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NATIONAL DRUG REFORM STRATEGY
February 1992
The Drug Policy Foundation
(C) 1992 by the Drug Policy Foundation
Any part of this publication may be reproduced without express permission
from the Drug Policy Foundation, so long as appropriate credit is given.
The Drug Policy Foundation is an independent forum for drug policy
alternatives. It is the leading organization dedicated to research,
education and public information related to the international war on
drugs. It is not a legalization organization, though some of its members
support such an alternative to the current policy approach.
The Foundation is a charitable corporation under the laws of the District
of Columbia and section 501(c)(3) of the U.S. Internal Revenue Code. All
contributions to the Foundation are tax-deductible. To maintain its
independence, the Drug Policy Foundation neither seeks nor accepts
government funding. It is supported by the contributions of private
individuals and organizations.
The Drug Policy Foundation
4801 Massachusetts Ave., N.W., Suite 400
Washington, D.C. 20016-2087 U.S.A.
(202) 895-1634 - Fax (202) 537-3007
President: Arnold S. Trebach
Vice President: Kevin B. Zeese
Public Information Officers: Kennington Wall, Dave Fratello
CONTENTS
-------------------------------------------------------------------------
Summary
Introduction: What's Wrong with the War on Drugs?
Recommendations:
1. Reverse Drug Policy Funding Priorities
2. Curtail AIDS: Make Clean Needles Available to Addicts
3. Increase Drug Treatment Availability
4. Stop Prosecutions of Pregnant Drug Users
5. Make Medical Marijuana Available to the Seriously Ill
6. Appoint a Commission to Seriously Examine Alternatives to Prohibition
Conclusion: Creating a Safer, Healthier America
Appendix: A History of Impartial Reports Demands Reconsideration of
Current Drug Policy
DRUG REFORM STRATEGY SUMMARY
o Reverse Drug Policy Funding Priorities
The Bush administration should eschew the course set by the previous
drug czar and give _highest_priority_ to drug education and treatment.
Reversing the current 70 percent-30 percent funding disparity favoring
law enforcement over drug prevention is a moral imperative.
o Curtail AIDS: Make Clean Needles Available to Intravenous Drug Addicts
President Bush and National Drug Control Policy Director Martinez
should heed the advice of the National Commission on AIDS, which urged
implementation of clean needle exchanges and other programs targeting
addicts.
o Develop a Plan for Drug Treatment on Demand, Allow Medicaid to Pay for
Treatment for the Poor, and Expand the Variety of Treatment Options
Available
The drug czar should make a comprehensive assessment of drug
treatment availability nationwide, then propose a target date and plan of
attack for achieving treatment on demand everywhere in the United States.
Mr. Martinez should also work with Congress on legislation allowing
Medicaid to cover drug treatment expenses for our nation's poor.
o Stop Prosecutions of Pregnant Drug Users
Director Martinez should use his national pulpit to urge states to
cease the counterproductive practice of prosecuting pregnant drug users.
Ending such prosecutions, while expanding drug treatment and prenatal care,
will help reduce the problem of drug-exposed infants.
o Make Medical Marijuana Available to the Seriously Ill
The president should order the Food and Drug Administration and Drug
Enforcement Administration to join in making marijuana available, by
prescription, to the tens of thousands of seriously ill Americans who
could benefit from its use.
o Appoint a Commission to Seriously Examine Alternatives to Prohibition
The national policy of drug prohibition has not reduced the supply
of illegal drugs, but it has bred crime and violence on a massive scale.
It is time to look honestly at the experiences of other nations with
illegal drugs and at our own experiences with legal drugs to develop new,
health-based policies for reducing substance abuse.
WHAT'S WRONG WITH THE WAR ON DRUGS?
President Bush launched his administration's war against drugs just
over two years ago on September 5, 1989. The strategy announced by the
president and his first drug czar, William Bennett, rubber-stamped the
Reagan drug control approach. In addition it promised more money, better
coordination and a full commitment from the commander-in-chief.
President Bush has intensified the war, but recent National Institute
on Drug Abuse statistics show that victory in the drug war is still far
from a reality. Indeed, on many fronts the problems are getting worse.
Meanwhile, the war on drugs is costing the states and federal government
billions of dollars, overfilling our prisons, breeding crime and violence,
and failing to treat those people who desperately want help.
Drug War at an Impasse
The drug war was the centerpiece of the administration's early
domestic agenda. But as the months wore on, the drug czar became
discouraged and abandoned his post, leaving the drug war adrift.
Leadership at the Office of National Drug Control Policy has been slow to
develop, and staff shakeups have hampered coordination and progress. The
issue has fallen from the headlines even as many of the social problems
related to illegal drugs have increased.
Drug-related crime and violence have reached record level today. In
1990, 23,438 Americans were murdered--a record figure fueled in part by
drug trade- related violence. While final figures for 1991 are not
available yet, all indications are that the homicide record will be broken
again. The worsening of the highest priority drug-related problems is the
paradoxical result of increased enforcement. As Nobel Laureate economist
Milton Friedman has pointed out, the homicide rate has gone up in response
to increase competition among drug sellers, much as it also climbed during
alcohol Prohibition.
AIDS continues its deadly spread in our society, with close to
one-third of all cases traceable to the use of infected needles by
intravenous drug users. The worst aspect of this gruesome situation is
that the spread of AIDS via dirty needles could have been prevented all
along. Federal drug war policy makers have refused to consider the single
measure that could undeniably and immediately reduce the number of people
contracting the disease through infected needles: sterile needle
exchange. By shutting down the spread of AIDS among addicts, we would
also reduce the incidence of the disease among their sexual partners and
children, thus helping curb the disease among the mainstream population.
Our courts and prisons are being flooded with drug cases, pushing
federal, state and local courts to the breaking point. Over 1.2 million
Americans now live behind bars, giving the United States the highest
incarceration rate in the free world. In some cities, it is now virtually
impossible to try a civil case because all the judges' dockets are filled
with drug cases, many of which involve only small transactions or simple
possession. What is worse, every drug dealer arrested is simply replaced
the next day by someone else who needs money desperately enough to risk
arrest by the police or death by competing traffickers.
Drug use-related problems continue to escalate. Drug-related deaths
have not declined during the last decade. Emergency room mentions of
illegal drugs have fluctuated, but the most recent government figures
indicate drug emergencies are on the increase again. And according to
both the National Institute on Drug Abuse and the Senate Judiciary
Committee, so-called "hard core" drug use is also rising.
Poor and Minority communities Have Been Disproportionately Affected by
Enforcement Emphasis
Because the illegal drug business thrives where legitimate economic
opportunities are limited, drug enforcement has inevitably become focused
on poor and minority communities. The result is a striking
disproportionality in arrest and incarceration figures, where minorities
are represented at two to three times their percentage in the general
population.
