheerleader and ideological enforcer, intent on maintaining current
ideas and defending the interests of the public and private agencies
that provide enforcement, prevention, treatment and drug-testing
services. A president who is serious about dealing with the twin
problems of drug abuse and drug enforcement, and is prepared to be
bold about it, would have to start either by finding smart,
knowledgeable, serious and bold people to staff that office--or by
getting rid of it entirely.

Such a president, alas, is nowhere is sight.

[footnotes]

1. For accounts of the "epidemic of isolated incidents" in which
innocent people have been killed or injured when their homes were
wrongly subjected to SWAT-style searches, see Radley Balko, Overkill:
The Rise of Paramilitary Police Raids in America (Cato Institute, 2006).

2. This topic deserves a book rather than an essay, and, as it
happens, a fairly good book has recently been published: David Boyum
and Peter Reuter, An Analytic Assessment of U.S. Drug Policy (American
Enterprise Institute, 2006).

3. In a typical American jurisdiction, something like a tenth of one
percent of the population consisting of chronic drunk and disorderly
arrestees accounts for about 15 percent of all arrests.