Legalizing Drugs: Just Say Yes

The National Review, July 10, 1995, pp. 44-51

Legalizing Drugs: Just Say Yes

Legalizing drugs may be the way to help addicts, and win the drug war

An interview with Michael S. Gazzaniga,
Director for the Center of Neuroscience at the University of California at Davis.

NATIONAL REVIEW: Professor Gazzaniga, thank you for talking with us again [cf. "The Federal Drugstore," NR, Feb. 5, 1990]. We would like to examine the possible consequences of legalizing drugs in America. However, before we take up this controversial issue, perhaps you can sketch a quick picture of drug use today?

DR. MICHAEL S. GAZZANIGA: The current figures suggest that about 10 per cent of Americans use illegal drugs. Of course, the vast majority of these users - perhaps as many as 90 per cent - are not addicted to drugs and use them only infrequently. There is also a strong correlation between age and drug use. In surveys, 13 per cent of 18- to 25-year-olds claim to have used drugs in the past thirty days, while a meager 4 per cent of people over age 26 say they have done so. So, while a substantial number of people have experimented with drugs in one way or another, very few become addicted.

NR: Are there any studies that help to explain why people take drugs - and why they don't?

MG: Human psychology is very complex; obviously, many factors go into the decision. Not surprisingly, the dominant factor seems to be simply the short-term pleasure of the drug experience. In other words, drugs make people feel good. This simple fact is what causes people to take these substances, sometimes at great medical and social risk. The long-term consequences are just not present in their minds at the moment of arousal.

NR: Nevertheless, the fear of being caught - and the consequences of being caught, like fines, confiscation and jail terms - must deter drug use to a certain extent?

MG: Again, human psychology is more complex than a basic analysis of reward and punishment. There is a large project, near completion, at the Rand Corporation, that is producing a lot of information and analysis, including a cross-national analysis of drug policies and outcomes and a historical analysis of pharmaceutical records from the period when cocaine was legal in the United States.

Many of these studies challenge the empirical basis for using deterrence as a means of controlling drug use. For example, the Scandinavians imposed a severe penalty for having blood-alcohol levels above .08 per cent, regardless of a driver's behavior or demeanor. There was a transitory drop in road fatalities but then a return to baseline levels. This pattern is seen over and over again when severe penalties are imposed.

In studies that zoom in on individual people's actual beliefs, we also find that the severity of penalties plays little or no role in controlling whether or not people prone to using drugs actually use them. This disregard for the law is truly remarkable since the cumulative risk of getting caught over an extended career of drug use is fairly high.

NR: So, you are saying that potential drug users are not all that sensitive to the threat of legal sanctions?

MG: Yes. Dozens of studies say exactly that.

NR: In that case, are there any other forces that control - and could therefore be manipulated by society to control - the decision to use drugs.

MG: There are several other forces at work here. One is the perceived health risk. If people believe that drugs are physically harmful to them, they are more likely to resist taking drugs. Other forces, such as a person's perception of the morality of the act, and perceptions of the morality of the law, also have an effect, as do stigmatization from being caught, shame, and other dimensions of humiliation. There are also informal social norms. Professor Robert MacCoun of UC Berkeley, whose study was part of the Rand project, makes a strong case for the importance of these factors. However, on the other side of the coin there is the forbidden-fruit effect, a process that may attract people to drug use. As I said, human psychology is extremely complex.

NR: You've considered drug use in terms of the individual user. Could you tell us a bit more about what drug use looks like from society's perspective? For example, what does drug use "cost" society?

MG: In terms of direct financial cost - money spent on drugs that could have been spent more productively - according to the Office of National Drug Control Policy (ONDCP) approximately $41 billion was spent on 1990, down from $54 billion in 1988. However, those numbers are probably highballs.

NR: Why is that?