According to the National Household Survey on Drug Abuse, blacks make
up 12 to 15 percent of the nation's illegal drug users. Yet in 1989, 41
percent of those arrested on drug charges were black. According to the
Washington, D.C.-based Sentencing Project, the United States has more
young black men in jail than South Africa on a per capita basis. Blacks
make up 46 percent of the U.S. prison population.
The long-term impact of disproportionate drug enforcement on the
livelihood of minority communities is still not well understood. But with
statistics showing that nearly one in four young black males is either in
prison, on parole or on probation, common sense says employment prospects
for many minorities will be hampered well into the next generation.
Having thousands of fathers in jail also hinders the development of strong
family values. So long as the illicit drug business continues to operate
in these communities and enforcement efforts target them with the same
vigor, the prognosis is grim.
Time for Change to Salvage the Future
The president's war is failing to achieve its stated objectives, and
is doing more harm than good. As our nation plans for the year 2000 and
beyond, it is imperative that the mistaken approach to drugs that has
dominated the last several decades be reconsidered seriously. It is time
to turn the corner and focus on methods that work to reduce drug abuse and
corollary social problems.
It is time for drug czar Bob Martinez and President Bush to admit
that our nation's drug policy needs a new focus, a new direction and a new
conscience. To aid the development of a rational and humane alternative
to the war against drugs, the Drug Policy Foundation hereby offers a
reform agenda for 1992.
Purpose of this Strategy
As critics of the drug war, we have consistently been asked to
produce a concrete, alternative plan to show our differences with
administration policy. We have often made such proposals. This strategy
represents a summary of those which could be immediately implemented.
Our agenda has been formulated with an eye towards achievability.
Each of the policy recommendations urged herein could be implemented by
the Bush administration without significant changes in the drug laws.
Each idea, however, could go far toward bringing a needed dose of
compassion and pragmatism into the national anti-drug effort.
Only slight statutory changes are recommended here. Some of the
items would merely require voluntary reforms by the states. We at the
Drug Policy Foundation have attempted to meet drug-war policy makers
halfway by urging reforms that fit within the current legal framework.
We hasten to add, however, that we feel the war on drugs is the
result of fundamentally flawed assumptions about drugs and drug users.
The drug war provides our nation little more than a course for disaster,
because like all prohibition policies it ignores basic rules of economics.
One of the cruelest ironies of our attempts to suppress drugs is that such
efforts actually expand the illegal market, enriching villains and
creating incentives for people to "push" drugs on others.
Hence, the final recommendation that alternative policies be
seriously examined. The Bush administration's strategy--stay the
course--offers little hope of short- or long-term success.
To date, the administration has avoided answering fundamental
questions about long-term drug policy. We believe this great nation must
now reform its current approach and consider finding new ways of thinking
about drugs. We encourage all Americans to join us in helping a sensible
and compassionate alternative to a permanent war, a war fought not to win
but to prove the ideological zeal of those who fight it.
MORE HOMICIDES, MORE PRISONERS
Rates per 100,000 population
110 11
X X X Homicides (right scale) X
100 X X | 10
X | | | Prisoners (left scale) X X X |
90 X X X X X X X X X|X| 9
X X X X X X X X X X X |X|X|X
80 X X X X X X X X X X X X X X X|X|X|X|X 8
X X X X X X X X X X X X X X X|X|X|X|X
70 X X X X X X X X X X X X X X X X X X|X|X|X|X 7
X X X X X X X X X X X X X X X X X|X|X|X|X|X
60 X X X X X X X X X X X X X X X|X X|X X|X|X|X|X|X 6
X X X X X X|X X X X|X X X X X X X X X|X X|X|X|X|X|X|X|X
50 X X X X X|X|X|X X|X|X|X X X X X X | | | | X X X X|X|X|X|X|X|X|X|X|X|X 5
X X X X|X|X|X|X|X|X|X|X X X|X|X|X|X|X|X|X|X|X|X X X|X|X|X|X|X|X|X|X|X|X
40 X X X|X|X|X|X|X|X|X|X|X|X X|X|X|X|X|X|X|X|X|X|X|X X|X|X|X|X|X|X|X|X|X|X 4
X X X|X|X|X|X|X|X|X|X|X|X|X|X|X|X|X|X|X|X|X|X|X|X|X|X|X|X|X|X|X|X|X|X|X
30 X X X|X|X|X|X|X|X|X|X|X|X|X|X|X|X|X|X|X|X|X|X|X|X|X|X|X|X|X|X|X|X|X|X|X 3
1 1 1 1 1 1 1 1
9 9 9 9 9 9 9 9
2 3 4 5 6 7 8 9
0 0 0 0 0 0 0 0
Sources: Historical Statistics of the United States; Statistical Abstract of
the United States
This graph originally appeared in _The_Wall_Street_Journal_, March 7, 1991.
[I had to hack the data for 1910-1920, and the translation to ASCII suffers
a little -- lamontg@milton.u.washington.edu]
1. REVERSE DRUG POLICY FUNDING PRIORITIES
President Bush should eschew the course set by his first drug czar
and give _highest_priority_ to drug education and treatment. Current drug
control policy director Martinez should take the lead in this effort to
refocus administration policy. Reversing the current 70 percent-30
percent funding disparity favoring law enforcement over drug prevention is
a moral imperative.
Priorities Are in the Numbers
When all is said and done, the Bush administration's drug-fighting
priorities show clearly through the budget it proposes each year. Since
the first national strategy in 1989, the administration has consistently
pushed for more than twice the money for drug law enforcement than it has
asked for drug treatment, prevention and education _combined_. Yet
administration spokesmen repeatedly claim that declines in reported drug
use are the result of successful education efforts. If that is the case,
why doesn't the administration put its money where its mouth is?
In a time of unprecedented budgetary crisis, the administration is
still advocating that more than $7 billion a year go to dubious efforts at
interdiction, crop eradication and other enforcement activities. Inverted
priorities lead the administration to quibble with Congress over smaller
drug-budget items, such as a $100 million dollar drug treatment program
that was not fully funded last year. The massive waste represented by
much of the drug enforcement budget could be averted and education and
treatment programs fully funded if the administration reversed national
anti-drug priorities. It is time to go with what works and stop wasting
taxpayers' dollars.
Every Law Enforcement Dollar Guarantees Bigger Prison Budgets in the Future
Heavy funding of law enforcement, as urged by the administration, is
truly a losers game. It is like hiring people to chase the horse after it
has left the barn, rather than closing the door to prevent the horse from
escaping. Taxpayers will get a better return on their dollars if our
nation's top drug control priorities are prevention, education and
treatment.
