Drug WarRant

Slopestylers are, without a doubt, the ultimate stoners of the Winter Olympics. And I’m not even saying that they use cannabis. They just have this awesome and relaxed joie de vivre.

I thought I’d share with you a post I made for my Facebook friends who generally aren’t as well-informed about drug policy as readers here. There had been so many posts regarding the death of Philip Seymour Hoffman that I felt it was important for them to hear a different perspective about heroin policy.

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Free heroin.  I’ve spent over a decade studying and writing about drug policy. My friends know this and sometimes one will come up to me and say “I know you think we should legalize and regulate drugs, and I’m with you when it comes to marijuana. But what would you do with a truly evil drug like heroin?”  And I respond, “I’d have the government give it away for free.”

Yes, that does tend to elicit a shocked reaction, but let’s take a moment to look at our experience with drug policy.

The “just say no” and “drugs are bad, mkay?” approaches to drug policy (espoused by well-meaning, but clueless, outsiders) have little chance of affecting those most likely to become heroin addicts. And close to a century of experience with prohibition laws has proven conclusively that we cannot stop people from getting and using heroin (even in countries where drug trafficking gets the death penalty), plus prohibition itself adds additional harms in terms of uncertain dosage, contamination, criminal involvement, stigma, etc.

Yes, we can do some significant prevention by educating people with real facts about drugs and their effects, but we also need to understand reality. For example, consider that we could completely eliminate sexually transmitted diseases if we could just convince people not to have sex. That’s a fact. It’s also an impossible fantasy. Eliminating heroin use through prohibition laws and societal disapproval is also an impossible fantasy.

Once we accept that there will be a small percentage of the population who use (and perhaps abuse) heroin, the real question is what we can do to reduce the harm.  In the U.S., we tend to focus on abstinence-based treatment programs (cold turkey quitting), often under stressful conditions (connected to arrest, job loss, etc.).

While it works effectively for some people, that approach has two problems.  First, those who have tried to quite smoking know that the worst/hardest time to do it is when they are in a stressful life situation. Yet, heroin addicts are told to quit cold turkey when they’ve reached rock bottom (loss of job, family/children, career, freedom, etc.).  This makes relapse more likely.

Second — and way too many people don’t know this:  you are much more likely to die from a heroin overdose after abstaining for a period of time. That’s right, when you quit cold turkey, if you then relapse, your chances of dying increase. Treatment, bizarrely, often leads to heroin overdose deaths.

How is this possible?  In a nutshell, it has to do with tolerance.  When you start using heroin, your body develops tolerance — you need more to reach a target level of euphoria, but your body adjusts and can handle more. When you quit, your body’s tolerance goes back down, so if you re-start, the same heroin you could tolerate before will now stop your breathing. Studies have indicated that the majority of heroin overdose deaths occur after quitting for a time. That’s probably why you often hear in famous overdose cases that they had recently been in treatment. As an additional complication, those who relapse tend to do so in solitude (stigma/shame) and thus cannot be helped by the simple application of Naloxone, which, while painful, can reverse pretty much any heroin overdose without causing damage.

Despite all this, we rarely discuss whether our approach to heroin use (prohibition and cold-turkey treatment) is the only, or best, approach. There is a better option.  (You were beginning to wonder when I was going to get around to talking about the government giving heroin away for free… here we go.)

I call it Heroin-Assisted Treatment (or HAT). The idea is that anyone using heroin could come to a government-run clinic and get a safe, controlled dose of heroin for free. The clinic would have medical staff and counselors to help people get their lives/jobs/families back into shape, if necessary, so they can maintain their habit without heroin disrupting their lives (and with controlled dosage, it’s possible to do pretty much anything as an addict that a non-addict can do). Once they’ve got their lives in order, they can work at reducing or completely quitting when ready.

I realize that it’s counter-intuitive and sounds completely bonkers. Free heroin? Ridiculous.

