TREAT COMPLEX PROBLEM AS A PUBLIC HEALTH ISSUE

Choice 3: Treat substance abuse as a health issue: Drug abuse is a
treatable illness, and illegal drugs are primarily a public health problem,
demanding medical, social and legal remedies. Government must jail drug
traffickers, but should treat drug users. Prevention programs should be
expanded to reach more families before they turn to drugs.

Nothing is as simple as it first appears. The extreme complexity of the
drug problem must be recognized in order to devise a workable plan to
reduce the harms that illicit drugs and their surrounding set of rules and
policies inflict on the public.

The drug problem is a crime problem. Millions of crimes occur daily, and
most are committed by the estimated 20 million users of illegal drugs who
generate more than a million arrests annually. More newsworthy are crimes
to obtain money for buying drugs. Competition for market share includes
gunfire to deter competitors from a seller's turf.

The drug problem is a major economic problem, coming to around $135 billion
annually. The largest part of this cost comes from the fact that many
recreational mood-altering drugs are illegal.

The drug problem is an international problem. The United States intercedes
in the affairs of other nations as we pressure them to stop lucrative
commerce in drugs headed our way and complain when they fail to relieve our
drug problem.

Finally, drugs -- legal and illegal -- comprise a health problem. People
get sick from taking drugs. Some die. A 1979 report cites 900 deaths
associated with 57 million Valium prescriptions to help people manage
stress. Annually we have nearly 35,000 alcohol-related deaths from injuries
and accidents, and 430,000 associated with smoking tobacco. And yes, lots
of people die annually from using illegal recreational drugs; a recent
estimate is 7,600, of which about half were from poisoning via impurities
and contaminated needles.

All told, the criminal orientation toward our drug problem, the predominant
emphasis in national policy, has failed. It is time to adopt a general
public health approach to the very complex problem.

What would a public health orientation look like? It would seek "to reduce
and control the use of all recreational mood-altering drugs in order to
provide for their safe, pleasurable use, consistent with centuries-old
human experience, while minimizing their harmful effects on individuals,
the family and society as a whole," according to Steven Jonas, a physician
and professor of preventive medicine. It is the broadest approach to this
complex problem because it encompasses all the features mentioned so far.
While opposing the use of drugs as unhealthful and socially damaging
behavior, the public health approach would emphasize the discovery and
alleviation of causal conditions, preventive efforts through education and
propaganda, and accessible treatment for the individual user.

What do advocates of the public health approach propose? One proposal is a
relaxation of controls on prescription pain relievers. Many physicians have
had needless trouble with the law for allegedly over-prescribing narcotics
for relief of the pains of organic illnesses.

Another proposal is the medicalization of illicit drugs that have
therapeutic value. The active ingredient in marijuana, for example, reduces
internal eye pressures that lead to glaucoma, reducing the nauseating
effects of several chemical treatments for cancer, and restores appetites
of AIDS patients. The 1996 referenda in California and Arizona legalizing
physician-ordered marijuana use for certain afflictions reflect the public
health orientation.

Non-enforcement of anti-marijuana laws can be expanded, emulating the
successful Dutch and German experiences. Ten American states have removed
criminal sanctions on possession of small amounts of marijuana for personal
use. One study shows that states without criminal sanctions on marijuana
experience fewer auto fatalities. Heavy restrictions on marijuana seem to
encourage substituting more dangerous drugs, including alcohol, especially
among teen-agers.

What about legalization of all currently illicit drugs? Eventually, total
and controlled legalization should come about, but only after extended
public debate and education on the risks and benefits of reform. The
experience with anti-nicotine education is instructive. Adult smoking and
its attendant hazards are way down. Increased treatment for addicted
people, while costly, is measurably less costly than repeatedly jailing
drug users.

In a public health orientation, gradual steps toward controlled
legalization could reduce many of the harms that now afflict us and would
more than offset the risks of increased drug use.

What form of legalization? There are many versions of legalization. I
propose that with a public health orientation we should work gradually
toward a regulated open drug market, starting with marijuana, and an
expanded educational program to inform the citizenry of the dangers of
drugs and the advantages of such a market.

Buyers and sellers of recreational drugs would be licensed, after passing
qualifying tests.

Records of sales would be used to substantiate license suspensions or
punishments based on violations of laws against reckless driving or other
offenses associated with overuse of drugs.

Protection against impurities would be provided by market competition and
governmental regulation. Packages would show contents and warnings about
overuse and health hazards.

Price regulation would be left to market processes.

Federal taxes would apply uniformly to each class of products, and states
and municipalities could tax at levels low enough to discourage black markets.

Tax proceeds and drug war cost savings would be dedicated to prevention and
treatment and to programs of human and social development -- child care,
education, job training, housing, recreation, parks -- all known to promote
a quality of life that breeds self-respect and reduces the need for
recreational mood-altering drugs.

Is such a changed policy attainable? Yes, with patience and steady effort.
Many members of Congress and state legislatures are open to gradual change,
but widespread misunderstanding and fear make sympathetic legislators
reluctant to speak out and possibly risk their jobs. At the state level,
further advocacy of medicalization of marijuana and decriminalization
through revising law enforcement priorities are reasonable goals. At the
national level, turning the authority back to the states would be simplest.
The 21st Amendment in 1933 didn't legalize alcohol; it just gave the issue
over to the states.

Yes, it is time to change our thinking about the drug problem and the
scourge of the drug wars. Treating the drug problem in a public health
context can liberate public and private resources for more constructive
use: prevention of drug abuse, treatment for addicts, and the development
of a society that has minimal demands for recreational drugs as the road to
happiness and mutual respect.

© 1998 Centre Daily Times