Refocusing the drug war is not just the right idea, it is becoming a
fiscal urgency as well. If we do not act now to de-emphasize law
enforcement, it will soon be impossible to reduce that budget. Every
dollar we spend now on drug enforcement is essentially an investment in
the future--_of_our_prisons_.
In each of the last three years, more than a million Americans were
arrested for drug violations. Thousands will be serving mandatory minimum
sentences of five years, ten years and more. Our prisons and jails are
already overflowing, making it necessary to build more and more just to
keep up. In 1991 the federal Bureau of Prisons estimated that
construction costs could soon approach $100 million a week. Factoring in
operating costs for completed prisons, the BOP estimates that total
prison-related fiscal obligations could be almost double the current
national deficit within five years.
The only real options are to fund massive new prison construction
projects or to stop flooding the prison system with small-time drug
offenders. Funding more prisons is impractical at this time, with all
governmental budgets under a squeeze. Thus reducing the annual number of
drug convictions is virtually inevitable. This is yet another reason to
focus less on enforcement and more on non-punitive approaches to drugs
where possible.
Some Immediate Budget Savings
There are some specific steps that the administration should
immediately take in changing federal drug control budget priorities.
These would be both practical and symbolic changes evidencing a more
humane approach to drug abuse:
o An immediate moratorium should be placed on new prison construction.
If there is one thing the last decade of rapid expansion of
prisons has taught us, it is that more prisons do not mean less crime.
o Reserve existing prison space for violent criminals--stop using
incarceration in drug possession cases and for non-violent drug
offenders.
We should focus on keeping extremely dangerous criminals under
lock and key, while utilizing alternatives to incarceration for
nonviolent individuals who may yet be capable of productive
livelihoods. Such alternatives would include intensive supervised
probation, high school equivalency programs, community service programs
and job training. Putting masses of young people in jail makes them
less productive citizens in the long run, while training and educating
them offers real options for the future.
o Reduce prison sentences for people incarcerated for possession
convictions and non-violent drug offenses.
As many of these people are serving mandatory sentences, the
administration should ask Congress to give judges discretion to
release certain inmates before their scheduled mandatory terms
expire. Money saved could be used to develop other programs within
the prisons, such as drug treatment, training and education.
o The President should order home all Department of Defense personnel
and quasi-military representatives of federal agencies stationed abroad
to fight drugs.
The DoD is an expensive participant in the drug war, with a drug
budget approaching $1 billion annually. Yet even with stepped-up
participation by the military and DEA advisers, interdiction and
eradication programs have remained a costly failure. We should
withdraw those forces and also stop the use of DoD in drug enforcement
within the United States.
These are immediate first steps that the administration should take
to begin reversing funding priorities. The remainder of this report
suggests some specific changes which need to be made on broader policy
issues.
DRUG BUDGETS EMPHASIZE ENFORCEMENT
XX -- Enforcement, Interdiction, Eradication
OO -- Treatment, Prevention, Education
100%
XX XX
75% XX XX XX XX XX
XX XX XX XX XX XX
XX XX XX XX XX XX
OO XX XX XX XX XX XX
50% OO XXOO XX XX XX XX XX XX
XXOO XXOO XX XX XX XX XX XX
XXOO XXOO XX XX XX XX XX XX
XXOO XXOO XX XX XX XX XX XXOO
25% XXOO XXOO XXOO XX XX XXOO XXOO XXOO
XXOO XXOO XXOO XXOO XXOO XXOO XXOO XXOO
XXOO XXOO XXOO XXOO XXOO XXOO XXOO XXOO
XXOO XXOO XXOO XXOO XXOO XXOO XXOO XXOO
------ ------ ------ ------ ------ ------ ------ ------
1970 1976 1981 1983 1985 1987 1989 1991
Sources: U.S. General Accounting Office and National Drug Control
Strategies of 1989 and 1991, NDCS figures reflect administration
requests, not appropriated funds.
[reasonably good ASCII translation -- lamontg@milton.u.washington.edu]
2. CURTAIL AIDS: MAKE CLEAN NEEDLES AVAILABLE
TO INTRAVENOUS DRUG ADDICTS
The Bush administration and drug czar Martinez should heed the advice
of the National Commission on AIDS, whose July 1991 report, "The Twin
Epidemics of Substance Use and HIV," urged implementation of clean needle
exchange and other programs targeting addicts. The report stated in part:
We must take immediate steps to curb the current spread of HIV
infection among those who cannot get treatment or who cannot stop
taking drugs. Outreach programs which operate needle exchanges
and distribute bleach not only help to control the spread of HIV,
but also refer many individuals to treatment programs. Legal
sanctions on injection equipment do not reduce illicit drug use,
but they do increase the sharing of injection equipment and hence
the spread of HIV infection.
The AIDS Commission used figures from the Centers for Disease Control
to calculate that 32 percent of known American AIDS cases began with a
dirty needle. These cases do not just reflect drug-injecting addicts
coming down with the disease, but also their sexual partners and children.
Injecting addicts are a major vehicle for transmission of the HIV virus
because their lack of access to clean needles forces them to share
injecting equipment, which is tantamount to sharing blood.
Needle Exchange is an Urgent Requirement for AIDS Policy
There is no excuse for delaying needle exchange any longer. The
nation is facing a public health crisis in the form of AIDS, and all
measures to curtail the spread of the disease are urgent requirements in
public policy. Recent reports from needle exchanges in Tacoma, Washington
and New Haven, Connecticut--as well as most of Europe and Australia--show
clearly and convincingly that providing addicts with sterile needles in
return for used needles reduces the prevalence of AIDS and gets addicts
into drug treatment programs.
President Bush and drug czar Martinez have firmly opposed needle
exchange, even in the wake of the National Commission on AIDS report.
Like many Americans, they have a lingering fear that needle exchange might
appear to condone drug use, and they would rather addicts stop using drugs
than use them more safely with clean needles. This fear ignores the
studies that show needle exchange programs increase the number of addicts
seeking drug treatment. Such concerns argue forcefully for providing
expanded treatment options, but are insufficient to override the immediate
need for needle exchange. No one can avoid the underlying reality--_drug_
_addiction_is_rarely_fatal,_but_AIDS_always_is_. An addict who contracts
AIDS is ultimately lost forever, as are all the people he or she infects.
It is time to end the posturing against clean needles that results in
thousands of deaths every year, and will only add more casualties the
longer it persists. Continuing the present course will sow the seeds for
an even greater crisis in health care, as the cost of treating AIDS
patients will help bankrupt the already strapped health care system. The
administration must reverse its stand on needle exchange to send a clear
and urgent signal to the states and cities.
Repeal the Federal Ban on Needle Exchange Research
In addition, the drug czar should work with Congress to repeal the
federal ban on use of government funds to study needle exchange. U.S.