But this isn’t my idea. It’s actually been done. And we have clear evidence it works. While each program has had different details, there have been successful HAT programs in Canada, Germany, Spain, the Netherlands, Switzerland, and the UK, going all the way back to 1994 in Switzerland. And every study done of these programs have shown that they work. Massive reductions in crime, improved physical and mental health, excellent cost benefit to society, and greater longevity for those in the programs.  And here’s the kicker — the existence of such programs takes away the profit potential for criminal heroin dealers, which actually can result in fewer people being exposed to heroin use.

So why don’t we have HAT here? (And why has HAT been under political attack in every country where it is successful?)  Because many people don’t like it. Despite the facts, it is politically unpopular to “provide heroin to addicts” because it sounds like we’re encouraging drug use.

 It’s the same political calculation that promotes abstinence-only sex education under the sadomoralistic belief that it’s better for children to die of sexually transmitted diseases than give them a condom (which might encourage them to have sex).

We can continue a century of provably failed prohibition approaches and continue to watch people die, or consider alternative drug policies that have been proven successes. The question is whether we are willing to learn, and whether we care more about good policy than superficial appearances.

There’s absolutely no doubt that illicit drug production threatens the environment in a number of ways. Prohibitionists, over the years, have tried to dishonestly coopt this basic truth as being an argument against drugs, as opposed to an argument against drug prohibition.

Things are changing and now those who care about conservation are realizing that they need to care about drug policy.

Narco-Deforestation: Linking Drug Policy and Forest Conservation

A new article published in the journal Science, co-authored by United Nations University researcher Dr. David Wrathall, provides compelling evidence that flows of drugs through the Americas are directly related to deforestation rates in North America’s most biodiverse and biosensitive region. The article, “Drug Policy as Conservation Policy: Narco-Deforestation” is the result of collaboration between researchers at the UNU Institute for Environment and Human Security (UNU-EHS) and four US universities: The Ohio State University, Northern Arizona University, the University of Denver and the University of Idaho. […]

The fact that drug crop eradication policies can push growers further into sensitive ecosystems is well documented. But the article references a parallel (but less-investigated) effect from drug trafficking interdiction programmes, which are deflecting drug traffickers, and their ecological impact, to new forest areas — a reminder to the international conservation community that “drug policy is conservation policy” and that continued protection of these ecosystems depends on an alternative policy approach to drug flows. […]

The article concludes that while “drug policy innovations alone will never end deforestation in Central America … rethinking the war on drugs could yield important ecological benefits”.

Drug warriors have a lot of explaining to do. It’s getting harder and harder for them to do their thing unchallenged. And the challenges are coming from a variety of interests.

One of the things that has constantly annoyed me is the heavy use of the perfect solution fallacy (which is also a straw man) by prohibitionists and their apologists. You’re always hearing them say things like “legalization of marijuana won’t destroy the cartels” with the implication being that there is no benefit since the actual current criminals in those positions will likely still exist and still be evil.

Yes, we know that it’ll take more than marijuana to significantly dismantle the operations (and we hope to get there with regulated legalization of all drugs), but in the meantime, every bit of income we deny the drug trafficking organizations means they have a tougher time recruiting new members, bribing government officials, and having the economic power to do their will upon a variety of things (including the environment) unchecked.

This hilarious graphic was tweeted by Drug Free America. They haven’t provided any sources (even when asked), but hey – it has the word “FACT” on it so it must be true.

I almost hate to keep beating this horse…

As you may recall, Mark Kleiman made some ridiculous ad hominem attacks on Jacob Sullum regarding discussion President Obama’s implication in an interview with Jake Tapper of CNN that he couldn’t reschedule marijuana (Sullum merely pointed out that Obama could, and Kleiman yelled at Sullum that rescheduling would have “identically zero” practical effect.)

This exchange continued in Twitter with Mark claiming that Jacob should have written about the question that Mark claims Jake Tapper actually meant to ask (yeah, really!).

