DRUG TRIAL: A NEW METAPHOR FOR AUTONOMY

In November 1996, Californians voted to allow possession and use of
marijuana for medical purposes with a physician's recommendation. Arizonans
went further. They permitted patients to possess and use any illicit drug,
provided they receive a written prescription from a physician, who, in
turn, obtains a concurring second opinion. In addition, the Arizona ballot
measure gave drug users probation and rehabilitation rather than prison
time for the first two convictions. It prohibited incarceration of
nonviolent drug offenders until the third conviction. Finally, the measure
made eligible for release all inmates serving time for simple drug
possession with no other offenses.

Vice President Al Gore, Attorney General Janet Reno, drug czar Barry
McCaffrey, and former Presidents Bush, Carter, and Ford participated in
media events warning voters of the dangers posed by these initiatives.
Despite those efforts, the ballot measures passed easily, with 56 percent
support in California and 65 percent in Arizona.

>From the perspective of some libertarians, most notably Thomas Szasz, the
public health model embodied in these initiatives can be seen only as a
pernicious extension of the meddlesome Therapeutic State. But when applied
to drug policy, medicalization actually represents a radical rupture with
the federal government's oppressive drug war.

I served as medical spokesman for the group that developed and promoted the
Arizona initiative. Our mission was to seek alternatives to current drug
policy. Accordingly, we commissioned focus group research to explore how
citizens felt about the drug issue.

Two dispositions were immediately apparent: 1) People overwhelmingly felt
the drug war was a failure, and 2) people strongly opposed the alternatives
of decriminalization and legalization. But this did not mean they opposed
significant reform. For example, focus group participants firmly rejected
the policy of "do drugs, do time." They believed treatment was much more
appropriate than imprisonment for drug users. This belief was so strong
that they were willing to parole offenders already in prison. Furthermore,
they believed that when it came to prescribing drugs - even marijuana,
heroin, and LSD - the patient/doctor relationship should supersede
government control. Arizona voters probably did not realize how widely such
beliefs were shared: Tracking polls showed that 60 percent supported the
initiative but only 25 percent thought it would pass.

The focus group and tracking poll results illustrate what postmodern
philosopher Michel Foucault calls "subjugated knowledge" - an implicit
belief that people cannot communicate unless given the language to do so.
The Arizona focus group research revealed a radical resistance to the drug
war that lacked a narrative with which to express itself. The common
"metaphors" of resistance - legalization and decriminalization - were
unsatisfactory. A new vocabulary took shape as a result of the focus group
experience. Group members repeatedly said drug abuse is really a "medical"
issue. They said drug treatment, even if it doesn't work, is a more just
form of punishment. Thus, a new discourse on drugs emerged, representing a
halfway position between prohibition and repeal. Years of prohibitionist
propaganda made it impossible to generate popular support for anything more
ambitious.

This new discourse of medicalization is not a top-down narrative of control
written by the government. Instead, the people have generated a language of
resistance to oppressive and ineffective policies. This discourse is
percolating up from citizens who believe medical authorities can address
the drug issue more effectively than government bureaucrats.

Libertarian critics mistakenly take the term medicalization to mean the
transfer of power from a political dictator to a medical dictator. To be
sure, the postmodernist would agree that medicalization is a metaphor of
control. But as Foucault argues, there is no way "outside of" power; all
human interactions involve power relations. Therefore, the only way of
conceiving issues of autonomy is through empowerment. In the context of
drug policy, "medicalization" is a metaphor of empowerment.

In practical terms, the Arizona and California ballot measures have eased
statist drug controls. The federal government responded by threatening to
punish doctors who prescribe illicit drugs to their patients. This policy
prompted federal lawsuits (including one in which I am a plaintiff) that
fundamentally challenge the way drugs and medical practice are regulated. A
recent national poll found that 69 percent of Americans oppose the federal
response to the medicalization initiatives.

During the Arizona campaign, I had many arguments with libertarian friends
who shared Dr. Szasz's suspicions of medicalization. But the reaction of
the federal government and the law enforcement community to the measure's
approval, coupled with strong public opposition to that reaction, has led
many of them to re-examine their positions. Any drug policy reform that
engenders so much outrage from the political establishment and incites such
widespread dissent can't be all bad.

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