Sen. Jesse Helms (R-N.C.) sponsored a successful amendment to a 1988
public health funding bill that prohibited many federal agencies and their
contractors from associating with or studying needle exchange programs.
After repeal of this cruel ban, studies can be commissioned looking at the
experiences of several American and foreign cities with underground and
legal needle exchanges. But such studies will be no substitute for
action--they must be undertaken concurrently with wider use of legal clean
needle programs.
Action Now Will Help Shut Down a Major Source of HIV Infections
The administration has the opportunity to take the lead in shutting
down one major vehicle for transmission of HIV, one that has led to nearly
one third of American AIDS cases. Failing to take action would be a
dereliction of public health responsibility of the highest order.
AIDS Cases Traced to IV Drug Use, by Year
16
14 X
XXXXXX
12 XXXXXXXXXXXX
XXXXXXXXXXXXXXXXX
10 XXXXXXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXXXXXXXX
8 XXXXXXXXXXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXXXXXXXXXXXX
6 XXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
4 XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
2 XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
0XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
-----------------------------------------------------------------
1983 1984 1985 1986 1987 1988 1989 1990
Figures, _in_thousands_, represent total adult AIDS cases associated
with intravenous(IV) drug use. Graph does not include HIV-positive
cases where full-blown AIDS has not yet developed.
Sources: National Commission on AIDS and Centers for Disease Control.
3. Increase Drug Treatment Availability
o Develop a Plan for Drug Treatment on Demand
o Allow Medicaid to Pay for Treatment for the Poor
o Expand the Variety of Treatment Options Available
The drug czar should take a comprehensive assessment of drug
treatment availability nationwide, then propose a target date and a plan
of attack for achieving treatment on demand everywhere in the United
States. Governor Martinez should also work with Congress on legislation
allowing Medicaid to cover drug treatment expenses for our nation's poor.
Martinez Treatment Record Lacking
Drug czar Martinez claims to have changed his stripes since his one
term as governor of Florida, where he strongly emphasized law enforcement
and mass arrests to control drug abuse. Under his leadership, Florida
lagged one-fifth behind the average state in per capita drug treatment
funding and gave less than half what the average state gave to drug
education and prevention. This poor record on treatment and education
came despite Florida's desperate drug problem throughout the 1980s.
Mr. Martinez now admits the importance of drug treatment and has
vowed to make it a focus of his tenure as drug czar. His commitment could
not come at a more urgent time. Nationwide, waiting lists for treatment
programs are months long. Recent figures from the NIDA Household Survey
on Drug Abuse show a particularly acute need for treatment among hard-core
drug-using populations in the inner cities. Too many Americans seeking
help for their drug problems are finding it unavailable or finding they
cannot afford it.
Make Treatment on Demand a Real Administration Commitment
Nineteen ninety-two must be the year that "drug treatment on demand"
is transformed from a mere slogan to a comprehensive program. To this
end, drug czar Martinez should order his office to undertake an assessment
of drug treatment availability and needs state-by-state, then work with
Congress to develop a plan to achieve treatment on demand by an
agreed-upon target date. Failure of the Office of National Drug Control
Policy to take the lead on such an initiative will indicate a purely
rhetorical commitment to providing urgently needed drug treatment
services.
Part of any plan to provide drug treatment more widely must be a
commitment to diversity in treatment methods and funding options. The
plan should include easier access to methadone programs, religious and
non-religious-based treatment and research on new treatment methods,
including other maintenance drugs. In light of evidence suggesting a
resurgence in heroin imports and usage, we must learn from our national
experience with heroin outbreaks in the 1960s and 1970s. Methadone
programs are one of the effective legacies of that experience, and they
must be strengthened in preparation for the new heroin surge.
Treatment should be non-coercive and user-friendly, not a new form of
punishment. Coercive treatment is particularly inappropriate when people
are waiting for treatment slots. In this regard we are especially
concerned about children abused in drug treatment programs. President
Bush should rescind his endorsement of Straight, Inc., the confrontational
youth treatment center found guilty of abuses and rights violations.
Reports of abuse continue to flow out of its centers across the country.
Whether a program is federally sponsored, state-sponsored, a
partnership or a private program, adequate funding should be made
available by state and federal authorities, subject to appropriate
conditions. This approach is the quickest way to expand treatment
availability without incurring great construction and startup costs, while
helping the private treatment business flourish.
President Should Tell HCFA to Arrange Medicaid Coverage of Treatment
Members of Congress and the General Accounting Office have recently
pointed out the great opportunities lost because Medicaid does not cover
most drug treatment services in most states. Our nation's poor, the
population which can least afford treatment and which contains many of the
hardest-to-reach drug abusers, would be the immediate winners if the
federal Medicaid guidelines were changed. The president and director
Martinez should work with the Health Care Financing Administration and
Congress now to develop a policy on the use of Medicaid funds for
substance abuse treatment, especially for pregnant women. This work will
also serve as a model for state health services departments to expand
treatment availability.
Florida Treatment, Prevention Lagged under Martinez
$8
$7.47
OOOOOOOO
OOOOOOOO Per Capita Spending
$7 OOOOOOOO 1989
OOOOOOOO
$6.29 OOOOOOOO
XXXXXXXX OOOOOOOO
$6 XXXXXXXX OOOOOOOO
XXXXXXXX OOOOOOOO XXXX Florida
XXXXXXXX OOOOOOOO
XXXXXXXX OOOOOOOO OOOO average state
$5 XXXXXXXX OOOOOOOO
XXXXXXXX OOOOOOOO
XXXXXXXX OOOOOOOO
XXXXXXXX OOOOOOOO
$4 XXXXXXXX OOOOOOOO
XXXXXXXX OOOOOOOO
XXXXXXXX OOOOOOOO
XXXXXXXX OOOOOOOO
$3 XXXXXXXX OOOOOOOO
XXXXXXXX OOOOOOOO
XXXXXXXX OOOOOOOO
XXXXXXXX OOOOOOOO
$2 XXXXXXXX OOOOOOOO
XXXXXXXX OOOOOOOO $1.41
XXXXXXXX OOOOOOOO OOOOOOOO
XXXXXXXX OOOOOOOO OOOOOOOO
$1 XXXXXXXX OOOOOOOO OOOOOOOO
XXXXXXXX OOOOOOOO $.61 OOOOOOOO
XXXXXXXX OOOOOOOO XXXXXXXX OOOOOOOO
XXXXXXXX OOOOOOOO XXXXXXXX OOOOOOOO
Treatment Prevention
Sources: National Association of State Alcohol and
Drug Abuse Directors and the U.S. Census Bureau
4. STOP PROSECUTIONS OF PREGNANT DRUG USERS
At least 20 states have resorted to prosecuting women for using drugs
during pregnancy, often through convoluted interpretations of drug
trafficking laws. But this law enforcement practice is counterproductive
in the long run because it frightens drug-using women away from seeking
treatment and prenatal care once they become pregnant. Drug czar Martinez
should use his national pulpit to urge states to cease this practice, so
that pregnant women can fully utilize prenatal care and drug treatment
programs without fear.