MG: Drug expenditures aren't tallied accurately like your hotel mini-bar charges. There's a lot of very iffy guesswork. ONDCP tries its best by using two different methods. The "consumption" method involves multiplying estimates of the number of drug users by estimates of the average amount of drugs used. As you can imagine, neither can be measured very accurately. So they try to verify these estimates by what they call the "supply" method, which estimates the amount of base crop raised by the amounts lost, the amounts seized or consumed in other countries, and the amounts seized in our country. The remaining amount is then assessed for value by considering current street prices. So the supply estimate is only as accurate as the six other estimates it is calculated from, and as ONDCP acknowledges, there are even more uncertainties because much of drug value is bartered for sex or for other drugs.

NR: So it's possible that the drug market may not be as large as it is commonly represented?

MG: Yes, it is likely, in fact. In 1992, Americans spent approximately $44 billion on alcohol and $37 billion on tobacco. The number of Americans using these drugs is vast compared to those using illegal drugs. Furthermore, alcohol and tobacco are not only available everywhere, but are actively promoted. Taken together, it is hard to imagine that the illegal drug trade produces an income nearly equal to that of alcohol or tobacco.

The overall pattern of data collected by government agencies is also at odds with other common impressions. For example, how much of the drug business is centered on high school and college students?

NR: Well, you're the one with the data. We'll guess at least half?

MG: According to ONDCP, only $2 billion of the $41 billion spent in 1990 was spent by high school and college students. That is less than 5 per cent of the drug market, if their figures are correct. So, students are not the primary drug consumers.

NR: Even if we can't pin down an exact number, it is clear that a substantial amount of money is wasted by drug users on purchasing drugs. On the flip side of the coin, how much of society's resources are being utilized in the war on drugs?

MG: The cost of the drug war is staggering at every level of government - local, state, federal. For example, federal grants to state and local drug-enforcement programs are now nearly a billion dollars a year. Federal efforts on international drug control cost more than $800 million annually. Federal efforts on drug interdiction are now at least $2.2 billion a year. The total federal drug control budget is in excess of $12.5 billion a year, according to the 1992 Bureau of Justice Statistics Sourcebook. And these numbers do not take into account the huge amount of money spent by state and local governments out of their own tax sources.

NR: What about non-financial costs? Certainly the criminal-justice system must be heavily burdened by the war?

MG: No question. In 1989, 1,247,000 people were arrested for drug-related offenses. Two-thirds of those arrests were for possession only, and most of those were for marijuana. As for incarceration, in 1990 there were 930,000 inmates across America in federal, state and local prisons. Of these, 50,000 were in federal institutions, and of these, half were in prison for drug offenses. Of the 684,000 prisoners in state prisons, no less than 22 per cent were being held for drug offenses. The courts and jails and prisons are just jammed with drug offenders.

NR: We've eased toward the issue of legalization, and now we'll ask you straight out. Why not legalize drugs?

MG: Adversaries of drug legalization or decriminalization feel that relaxing drug laws will lead to increased consumption. They submit that the increase in consumption in turn will produce an unacceptable burden on society. This single point, for example, is the basis for James Q. Wilson's anti-legalization position. However, there are several reasons to think that this concern is misplaced.

Studies on the decriminalization of marijuana suggest that it leads to no significant increase in consumption. Now, these studies have been contested because decriminalization occurred at a time when overall drug use was declining for many other reasons. However, recent re-evaluations of Prohibition data are consistent with the value of drug legalization.

Furthermore, current studies indicate that among non-users, only 1.7 per cent thought that, if drugs were legal, they would become users. Addicts did say they might use more. But controlled users thought their own use would be unaffected.

These answers make sense, if you think about it. As I mentioned before, the legality of drug use is only one among many factors that a person considers when deciding whether or not to use drugs. At least as important are considerations such as risks to health, costs in terms of lifestyle, the morality of the act.

NR: But wouldn't lots of people "try it out" if it were legalized?

MG: It's possible that there would be a minor bulge in drug use immediately after legalization - again, the forbidden-fruit phenomenon. But think about it. Suppose heroin were legalized tomorrow and available everywhere. Would you suddenly become an addict, or even a user? Probably not. Well, why not? Because you would decide that the pleasure does not outweigh the risks.

