HOOKED ON NARCOMYTHS

America's longest-running metaphorical war, a campaign against
a hidden and even less well defined enemy than terrorism, is the war
on drugs. This one also has its insidious domestic threats, its
overseas campaign of interdiction and extermination, its potential to
foster guerrilla wars and destabilize governments. It too has been
supported with little dissent from a Congress where few dare to
question the prevailing orthodoxy.

Of course the analogy is misleading. There are huge differences
between the threat of drugs and the threat of terrorism, whose very
object is the slaughter of innocents. But to point out that obvious
distinction is also to underline the excesses of a campaign whose cost
in lives, privacy, social damage and political instability easily
exceeds the more than $25 billion in tax money that the nation now
spends on it every year. More than half of all those sent to federal
prison are drug offenders.

Nonetheless, the most significant challenge to that orthodoxy so
far-most of it from intellectual and social elites-is a free-market
libertarianism that's as ideological and unrealistic, both as politics
and policy, as the case for an all-out war. So the issue tends to be
vastly oversimplified: the zero-tolerance absolutism of former US drug
czar William Bennett versus the libertarian, free-market absolutism of
economist Milton Friedman; prohibition with long prison terms even for
simple possession versus decriminalization, including, at the margins,
regulated commercial sale.

Robert J. MacCoun, a professor of law and public policy at Berkeley,
and Peter Reuter, a professor of public policy at the University of
Maryland, are certain that there is a third, and better, set of
alternatives-more rational, based on experience, less sure of
itself-that can thread its way, almost on a case-by-case basis,
between the ideological poles and out of the morass in which US drug
policy has been stuck.

In part that third way requires doing more-in needle exchanges,
safe-use campaigns targeted at addicts and a whole range of non-drug
policy issues like better welfare and healthcare. In part it means
doing less-particularly through selective, targeted enforcement of
prohibitions, shorter criminal sentences and fewer encroachments on
civil liberties. MacCoun and Reuter make a sharp distinction between
decriminalization and what they call depenalization, which differs
from conventional prohibition not in restricting access but in
limiting the severity of the penalties, particularly by replacing
criminal with civil penalties. (In the case of cocaine, which they
regard as far too destructive, they don't favor depenalization but
only a reduction of the severe and unequal criminal sentences the
United States imposes even for possession.) Nor do they support
anything that would lead to commercialization even of soft drugs like
marijuana, which they feel would bring-and, in places like the
Netherlands, has brought--expanded use.

But their preference, often implicit, nonetheless follows a general
European model that seeks overall harm reduction rather than merely a
reduction in the prevalence of use, as US policy now does. They
acknowledge that total harm reduction-- mitigating the overall social
costs not only of drug use but of prohibition and the criminal
behavior associated with it-is not always an easy calculation. Among
other things, calculations need to include measures of total
consumption-reduction in heavy use-not just in the number of users.
But it's certainly more realistic than measuring the success of policy
simply by how many fewer people regularly use some illegal substance.

The implicit, and occasionally explicit, policy preferences in Drug War
Heresies seem almost an afterthought next to the huge amount of data that
forms the core of this book and that sheds light on almost every aspect
of this issue. MacCoun and Reuter have surveyed and analyzed hundreds of
studies, past and present, in this country, Europe and Australia, not just
on drug policies but on experience with a range of issues that have parallels
to this one-alcohol prohibition in the United States, tobacco regulation,
legalized gambling, the enforcement of laws against prostitution. The real
objective of the book is to document the complexity of drug policies, their
often unintended consequences and, more fundamental, the lack of scientific
foundation for so much of US policy. The analysis of these data,
dispassionately
presented in all their complexity, makes this an enormously important book.
This is especially true because drug policy is a field where tendentiousness
prevails, with the exception of a very few other works, like Mark Kleiman's
Against Excess: Drug Policy for Results (1992).