Drug War is Bad for Medicine
In one of its most destructive intrusions, the drug war has moved
into the realm of medicine. Putting police and prosecutors in charge of
doctors has harmed health care in a number of ways. People are denied
medicines of proven efficacy, drug users and addicts are afraid to seek
medical treatment of any kind, and research on drugs with potential
medical uses is stunted. Doctors are afraid to prescribe adequate amounts
of powerful painkillers due to the threat of unwarranted prosecution. As a
result hundreds of thousands of innocent Americans live and die in pain
every year.
This recommendation focuses on one specific example of the perverse
effects that arise when drug war tactics are used to handle medical
problems. In short, the use of criminal prosecutions may have resulted in
more drug-exposed babies being born than would have existed otherwise. It
is now time to reverse this basic strategic error and reduce the damage
caused by criminalizing pregnant women.
Prosecutions: A counterproductive Reaction to the Crack Baby Problem
As the problem of crack babies has received wider national attention,
many states have tried to use criminalization to reduce the number of
babies born to drug-using mothers. Several women have been prosecuted
under a bizarre legal doctrine: "drug trafficking through the umbilical
cord." This theory holds that in the 30 to 60 seconds between birth and
the severing of the umbilical cord, a mother passes illegal drugs to her
baby, thereby trafficking drugs to a minor.
Several states have made pregnant drug use a violation of civil codes
with punishments ranging from fines to loss of custody of the mother's
children. In 1991, according to the ACLU, efforts were made in at least
seven states to create the new and separate crime of drug use during
pregnancy.
The problem is that such laws and prosecutions--aimed at deterring
pregnant women from using drugs--have the effect of discouraging
drug-using mothers-to-be from entering drug treatment programs or seeking
proper prenatal care. Thus laws targeting pregnant drug users risk
increasing the incidence of the very problem they were designed to
curtail. Surely the threat of law enforcement action contributes to the
fact that less than 11 percent of pregnant women who need drug treatment
actually get it, as estimated by the National Association of State Alcohol
and Drug Abuse Directors (NASADAD).
Drug Czar Should Support a Moratorium on Prosecutions
Drug czar Martinez can help reverse this trend by encouraging a
moratorium on prosecutions of pregnant women. That would be an essential
part of any genuine effort to reduce the crack baby problem. When women
caught up in the cycle of drug use and addiction become pregnant, they
must know they can get immediate help for themselves and for their babies
without risk of jail time or other harsh repercussions. Otherwise they
will avoid help or try, against all odds, to help themselves--with
disastrous results.
Supporting a moratorium on state-level prosecutions of pregnant women
should be consistent with stated administration views. In the 1991
National Drug Control Strategy (page 53), the ONDCP wrote:
Some states have brought criminal prosecutions against pregnant
addicts on the grounds of fetal endangerment. Such prosecutions,
however, have generally been unsuccessful, and the administration
views criminal incarceration of these women as a last resort.
From these words, it is not clear whether the administration merely
considers prosecutions too blunt an instrument or if it sees the genuine
dangers posed by a continuation of the criminal threat against women. But
it should resolve any uncertainty now and make an effort to stop this
trend. A message delivered by the drug czar to the National Association
of Attorneys General and the National Association of District Attorneys
could instantly halt the practice.
Until women get the message that a helping hand is available, the
nation risks creating more crack babies by means of laws aimed at
preventing them.
5. MAKE MEDICAL MARIJUANA AVAILABLE TO THE SERIOUSLY ILL
Doctors, cancer therapists, opthamologists, and the Drug Enforcement
Administration's own chief administrative law judge agree that marijuana
has medical value. President Bush should order the Food and Drug
Administration and DEA to join in helping make marijuana available, by
prescription, to the tens of thousands of seriously ill Americans who
could benefit from its use. It is fully within the president's power to
take this action. There is no reason to delay this compassionate step for
one more day.
FDA Should Reinstate Its Medical Marijuana Program
Last July, the Public Health Service and FDA announced the shutdown
of the so-called "compassionate IND (investigative new drug)" program
which provided government-grown marijuana to sufferers of glaucoma,
cancer, multiple sclerosis and AIDS. The cancellation--announced but not
yet official--came at a time when even greater need for the program was
showing. Hundreds of applications had begun to flow in from AIDS patients
and their doctors, who understood the medical benefits marijuana has for
symptoms such as the "wasting syndrome" faced by late-stage AIDS
sufferers.
The reasons given by the administration for closing down the program
had little to do with science or medicine. PHS Director James O. Mason
cited his concern that wider use of the compassionate IND program might
undermine the administration's broader anti-drug effort. But such
reasoning is fallacious. Most Americans can easily see the difference
between medical uses of a drug and non-medical uses. Otherwise, cocaine,
morphine and other opium-derived drugs--all used medically--would be
perceived much differently today.
DEA Urged to Transfer Marijuana to Schedule II By Its Own Chief Justice
The DEA has used the same reasoning to fight the reclassification of
marijuana for almost two decades. But at each critical juncture in the
battle, the agency has faced defeat in objective forums. Among these was
the U.S. Court of Appeals for the District of Columbia last April 26,
where a three-judge panel unanimously agreed DEA was being "unreasonable"
in its persistence in the medical prohibition. In 1988 the agency's own
chief administrative law judge, Francis L. Young, had urged that marijuana
be moved to DEA's Schedule II, allowing prescription of the drug by
doctors.
The most flaccid argument against medical marijuana is that it is not
medically effective, or that other drugs are as good or better. The
administration and its defenders should try telling that to the doctors
and patients who have found otherwise. Instead of taking the government's
word, they are going out and purchasing the drug through illicit channels,
risking arrest for relief. As a result, many have faced criminal
prosecution. Sufferers of any disease should not be forced to buy their
medicine on the street.
Every day tens of thousands of seriously ill Americans suffer
needlessly because of the Bush administration's intrasigence on medical
marijuana policy. Mr. Martinez can help eliminate the absurd stigma
preventing marijuana's legitimate medical usage by assuring the nation
that medical use and non-medical use of the drug are different. The
president should then order the responsible federal agencies to do
everything in their power to give patients with a demonstrated need access
to the drug.
Patients Enrolled in Government Medical Marijuana Program, by Disease
AIDS..................................11
Cancer.................................1
Chronic Pain...........................4
Glaucoma...............................5
Spasticity/Paralysis...................9
Other..................................4
----------------------------------------
Total Marijuana Approvals.............34
Current Recipients....................12
----------------------------------------
Estimated Applicants "On Hold".......300
Table describes patients who have gone through application process
for FDA's "Compassionate IND" program seeking marijuana cigarettes
for medical use. Applications listed as "on hold" were submitted but
had no government action taken on them before June 21, 1991
announcement of program cancellation.