As for current addicts, if they did use a little more, that would not necessarily increase their inability to function, or further impair society's efforts to deal with them. Addicts already cause harm to themselves and present a danger to others. But there is a limit to the amount of harm they can inflict on themselves and to the degree of risk they can present to society. Is a bum on the street much worse off if he drinks four bottles of Jack Daniels a day instead of only three? Is society much worse off?

NR: Then the question, perhaps, is, Would there be more addicts if drugs were legalized?

MG: If non-users are unlikely to begin using drugs, as we've discussed, new addicts would have to come from the ranks of controlled users. As I said, controlled users believe their drug use would be unaffected by legalization. Is this a credible belief? Absolutely. Because drugs are already widely available, controlled users could use more right now if they wanted to. They choose not to use more because they have determined how much they can take and still function. In other words, they regulate their own behavior. And for that reason, they would be no more likely to become addicts post-legalization than they are right now.

NR: This may be a naive question, but are drugs really that widely available?

MG: National Institutes of Health studies show that perceived availability has remained consistently high for marijuana since 1975. As it has for cocaine. Furthermore, from 1988 to 1992 drug availability, by and large, increased - despite the war on drugs. These was a 2.5-metric-ton increase in marijuana, with a peak in 1989-90. Cocaine, according to the Drug Enforcement Administration as of 1993, "remained readily available in virtually all major U.S. metropolitan areas." Heroin is available, and its purity has increased. There are some regional variations in this pattern, but overall, drugs are everywhere.

NR: So legalization would not affect availability. However, the street price of drugs is artificially inflated because drugs are contraband. If the price of drugs dropped precipitously - as presumably it would if they were legalized - could this lead to increased consumption? Perhaps controlled users are controlled partly by the high price of drugs.

MG: Lower prices might mean increased use, but the data on this point are mixed, and there is some indication that drug users are insensitive to price. That is, that they use similar amounts regardless of the price of drugs. And again, consider alcohol. It is widely available and inexpensive, but not everyone is a drunkard. In fact, attitudes have changed markedly as far as drunkenness is concerned. In the decades after Prohibition was repealed, drinking hard liquor was a way of showing how sophisticated you were, how you were more urbane than the rubes in the Women's Christian Temperance Union. Think of the image of cocktail parties, of the Thin Man movies in which much of the humor revolved around getting drunk, of Dean Martin's shtick. Nowadays public drinking of hard liquor to a point of slurring and dizziness is just tacky. Square, corny old Johnny Carson had a running joke where he affectionately teased Ed McMahon for his excessive drinking. Cool, hip Letterman and Leno wouldn't be caught dead doing it. These pushes and pulls to alcohol use have nothing to do with jail or availability or price and everything to do with social mores. There's no reason to think that the psychology of drug use is any simpler.

NR: So is the "bulge" you mentioned earlier something like the post-Prohibition bingeing you just described?

MG: Yes. But there is an important difference. Just after Prohibition was enacted, the drinking rate fell off sharply. However, throughout the Twenties the drinking rate rose, despite Prohibition, and it was on the rise when Prohibition was repealed. By contrast, drug use is down in every age group and across all sectors of society, and it is continuing to fall. Just as an example, in 1973, 37 per cent of 18- to 25-year-olds said they had used drugs in the previous month. In 1992, only 13 per cent said they had.

NR: That would seem to prove the point of the prohibitionists: it's the war on drugs that has caused drug use to go down.

MG: No. The drug war targets three specific factors that affect the drug-use rate, namely the availability of drugs, the perceived risk of arrest or legal sanction, and the perceived risk to personal health. As far as drug availability is concerned, the drug war has been a total failure. Drugs are as widely available now as they ever have been. The risk of arrest has certainly increased - since 1985 drug arrests have gone up from 718,000 to 1,247,000 a year. Remember though, studies indicate that the perceived risk of arrest is often ignored by drug users. Finally, health-education programs are widely promoting the belief that drugs are bad for bodily and mental health.

So, the war on drugs may be having an effect. But it is important to understand that that effect is created through several approaches. I don't know if the risk of arrest reduces drug use more than education does - or even if it reduces drug use at all. However - and this is an important point - if drugs were legalized, health-education programs would continue to disseminate information. And they might then have the resources that now go wastefully toward trying to decrease availability, and toward arresting people. If we could have the same level of drug use through simple education programs, wouldn't we as a society prefer that to incarcerating millions of our citizens?