Needless to say, Drug War Heresies is hardly an easy read, much less
an easy book to summarize. Nor will either side in this fight find it
entirely to its liking. It leaves the standard slogans and
cliches-that better policy research on things like marijuana, for
example, would send the wrong message-lying in the dust. Excepting
only Sweden, most of Europe, as MacCoun and Reuter make clear, is
moving away from the punitive model, only rarely toward legalization
and more commonly toward a far more realistic, nuanced, "harm
reduction" approach not stuck in the puritanical mode that so much of
US policy finds itself in. (And even the Swedes, who reject methadone
maintenance and needle exchange, provide well-supported treatment and
social services to addicts.) That hardly means that policies in the
Netherlands, Britain, Spain and Italy, all of which they examine, are
beyond question. All of them, as MacCoun said in a recent talk, are
flawed in one way or another. But Europe is a rich source of lessons.

At the core of those lessons is the question of trade-offs: How much
do the substantial reductions in crime and criminal justice costs
(including the cost of police corruption) resulting from any loosening
of criminal penalties, plus the benefits of safe-use programs, offset
the costs imposed on families, individuals and neighborhoods from
increased drug consumption?

And that, in turn, depends again and again on individual
circumstances-on the details of the policy and the surrounding
culture. The Dutch, for example, appear to have successfully
depenalized marijuana possession without terribly significant
increases in use, thereby reducing both the costs of incarcerating
marijuana users and the associated human costs. In the mid-- 1980s,
when passive depenalization-essentially, nonenforcement of laws
against personal possession-became de facto decriminalization,
marijuana became commercially available in coffee shops and use did
drift up. But even that increase didn't drive up the use of hard drugs
or increase drug-related crime. Other than producing an increase in
patients seeking treatment for marijuana-related problems and
occasional complaints from neighboring retailers about certain coffee
shops, say MacCoun and Reuter, "we are unable to document any
significant social harms accompanying increased cannabis use."

MacCoun and Reuter make clear that at times harm reduction can go
badly wrong. After years of chasing an active heroin scene around its
neighborhoods, Zurich established its so-called Needle Park
(Platzspitz), thereby concentrating heroin users in one park near the
main railroad station, in an effort to minimize petty crime and
neighborhood nuisances, and to create a central location for providing
health services to addicts. The experiment failed: It drew heroin
users from far and wide, and turned the place into a "Hieronymous
Bosch vision of a drug hell," which in turn was cited by
prohibitionists everywhere as evidence that such ventures never work.
But there were also gains: from AIDS outreach, which appears to have
driven down HIV-positive rates, and from the efficient handling of
medical emergencies. And while there were some notorious gang-related
murders, crime rates were surprisingly low. Switzerland had a serious
heroin problem before Platzspitz was created, but there is no evidence
that overall use of heroin in the country increased as a result of
it.

The book's general read of the overall European experience is that it
has a lot to tell us about what is feasible. "The Dutch have shown
that harm reduction can be used as a principle to guide decisions
consistently; [it has] some successes to show and no disasters to
hide. Italy has removed criminal sanctions for possession of small
quantities of cocaine and heroin without experiencing much greater
problems than their neighbors." Swiss trials (begun following the
Platzspitz failure) "show that heroin maintenance programs can operate
in an orderly and systematic fashion for the benefit of a substantial
fraction of the clients." The authors also point out that American
experience with the enforcement of prostitution laws indicates that
the harms that theoretically follow from vice prohibition can be
mitigated-hough not eliminated-by selective enforcement. Indeed,
despite America's moralistic views about prostitution and adultery,
policing of prostitution has much in common with the discretionary
policing of drug use in many European cities. Conversely, however,
MacCoun and Reuter also caution against excessive enthusiasm for the
contention that regulatory policies are inevitably an improvement over
outright prohibition. t

Recent US experiences with alcohol and tobacco illustrate the power of
commercial marketing and the difficulty of maintaining or tightening
regulatory controls in the face of that power. The evidence for both
of those licit substances shows quite clearly that while "prohibition
may cause considerable harm, eliminating prohibition does not mean
eliminating drug-related harm." Put briefly, they contend that
contrary to the libertarian enthusiasm for such a course, the alcohol
and tobacco model has to be approached with a lot of caution. In the
case of tobacco, for example, restrictions on promotion, product
regulation and taxation have all been greatly attenuated by the
industry's strategic use of political contributions and refraining of
legal issues (e.g., making promotion of a dangerous product a
free-speech issue).