Source: Alliance for Cannabis Therapeutics.
6. APPOINT A COMMISSION TO SERIOUSLY EXAMINE ALTERNATIVES TO PROHIBITION
The national policy of drug prohibition has not appreciably reduced
the supply of illegal drugs, but it has bred crime and violence on a
massive scale. Education, prevention and treatment are going to be the
keys to reducing drug use whether drugs can be purchased legally or only
on the black market. It is time to look honestly at the experiences of
other nations with illegal drugs and at our own experiences with legal
drugs to develop new, health-based policies for reducing substance abuse.
We must also look at effective new measures to reduce the incentives for
crime, rather than focusing on punishment. Continued reliance on law
enforcement as the centerpiece of drug policy would be absurd in light of
its track record.
Prohibition's Failures Evident Everywhere
Efforts to stem the importation and distribution of illegal drugs
have been boosted in the last decade. But little effect has been noted
from these increasingly expensive and dangerous activities. The National
Narcotics Intelligence Consumers Committee (NNICC), the leading federal
interagency drug intelligence group, estimates that 30,000 tons of
marijuana, 800 tons of cocaine and 350 tons of heroin were available to
American drug users in 1990. Interdiction attempts still fail to catch
anything more than 5 to 15 percent of all the drugs shipped to the United
States. In short, prohibition is not preventing drugs from coming into
the country, it is not preventing their distribution to all corners of the
nation and it is not preventing those who wish to use drugs from doing do.
Meanwhile, drug-related violence, crime and homicide rates have
reached record levels. The District of Columbia, once touted by drug czar
William Bennett as a "test case" for the national strategy, broke its
record for homicides for the third straight year with 489 citizens killed
in 1991. Much of this violence in D.C. and in other major cities is
traceable to fights among drug dealers and traffickers that would not
occur without prohibition. Innocent victims caught in the crossfire
compromise an increasing proportion of those killed. Many more Americans
are victims of petty thefts and property crimes directly related to the
high prices addicts pay for their black market drugs.
'Final Victory' Not Possible; Nation Needs a New Drug Policy Direction
It is interesting to note that only a few years into the Bush
administration's anti-drug effort, we have ceased to hear talk of a
"drug-free society." Perhaps this phrase--so popular in the 1988 campaign
and during 1989 as President Bush prepared to launch his drug war--was
never anything more than a rhetorical chimera. But its absence from the
current drug debate leaves some questions as to what the ultimate goal of
prohibitionist drug policy really is. If no one believes illegal drugs
can be completely eliminated, what will constitute the "final victory"
drug czar Martinez recently said he is committed to achieving?
We fear the reality is that the administration has chosen a path
favoring drug war forever, without regard to its impact on our society.
This path will unquestionably lead to greater financial costs, greater
violence, diminished health protection, creation of more potent and
dangerous drugs, and continued erosion of civil liberties. There are
alternatives to having a drug war forever. We urge the administration and
Congress to appoint a national commission to evaluate the available
options.
No serious alternative to prohibition would constitute abandonment of
the anti-drug mission. After decades of drug war, however, we ought to be
sensible enough to recognize which strategies work and which exacerbate
the problems they target. With this knowledge, we can reorient our
national drug policy to make it more cost-effective and less socially
harmful. Alternatives considered should span the following range of
options:
o A treatment and prevention emphasis aimed at reducing the
demand for drugs while imposing less of a burden on the
criminal justice system.
o Reduction or elimination of criminal sanctions for drug
possession and use, lessening the costs associated with
prosecuting individuals who pose no immediate threat to
others. Treatment offerings could be combined with civil
fines toward this end. reducing reliance on penalties
would include returning sentencing discretion to judges,
whose role has been undermined by statutory mandatory
sentences and mandatory sentencing guidelines.
o Eliminating the federal monopoly on drug policy and leaving
the states to decide which drugs, if any, to prohibit. States
would have maximum choice to tailor drug policy in various
cities and counties, as problems warranted. This model is
based on the repeal of Prohibition, which returned control
over the drug alcohol to state legislatures.
o Allowing some physicians to prescribe currently illegal drugs
to their addicted patients as part of a privatized treatment
regime. This strategy could ultimately bring more people into
treatment at less cost to taxpayers.
o Conversion of the unregulated black market in drugs to a legal
free market with moderate government regulation. This would
be part of a strategy to eliminate drug-trade-related crime and
thefts related to high prohibition-era drug prices. Such a
change would require us to look carefully at our current
policies towards legal drugs, such as alcohol and tobacco, where
success has been mixed.
Develop New, More Comprehensive Measures of Progress
While looking at alternatives to current policy, the commission
should also develop new standards for gauging drug policy progress. At
present, our nation's overall drug policy tends to be analyzed mainly in
terms of changes in the rates of drug use among various populations. If
certain rates go up, the drug war is viewed by some as a failure. If
other rates go down, drug policies are touted as a success.
More specific standards would help make a cost-benefit analysis of
drug policy possible. A cost-benefit framework based on hard
numbers--including better figures on drug usage levels, crime and homicide
rates, drug emergencies, data from the AIDS front, and treatment
availability--could help to drive wiser policy choices. With such a
framework in place, Americans will be assured that they are receiving the
best possible return on their tax dollars while effectively managing
drugs. New standards would also permit analysts to take all aspects of
the drug situation into account in producing an informed judgment on the
nation's overall drug policy.
CONCLUSION
We suspect--as many Americans do--that drugs are here to stay. Drugs
including everything from alcohol to Xanex, coffee to cocaine, tea to
cannabis, and tobacco to LSD have been around for years. they only
diminish or disappear when people lose interest in them, not when
governments decide to eradicate them. Given this most basic reality of
the drug situation, a sand drug policy must be one which focuses on
steering people away from harmful substances and harmful behaviors, and
toward productive lives. Government's primary concerns in the drug policy
realm should be protecting citizens from unnecessary crimes and
facilitating recovery from drug dependency.
For once, it would be good to see America's leaders attack a problem
without using the language and tactics of war. War tends to rally the
public passions and to equip the soldiers well, but too often at the
expense of not dealing with the root causes of the problems.
The drug war is an unconventional war being fought against an
unconventional enemy--ourselves. It is time now for all Americans to come
to a solemn realization: we cannot help our neighbor by fighting our
neighbor.
Drug czar Martinez, President Bush and the Congress have a historic
opportunity to learn from the last two decades of intense but failed drug
war. We can then make necessary changes in drug policy to help create a
safer, healthier America.
Or the administration can persist in repeating the mistakes of the
past.