NR: Isn't there also a financial dimension? Education might be far less expensive than our current full mobilization of the judicial system, would you agree?

MG: I have seen only one attempt at estimating the potential costs and savings that would accrue to society from legalization. In a recent book, Prohibition's Second Failure, Theodore R. Vallance, former chief of the Planning Branch at the National Institutes of Mental Health, laid out a proposal based on his experience and research. His main professional effort for many years was to come up with estimates and plans concerning America's drug problem.

Vallance's analysis builds on several sources. First, he used the 250-page report prepared for the NIH by Dorothy Rice and her colleagues at the University of California. Dr. Rice compared the direct and indirect costs of alcohol and drug abuse as well as of mental illness. Direct costs refer to actual program expenditures such as those by health professionals, the police, the courts, and the prison system. Indirect costs refer to such things as premature mortalities and morbidities due to substance abuse. These reflect real losses in terms of productivity and participation in normal society. Not surprisingly, alcohol costs society more than illegal drugs; in 1985, $70 billion versus $44 billion. For alcohol, most of the cost was for treatment and estimated damage to personal health. For drugs, most of the cost was for law enforcement and losses sustained by crime victims.

NR: Could you break those numbers down a little?

MG: Yes. Let me just review the drug abuse numbers. Again in 1985, the year that was analyzed in such detail, $13.5 billion was spent directly on the criminal-justice system - police, legal adjudication, state and federal corrections, local corrections, private legal defense and so on. There was another $19 billion in the indirect-costs category: around $1 billion for victims of crime, $4.4 billion in loss of productivity for those incarcerated, and $14 billion in loss of productivity for those in crime careers. Throw in around $10 billion for the costs of treatment, and you have the 1985 estimate of $44 billion. The figures for direct cost are surely much higher today. For example, totally new moneys in the amount of $6 billion were added by the Bush administration for new task forces, prisons, interdiction programs, and many, many other projects. A realistic current figure would be around $100 billion a year.

Vallance does not, however, simply summarize the past. He uses the Rice data, combines it with 1993 data on extra expenditures for enforcement, and comes up with the startling conclusion that legalizing drugs could save society approximately $37 billion a year! In fact, I am sure his estimate is low, given the documented increase in the direct costs already discussed. (See table.)

Reductions (in millions of $)           From            To              Saving

Direct
Law Enforcement                        13,203          3,300            9,903
*Interdiction costs                     2,200              0            2,200
*International anti-drug                  768            384              384
*OCDETF (Organized Crime & Drug           399             40              359
         Enforcement Task Force)

ONDCP (the "drug czar")                    69             17               52

Indirect
Victims of Crime                          842            210              632
Incarceration                           4,434            887            3,547
Crime careers                          13,976          2,679           11,297

Subtotal                                                               28,374

Less increase in prevention research and service                       (3,572)
Less increase in treatment research and service                        (2,802)

Subtotal                                                               22,000

Plus net income from drug taxes                                        15,000
________

Total                                                                  37,000

*1993 Figures.

NR: So the Vallance estimate is about $37 billion, and you say that it is probably low. How did he estimate how much of the saving should be reinvested in treatment? And how do you measure other dimensions of the problem like reduced suffering that might occur under a legalization scheme?

MG: He was making best guesses based on his experience, which he writes about with great verve. For years he had been pushing alternative plans within the government, only to be scolded by his superiors for attempting to question other government agencies' capacity to deal with the drug problem. But he emphasizes that the details could all vary a bit, but the overall pattern of the savings would remain the same.

It is another matter to find a metric for human suffering. Surely a legalization scheme ought to find people less fearful of criminal activity in their neighborhoods. Parents should feel better knowing the police could concentrate on those criminal forces that would continue to peddle drugs to children. Addicts ought to feel better knowing that society is dealing with their problem from a health point of view, and surely there would have to be more programs to assist those who abuse drugs.

