VIEWS ON PROPOSITION 36

YES Prop. 36 `Medicalizes' a Health Problem Steve Heilig, David E. Smith

LONG AGO, a member of one of our families got off on an unfortunate path in
high school. Though bright and athletic, he smoked a lot of marijuana and
soon found he liked the ``high life'' of a successful pot dealer.
Eventually, he got caught with too much of his illegal product. The
prosecutor asked for 15 years, he was sentenced to six, and spent three
years in a notorious state prison. Having gone in a quiet and remorseful
citizen, he came out addicted to heroin, with violent tendencies --
acquired as a survival tactic -- more unemployable than before as a
convicted felon and hating ``society.''

For this outcome, taxpayers paid between a quarter million and half a
million dollars. Sometime this month, the United States will pass the 2
million mark in terms of people held behind bars. This represents almost a
doubling of prisoners in the last decade. Our nation leads the world in the
percentage of citizens incarcerated. By one projection, at current rates,
in 50 years the last American will have to lock the door behind him or her
and toss the key back out through the bars.

More than half of all American prisoners are there for drug-related
offenses. The number of such prisoners has increased sevenfold since 1980.
There are now somewhere between 13 million and 25 million Americans who use
illegal drugs of some kind -- not including those who still do so behind
bars. Most will be able to handle whatever problems this use might cause
them. But for those for whom drugs become a problem, medically and /or
legally, what might be done?

The concept of ``therapeutic jurisprudence'' is one great improvement. Drug
courts, where judges may divert drug users to treatment instead of jail,
has shown great potential. San Francisco has been a leader in this arena,
and our district attorney made drug courts a central part of his policy in
winning re-election last year. But drug courts have unfortunately had a
difficult time becoming accepted in other areas and remain a small part of
the judicial system. And remember, a majority of surveyed ex-prisoners say
they could easily get drugs in prison and that incarceration was no help to
them in getting off drugs. The Substance Abuse and Crime Prevention Act of
2000 is another potential answer. Now on the November ballot, Proposition
36 would provide drug treatment for nonviolent drug offenders instead of
prison. In addition to being a more humane and medically sound approach, it
would save state taxpayers more than $1 billion in the first five years.
For years now, American medicine has recognized addiction as a disease.
Treatment for this disease has made real strides in recent years. Many
researchers feel that we are on the verge of a new era of more effective
therapies. Currently, the results are still far from ideal, but even at
this point, an interesting side effect of drug treatment has been observed.
It seems that, for every dollar we spend on quality addiction treatment, $4
to $7 are saved in the broader society in terms of law enforcement, other
health-care costs and work-related problems. When comparing treatment with
jail, strictly in terms of direct costs, consider that in 1998 the annual
cost of residential drug treatment was less than $7,000; incarceration,
however, cost about $26,000.

Make no mistake: Violent, dangerous drug users belong behind bars. But
those prisoners still need drug treatment while incarcerated. However, such
prisoners are in the minority. For the majority, treatment would be better
for them and for society in every way. This is not ``legalization'' of
drugs, but rather a step toward ``medicalization'' of a major health
problem. Drug treatment is no picnic for users, but it is more effective
than prison. Polls show that most voters oppose legalization but agree with
this commonsense approach, as does our city's mayor, county sheriff, Board
of Supervisors, medical society and the California Society of Addiction
Medicine.

Who opposes it? Primarily a large and powerful prison lobby, which has
developed along with the prison complex itself. This lobby supports jobs in
prison construction and staffing, fighting any change in our drug laws as
being ``soft on drugs'' and tossing a lot of money around in Sacramento. In
California alone, 23 prisons have been built in the past 15 years at a cost
of $4.2 billion, with more under construction. Some guards make more than
$100,000 a year. This lobby is doing its best to frighten voters away from
Prop. 36.

Addiction itself has often been referred to as a kind of personal prison.
Why add real incarceration to the tragedy when more humane and efficient
alternatives exist? Prop. 36 is a good step in the right direction -- away
from jail and into medical treatment.

Steve Heilig is director of Public Health and Education for the San
Francisco Medical Society. Dr. David Smith is founder and president of the
Haight-Ashbury Free Medical Clinics.

VIEWS ON PROPOSITION 36 NO A Front for Legal Drug Use Robert DuPont

THE PROPONENTS of Proposition 36 are attempting to mislead the voters into
thinking that they have a quick fix for the tragedy of drug addiction.
Simply pump $120 million a year into unregulated drug-treatment programs,
let drug addicts police themselves and prevent judges from punishing
addicts for failing to stop their drug use.

Like a Trojan horse -- voters will discover upon closer scrutiny that Prop.
36 is a fraud. No incentives for drug addicts to stick with treatment. No
standards for drug treatment. No funding for drug testing. No
accountability for continued drug abuse. No hope for drug abusers and their
families, who want real solutions, not tolerance of more illegal drug use.

Why does Prop. 36 fail to take into account the advice of the leading
drug-treatment experts, who say that accountability for illegal drug use is
vital to recovery? Because Prop. 36 is not a serious drug-treatment
measure. It is an attempt to manipulate voters into approving the
decriminalization of dangerous drugs, such as heroin, crack cocaine, PCP
and methamphetamine.

How did this irresponsible and misleading initiative get on the ballot? The
answer is simple: a well-financed and deceptive campaign bankrolled by the
pro-legalization movement.

New York billionaire George Soros and two other out-of-state backers are
falsely portraying this initiative as a humane answer to drug addiction --
a feel-good measure that will appear to help addicts kick their habits
while saving taxpayers millions of dollars.

Because advocates of drug legalization cannot win on its merits, they have
learned to cloak their efforts under the guise of socially attractive
programs. In this case, they have chosen drug treatment for addicts to hide
their goal of tolerating illegal drug use.

What they don't say is that the drug-treatment programs on which this
initiative proposes to spend $120 million a year will not stop illegal drug
use. Under Prop. 36, anything goes. Everything from videotaped
``treatment'' programs to Internet chat rooms for addicts can qualify for a
share of your tax dollars. The predictable result would be a proliferation
of pseudo treatments for the drug addicts who desperately need real help.

Prop. 36 specifically prohibits any of the proposed funding for drug
testing, choosing instead to trust drug addicts to hold themselves accountable.

Prop. 36 prohibits payment for any treatment over 12 months, even though
extended treatment often is the most effective approach for many long-term
addicts.

Prop. 36 also doesn't provide funding for treatment programs to help
addicts in California prisons.

Finally, Prop. 36 would undermine California's highly effective,
individualized addiction treatment. Drug courts, unlike Prop. 36, hold
illegal drug users accountable for their behavior.

The drug courts also save taxpayer dollars. Every $1 invested in the drug
court system saves an estimated $10 by reducing jail time, decreasing crime
and lowering criminal justice costs.

Californians can take a stand against deceptive efforts to legalize
dangerous drugs and support the state's real drug-treatment programs --
including drug courts -- by voting ``no'' on Prop. 36.

Robert DuPont is a clinical professor of psychiatry at Georgetown Medical
School.