APPENDIX
A History of Imparital Reports Demands Reconsideration of Current Drug Policy
The recommendations contained in this reform strategy are consistent
with the findings of many independent commissions that have evaluated drug
policy alternatives in the past. We urge the Office of National Drug
Control Policy to review these impartial scientific reports and rely on
them as we have.
Many of these reports come from the United States, but some of the
most insightful come from other countries. None calls for full
legalization of drugs or views any of the drugs, including marijuana, as
harmless, but each of the reports without fail calls for a gentle, humane
approach to dealing with drug users and abusers. None of these great
commission reports calls for a war on drugs, on users or on addicts. Some
countries, notably Britain and Holland, have followed much of the advice
of these non-partisan expert reports. Others, most notably the United
States, have consistently ignored them.
Following are the summaries of the key findings of these reports.
Indian Hemp Drugs Commission, _Marijuana_, 1893-94.
This 3,281-page, seven volume classic report on the marijuana problem
in India by British and Indian experts concluded: "Viewing the subject
generally, it may be added that the moderate use of these drugs is the
rule, and that the excessive use is comparatively exceptional. The
moderate use produces practically no ill effects." Nothing of significance
in the report's conclusions has been proven wrong in the intervening
century.
_The_Panama_Canal_Zone_Military_Investigations, 1916-1923.
After an exhaustive study of the smoking of marijuana among American
soldiers stationed in the zone, the panel of civilian and military experts
recommended that "no steps be taken by the Canal Zone authorities to
prevent the sale or use of Marihuana." The committee also concluded that
"there is no evidence that Marihuana as grown and used [in the Canal Zone]
is a 'habit-forming' drug."
Departmental Committee on Morphine and Heroin Addiction, _Report_, 1926
(The Rolleston Report).
This landmark study by a distinguished group of British doctors,
appointed by the government, codified existing practices regarding the
maintenance of addicts on heroin and morphine by individual doctors and
recommended that they continue without police or medical society
interference. In coming to this conclusion, these physicians displayed a
humane regard for the addicts in their care, perhaps due to their view of
the nature of narcotic addiction: "the condition must be regarded as a
manifestation of a disease and not as a mere form of vicious indulgence."
The British addiction experts took pains to state that they did not agree
with the opinions of "some eminent physicians, especially in the United
States" that addicts "could always be cured by sudden withdrawal."
Mayor's Committee on Marihuana, _The_Marihuana_Problem_in_the_City_of_New_
_York_, 1944 (The La Guardia Report).
This study is viewed by many experts as the best study of any drug
viewed in its social, medical and legal context. The committee covered
thousands of years of the history of marijuana and also made a detailed
examination of conditions in New York City. Among its conclusions: "The
practice of smoking marihuana does not lead to addiction in the medical
sense of the word." And: "The use of marihuana does not lead to morphine
or heroin or cocaine addiction and no effort is made to create a market
for those narcotics by stimulating the practice of marihuana smoking."
Finally: "The publicity concerning the catastrophic effects of marihuana
smoking in New York City is unfounded."
Interdepartmental Committee, _Drug_Addiction_, 1961 (The First Brain Report).
When the Brain Committee first met at the invitation of the Minister
of Health, its mission was to review the advice given by the Rolleston
Committee of 1926. That advice had been to continue to allow doctors to
treat addicts with maintenance doses of powerful drugs when the doctors
deemed it medically helpful for the patient. Brain I reiterated that
advice and in this first report recommended no changes of any significance
on the prescribing powers of doctors. This report expanded on one
important point alluded to in Rolleston: the authenticity of the
existence of "stabilized addicts." While many American experts doubt their
existence, this report explained, "careful scrutiny of the histories of
more than a hundred persons classified as addicts reveals that many of
them who have been taking small and regular doses for years show little
evidence of tolerance and are often leading reasonably satisfactory
lives." Six "case histories of known stabilized addicts" were included in
an appendix. They were mature, older patients, functioning normally on
what would be huge doses of drugs by American standards. "Mr. F.," for
example, a clerical worker, was receiving the equivalent of 200 milligrams
of morphine tablets each day. It is likely that these patients and their
doctors would be dealt with as criminals in the United States.
Joint Committee on the American Bar Association and the American Medical
Association on Narcotic Drugs, _Drug_Addiction:_Crime_or_Disease?, Interim
and Final Reports, 1961.
This report was the result of the only major combined study of drug
policy made by two of the most important professional societies in the
country. Chaired by attorney Rufus King of Washington,D.C., the committee
presented a direct challenge to the touch policies of Federal Bureau of
Narcotics Directory Harry Anslinger, a philosophical ancestor of the
previous drug czar, William Bennett. The blue-ribbon committee included a
senior federal judge and was advised by Indiana University's Alfred
Lindesmith, one of the most distinguished addiction scholars in history.
The report observed, "drug addiction is primarily a problem for the
physician rather than the policeman, and it should not be necessary for
anyone to violate the criminal law solely because he is addicted to
drugs." The report concluded that drug addiction was a disease, not a
crime, that harsh criminal penalties were destructive, that drug
prohibition ought to be reexamined, and that experiments should be
conducted with British-style maintenance clinics for narcotic addicts.
Interdepartmental Committee, Drug Addiction, _Second_Report_, 1965 (The
Second Brain Report).
Brain II has been consistently misinterpreted by leading American
scholars and officials. It did not recommend the dismantling of the
British prescription system nor the compulsory registration of addicts, as
has been claimed. Instead, Brain II urged that (1) doctors who wished to
prescribe "restricted drugs" to addicts for the purpose of maintenance be
required to obtain a special license from the Home Office, (2) treatment
centers be established for treating addicts who were to be regarded as
sick and not criminal, and (3) doctors and other medical personnel be
mandated to "notify" the Home Office when they encountered and addict in
the course of their professional work. Originally, the category of
restricted drugs included heroin and cocaine; now, dipipanone has been
added.
However, the core of the British system remains, and in recent years,
has been reinvigorated. Approximately 200 doctors with special licenses
are free to prescribe all drugs, including the restricted medicines, for
maintenance, including, for example, injectable morphine and methadone.
Brain II in the end was aimed at controlling a few overprescribing
doctors, not at adopting the American system of treating addicts as the
enemy.
Advisory Committee on Drug Dependence, _Cannabis_, 1968 (the Wooton Report).
This study report on marijuana and hashish was prepared by a group
that included some of the leading drug abuse experts of the United
Kingdom. These impartial experts worked as a subcommittee under the lead
of Baroness Wooton of Abinger. The basic tone and substantive conclusions
were similar to all of the other great commission reports. The Wooton
group specifically endorsed the conclusions of the Indian Hemp Drugs
Commission and the La Guardia Committee. Typical findings included the
following. "There is no evidence that in Western society serious physical
dangers are directly associated with the smoking cannabis." "It can
clearly be argued on the world picture that cannabis use does not lead to
heroin addiction." "The evidence of a link with violent crime is far
stronger with alcohol than with the smoking of cannabis." "There is no
evidence that this activity...is producing in otherwise normal people
conditions of dependence or psychosis, requiring medical treatment."