NR: Thank you for your time, Professor Gazzaniga.

[sidebar, pp. 46-47:]

Switzerland's Heroin Experiment

The Swiss government is selling heroin to hard-core drug users. But in doing so, the government isn't offhandedly facilitating drug abuse; it's conducting a national scientific experiment to determine whether prescribing heroin, morphine, and injectable methadone will save Switzerland both money and misery by reducing crime, disease, and death.

The Swiss deal with drug users much as the U.S. and other countries do - prisons, drug-free residential treatment programs, oral methadone, etc. - but they also know that these approaches are not enough. They first tried establishing a "Needle Park" in Zurich, an open drug scene where people could use drugs without being arrested. Most Zurichers, including the police, initially regarded the congregation of illicit drugs injectors in one place as preferable to scattering them throughout the city. But the scene grew unmanageable, and city officials closed it down in February 1992. A second attempt faced similar problems and was shut down in March 1995.

So Needle Park wasn't the solution, but the heroin-prescription program might be. In it, 340 addicts receive a legal supply of heroin each day from one of the nine prescribing programs in eight different cities. In addition, 11 receive morphine, and 33 receive injectable methadone. The programs accept only "hard-core" junkies - people who have been injecting for years and who have attempted and failed to quit. Participants are not allowed to take the drug home with them. They have to inject on site and pay 15 francs (approximately $13) per day for their dose.

The idea of prescribing heroin to junkies in hopes of reducing both their criminal activity and their risk of spreading AIDS and other diseases took off in 1991. Expert scientific and ethical advisory bodies were established to consider the range of issues. The International Narcotics Control Board - a United Nations organization that oversees international anti-drug treaties - had to be convinced that the Swiss innovation was an experiment, which is permitted under the treaty, rather than an official shift in policy. In Basel, opponents of the initiative demanded a city-wide referendum - in which 65 per cent of the electorate approved a local heroin-prescription program. The argument that swayed most people was remarkably straightforward: only a controlled scientific experiment could determine whether prescribing heroin to addicts is feasible and beneficial.

The experiment started in January 1994. The various programs differ in some respects, although most provided supplemental doses of oral methadone, psychological counseling, and other assistance. Some are located in cities like Zurich, others in towns like Thun, which sits at the foot of the Bernese Alps. Some provide just one drug, while others offer a choice. Some allow clients to vary their dose each day, while others work with clients to establish a stable dosage level. One of the programs in Zurich is primarily for women. The other Zurich program permits addicts to take home heroin-injected cigarettes known as reefers, or "sugarettes," (since heroin is called "sugar" by Swiss junkies). It also conducted a parallel experiment in which 12 clients were prescribed cocaine reefers for up to 12 weeks. The results were mixed, with many of the participants finding the reefers unsatisfying. However, since more than two-thirds of Swiss junkies use cocaine as well as heroin, the Swiss hope to refine the cocaine experiment in the future.

The national experiment is designed to answer a host of questions that also bubble up in debates over drug policy in the United States, but that our drug-war blinders force us to ignore. Can junkies stabilize their drug use if they are assured of a legal, safe, and stable source of heroin? Can they hold down a job even if they're injecting heroin two or three times a day? Do they stop using illegal heroin and cut back on use of other illegal drugs? Do they commit fewer crimes? Are they healthier and less likely to contract the HIV virus? Are they less likely to overdose? Is it possible to overcome the "not in my back yard" objections that so often block methadone and other programs for addicts?

The answers to these questions are just beginning to come in. In late 1994, the Social Welfare Department in Zurich held a press conference to issue its preliminary findings: 1) Heroin prescription is feasible, and has produced no black market in diverted heroin. 2) The health of the addicts in the program has clearly improved. 3) Heroin prescription alone cannot solve the problems that led to the heroin addiction in the first place. 4) Heroin prescription is less a medical program than a social-psychological approach to a complex personal and social problem. 5) Heroin per se causes very few, if any, problems when it is used in a controlled fashion and administered in hygienic conditions.