Despite the wealth of research available to help guide drug policy,
the tests and calculations-essentially on the harm-reduction
principle-MacCoun and Reuter are under no illusion that there's any
specific formula by which to evaluate reform proposals. In the end,
value judgments still have to be made, weights attached to each
element of harm. Politically, moreover, the burden of proof is still
on reformers to show why their proposals are preferable to the status
quo, no matter how dismal it is. And that's often complex. Much
easier, unfortunately, are the simplistic warnings put out by
government prohibitionists that any experiment-say, with safe-use
programs or even good medical studies on the safety and efficacy of
marijuana in reducing the nausea associated with chemotherapy or the
loss of appetite of AIDS patients-- would "send the wrong signal."

MacCoun and Reuter may overestimate the political obstacles blocking
the kind of reform that thev clearly seem to prefer. A call for
"nonzero tolerance," they write, is tantamount to treason in some
circles; but such a call might encourage more humane, less intrusive,
less damaging ways of coping with drugs and their harms. They cite the
passage of the first initiatives, in California and Arizona in 1996,
permitting the medical use of marijuana, which they call "at best
sloppy," because those ask doctors to make decisions without adequate
scientific evidence. But their book apparently went to press before
the wave of recent ballot measures and state laws: medical marijuana
initiatives in six or seven other states, state laws liberalizing
sterile syringe access and reducing prison terms for drug possession,
and California's Proposition 36, passed in the fall of 2000, which
requires all those convicted of simple drug possession or drug use to
be sent to treatment rather than prison. All suggest that, at least
before the terrorist attacks of September 11, the public may have been
in a far more tolerant and reformist mood than its elected leaders.

Still, the authors are right that despite polls showing that Americans
believe the drug war has been a failure, it's a political standard,
not a philosophical or analytic one, that reformers have to meet. And
that standard is quite protective ofthe status quo. The combination of
high uncertainty about the outcome of any change; the partial
irreversibility of any bad outcomes; and a pervasive tendency for
decision-makers to favor the status quo pose steep barriers for
reformers. Despite the high number of Americans incarcerated for
nothing more than marijuana offenses-an affront to a liberal society's
belief in the benevolence of government-reactions to existing policies
have not been strong enough for politicians to risk any real reforms.
A punitive stasis prevails.

Yet even in the face of such passive resistance, Drug War Heresies
should pose a formidable challenge, not necessarily to cause pursuit
of the policies and trial programs that MacCoun and Reuter seem to
favor-maintenance, reducing the penalties for use of marijuana, more
judicious drug law enforcement-but to pay attention to the data, end
the misrepresentation of information where it exists and go after it
where fear has repressed even research, especially in assessing the
consequences and efficacy of existing policies.

More fundamentally, the book may also introduce policy-makers to the
relatively novel thought that prevalence reduction and use reduction
are not the same. While cocaine prevalence has gone down, they point
out, "total cocaine consumption and its related harms have remained
relatively stable." It may also make clearer that harm reduction is
not simply a flag flown by closet libertarians who are philosophically
opposed to all prohibitive drug laws.

At the same time, Drug War Heresies leaves no doubt about the limits
of policy-- and on that score it's important for a lot of other
fields. It's doubtful, as the authors say, that a complete solution to
the US drug problem exists. The major differences between the American
and European illicit drug situations, they suggest, may be rooted as
much in broader societal differences, in the peculiarities of
geography or in other policies-in lack of healthcare or unequal income
distribution-as in drug law per se and its enforcement. That's
particularly true of treatment programs, which, even under the best of
circumstances, will only be partially successful. But that hardly
eliminates the need for reform, in reducing the severity of sentences
and the intrusiveness of drug law enforcement, and shifting to more
selective, targeted enforcement. Such a course, MacCoun and Reuter
acknowledge, reflects only their opinion. But they leave little doubt
that the evidence indicating a need for major reform has both an
empirical and an ethical basis. "To scorn discussion and analysis of
such major changes, in light of the extraordinary problems associated
with current policies, is frivolous and uncaring." For many reasons
this book isn't easy; but for anybody seriously and earnestly
concerned about drug policy, it is likely to become
indispensable.

Peter Schrag, former editorial page editor of the Sacramento Bee, is the
author most recently, of Paradise Lost: California's Experience, America's
Future (California). He has been doing research on the politics of the
drug war.