National Commission on Marihuana and Drug Abuse, _Drug_Use_in_America:_
_Problem_in_Perspective_, 1973.
This commission was directed by Raymond P. Shafer, former Republican
governor of Pennsylvania, and had four sitting, elected politicians among
its 11 members. The commission also had leading addiction scholars among
its members and staff. It was appointed by President Nixon in the midst
of the drug war hysteria at that time. While the commission supported
much existing policy, it produced two reflective reports, this being the
final comprehensive document, which recommended research, experimentation
and humane compromise. The first recommendations of the commission were:
"1. Possession of marihuana for personal use would no longer be an
offense, but marihuana possessed in public would remain contraband subject
to summary seizure and forfeiture.
"2. Causal distribution of small amounts of marihuana for no
remuneration, or insignificant remuneration not involving profit, would no
longer be an offense."
National Research Council of the National Academy of Sciences, _An_Analysis_
_of_Marihuana_Policy, 1982
The NAS Committee on Substance Abuse and Habitual Behavior was
composed of some of the leading American experts on medicine, addiction
treatment, law, business and public policy. These experts reviewed all of
the available evidence on every aspect of the marijuana question. The
committee then recommended that the country experiment with a system that
would allow states to set up their own methods of controlling marijuana as
is now done with alcohol. Under this approach, federal criminal penalties
would be removed and each state could decide to legalize the drug and
impose regulations concerning hours of sale, age limits and taxation.
In the same vein as all the previous major objective studies, this
report stated that excessive marijuana use could cause serious harm, that
such use was rare, and that on balance the current policy of total
prohibition was socially and personally destructive. The report placed
great emphasis on building up public education and informal social
controls, which often have a greater impact on drug abuse than the
criminal law. Regarding the possibility of disaster for our youth under
legalization, the report observed: "...there is reason to believe that
widespread uncontrolled use would not occur under regulation. Indeed,
regulation might facilitate patterns of controlled use by diminishing the
'forbidden fruit' aspect of the drug and perhaps increasing the likelihood
that an adolescent would be introduced to the drug through families and
friends, who practice moderate use, rather than from their heaviest-using,
most drug-involved peers."
Advisory Council on the Misuse of Drugs, _AIDS_and_Drug_Misuse,_Part_1_,
1988; _Part_2_, 1989.
"The spread of HIV is a greater danger to individual and public
health than drug misuse," declared the leading drug abuse and health
experts of the United Kingdom who sit on this distinguished
quasi-governmental advisory group. This concept operated as the guiding
principle in this commission report, one part issued in 1988, on in 1989.
In stark contrast to the Bush Administration's war plans the British
council provided a comprehensive health plan that seeks to prevent the use
of drugs, as is the American goal. However, the plan has realistic goals
regarding drug abusers: abstinence in the American mode, where possible,
but above all else, health and life. Thus, the Advisory Council accepted
the lessons of the "harm reduction" programs of the Liverpool area and
recommended that they be spread to the entire United Kingdom. Some of
these lessons involve needle exchanges and prescribed drugs for addicts.
The report even went beyond the Liverpool experience when these
leading British experts quietly observed "we believe that there is a place
for an expansion of residential facilities where drug misusers may gain
better health, skills and self-confidence whilst in receipt of prescribed
drugs." Thus, while the United States is planning more prison space for
drug addicts, the United Kingdom is contemplating more hostels where
addicts could be taught to live more healthy, more self-confident and more
productive lives in the community whilst in receipt of prescribed drugs.
_The_Twentieth_Annual_Report_of_the_California_Research_Advisory_Panel, 1989
This panel, appointed by the state legislature of California to
regulate all research on controlled substances, reviewed drug policy and
recommended that "the legislature act to redirect this state away from the
present destructive pathways of drug control." The report noted that we
had followed a path of prohibition over the last 50 years and concluded
this policy "has been manifestly unsuccessful in that we are now using
more and a greater variety of drugs, legal and illegal." In addition, the
failure of prohibition has resulted in "societal overreaction [that] has
burdened us with ineffectual, inhumane and expensive treatment education
and enforcement efforts." They recommend a move toward the formulation of
"legislation aiming at regulation and decriminalization" and the winding
down of the war on drugs.
The Research Advisory Panel made three specific recommendation for
initial legislative action. These were:
1. Permit the possession of syringes and needles.
2. Permit the cultivation of marijuana for personal use.
3. In order to project an attitude of disapproval of all drug use,
take a token action in forbidding the sale or consumption of alcohol in
state- supported institutions devoted in part or whole to patient care or
educational activity.
The panel recommended immediate and innovative action, concluding it
is "incontrovertible that whatever policies we have been following over
the past generations must not be continued unexamined and unmodified since
our actions to date have favored the development of massive individual and
societal problems."
The National Commission on AIDS, "The Twin Epidemics of Substance Use and HIV,"
July 1991.
This indictment of current drug policy focuses on the relationship
between the spread of HIV and drug use. The commission criticized the
federal government's failure to recognize that these are twin epidemics
and found that the "strategy of interdiction and increased prison
sentences has done nothing to change the stark statistics" showing spread
of AIDS by drug users. The commission singled out the Office of National
Drug Control Policy for ignoring AIDS and "neglect[ing] the real public
health and treatment measures which could and must be taken to halt the
spread."
The Commission put forward five recommendations:
1. Expand drug treatment so that all who apply for treatment can be
accepted into treatment programs.
2. Remove legal barriers to the purchase and possession of injection
equipment.
3. The federal government must take the lead in developing and
maintaining programs to prevent HIV transmission related to licit and
illicit drugs.
4. Research and epidemiologic studies on the relationships between
licit and illicit drug use and HIV transmission should be greatly expanded
and funding should be increased, not reduced or merely held constant.
5. All levels of government and the private sector need to mount a
serious and sustained attack on the social problems of poverty,
homelessness and lack of medical care that promote licit and illicit drug
use in American society.
The National Commission on AIDS could be described as the echo of the
British Advisory Council on the Misuse of Drugs in its report on AIDS and
Drug Misuse, as it made virtually the same policy recommendations. The
Commission concluded that "the federal government must recognize that HIV
and substance use is one of the issues of paramount concern within the
'war on drugs.' Any program which does not deal with the duality of the
HIV/drug epidemic is destined to fail." The Commission urged the federal
government to move away from a law enforcement approach in controlling
drugs toward a public health approach which to date has "been seriously
neglected." (End)
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