Program administrators also found little support for the widespread belief that addicts' cravings for heroin are insatiable. When offered practically unlimited amounts of heroin (up to 300 milligrams three times a day), addicts soon realized that the maximum doses provided less of a "flash" than lower doses, and cut back their dosage levels accordingly. On the basis of these initial findings, the Swiss federal government approved an expansion of the experiment - one that may offer an opportunity to address the bigger question that small-scale experiments and pilot projects cannot answer: Can the controlled prescription of heroin to addicts take the steam out of the illegal drug markets?

Switzerland's prescription experiment fits in with the two-track strategy Switzerland and other Western European countries have been pursuing since the mid-1980s: tough police measures against drug dealers, and a "harm reduction" approach toward users. The idea behind harm reduction is to stop pretending that a drug-free society is a realistic goal; focus first on curtailing the spread of AIDS - a disease that will have cost the U.S. $15.2 billion by the end of 1995, and the lives of over 125,000 Americans - and later on curtailing drug use. The effort to make sterile syringes more available through needle-exchange programs and the sale of needles in pharmacies and vending machines epitomizes the harm-reduction philosophy. Swiss physicians and pharmacists - along with their professional associations - are outspoken in their support of these initiatives. Study after study, including one conducted for the U.S. Centers for Disease Control, show that increasing needle availability reduces the spread of AIDS, gets dirty syringes off the streets, and saves money.

The Swiss have also created legal Fixerräume, or "injection rooms," where addicts can shoot up in a regulated, sanitary environment. Swiss public-health officials regard this harm-reduction innovation as preferable to the two most likely alternatives: open injection of illicit drugs in public places, which is distasteful and unsettling to most non-addicts; and the more discreet use of drugs in unsanctioned "shooting galleries" that are frequently dirty, violent, controlled by drug dealers, and conducive to needle sharing. Five Fixerräume, are now open in Switzerland. Initial evaluations indicate that they are effective in reducing HIV transmission and the risk of overdose.

So what does the future hold? Last month, Switzerland's governing body, the Federal Council, voted to expand the number of prescription slots to 1,000: 800 for heroin, 100 each for morphine and injectable methadone. Interior Minister Ruth Dreifuss, who initially was skeptical of the experiment, is now a strong supporter. She is backed by the ministers of justice, defense, and finance, who together constitute what has become known as "the drug delegation" of the Federal Council. The three leading political parties have combined to issue a joint report on drug policy that supports the heroin experiment and other harm-reduction initiatives. Outside Switzerland, the Dutch are about to embark on their own modest experiment with heroin prescription. The Australians, who recently conducted an extensive feasibility study, seem likely to start a heroin-prescription program. In Germany, officials in Frankfurt, Hamburg, Karlsruhe, Stuttgart, and elsewhere are seeking permission from the central government to begin their own heroin-prescription projects.

While these countries experiment with more sensible and humane approaches to drug policy, the United States clings to a war not only against drug dealers, but also against drug users. Most scientific researchers studying drug abuse acknowledge that the Swiss experiment makes sense socially, economically, and morally. The point of these innovations isn't to coddle drug users. It's to reduce the human and economic costs of drug use - costs paid not only by users but also by non-users through increased health-care, justice, and law-enforcement expenditures.

But no distinguished researcher seems prepared to take on all the forces blocking a heroin-prescription experiment in the United States. Through our reticence, we are shutting our eyes to drug policy options that could reduce crime, death, and disease and ultimately save this country billions of dollars. - Ethan Nadelmann

Dr. Nadelmann, director of The Lindesmith Center, a drug-policy research institute, is the author of Cops Across Borders: The Internationalization of U.S. Criminal Law Enforcement (Penn State Press, 1994).

[End]

Back to the Articles page.

Go to The War on Drugs is Lost, The National Review, February 12, 1996. Includes the full text of essays by publisher William F. Buckley Jr.; Ethan A. Nadelmann, a scholar and researcher; Kurt Schmoke, the mayor of Baltimore and a former prosecutor; former police chief Joseph D. McNamara; Robert W. Sweet, a federal judge and former prosecutor; psychiatrist Thomas Szasz; and Steven B. Duke, a law professor.

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