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--though 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. 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 reframing 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 they 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 of the 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.