Now Jacob Sullum has come back with an article specifically addressing some of the possible benefits of rescheduling: More Than Zero: Reclassifying Marijuana Would Have a Significant Impact on Drug Policy

Moving marijuana to a less restrictive legal category would have some significant practical effects, perhaps the most important of which would be to advance a more honest discussion of marijuana’s hazards and benefits. […]

Rescheduling marijuana would not affect the legal status of state-licensed cannabusinesses in states such as Colorado and Washington, which would still be criminal enterprises in the eyes of the federal government. But Gieringer notes that rescheduling could remove one of the major financial challenges facing state-legal marijuana suppliers: Section 280E of the Internal Revenue Code prohibits the deduction of business expenses related to “trafficking in controlled substances,” but only for drugs on Schedule I or II. If marijuana were moved to, say, Schedule III, that prohibition would no longer apply. […]

But even moving marijuana down one level, from Schedule I to Schedule II, could have an important impact on the drug policy debate. For one thing, it would free the Office of National Drug Control Policy (ONDCP), which is required by law to oppose the legalization of any Schedule I substance, to talk about the hazards of marijuana a little more honestly. Such freedom is desperately needed, to judge by the effort required to extract the concession that marijuana is safer than alcohol from ONDCP Deputy Director Michael Botticelli at a congressional hearing this week. […]

Since Congress banned marijuana in 1937, says Houston, “we have seen extremely cynical efforts to overblow the danger of marijuana and to demonize it. A move to reschedule or unschedule would be the first time since 1937 that our government started to roll back some of that reefer madness.”

The best solution, of course, is to completely deschedule cannabis and that would require Congress to do something. But the President could and should (given this administration’s claims to care about science) do the right thing and at least reschedule. The impact would certainly be more than identically zero.

Yes, that Congress… (via Jacob Sullum and Raw Story)

“How many people die from marijuana overdoses every year?” Connolly asked.

“I don’t know that I know. It is very rare,” Botticelli replied.

“Very rare. Now just contrast that with prescription drugs, unintentional deaths from prescription drugs, one American dies every 19 minutes,” Connolly said. “Nothing comparable to marijuana. Is that correct?”

Botticelli admitted that was true.

“Alcohol—hundreds of thousands of people die every year from alcohol-related deaths: automobile [accidents], liver disease, esophageal cancer, blood poisoning,” Connolly continued. “Is that incorrect?”

But Botticelli refused to answer. Guessing where the line of questioning was headed, he said the “totality of harm” associated with marijuana indicated it was a dangerous drug, even though it was not associated with deaths.

“I guess I’m sticking with the president—the head of your administration—who is making a different point,” Connolly fired back. “He is making a point that is empirically true. That isn’t a normative statement, that marijuana is good or bad, but he was contrasting it with alcohol and empirically he is correct, is he not?”

Botticelli again tried to dodge the question, but Connolly interrupted him and told him to answer.

“Is it not a scientific fact that there is nothing comparable with marijuana?” Connolly asked. “And I’m not saying it is good or bad, but when we look at deaths and illnesses, alcohol, other hard drugs are certainly—even prescription drugs—are a threat to public health in a way that just isolated marijuana is not. Isn’t that a scientific fact? Or do you dispute that fact?”

“I don’t dispute that fact,” Botticelli said.

Thud.

Decriminalization in DC — decrim vote expected today. $25 fine for marijuana possession.

Former cop is ‘linchpin’ of campaign to legalize marijuana – nice profile of LEAP’s Neill Franklin

The dangers of abstinence-based recovery programs – by David Nutt

Did libertarianism kill Philip Seyour Hoffman? Conservative Ben Shapiro thinks so – Nick Gillespie

I had the distinct pleasure of seeing Philip Seymour Hoffman’s astonishing performances live on stage in both Long Day’s Journey Into Night (2003) and Death of a Salesman (2012), and I always found him a joy to watch in his incredible range of roles in the movies. He was one of those rare truly unique talents.

I admit to some purely selfish reasons for being upset with his passing, just in thinking about all those future roles he now won’t play. I would have loved to see what he could do as an old man.

There will be a lot of discussion about heroin and addiction in the next few days, and a lot of that will be ignorant knee-jerk reactions (I’m already seeing some friends on Facebook declaring how this reinforces the importance of telling people to just say “no” to drugs.)

It’s a lot more complicated than that, and I have questions… Does this have any connection to the new batch of dangerous fentanyl-poisoned heroin being distributed on the east cost? How does this connect to his recent stint in treatment? (As we know, treatment can actually lead to overdose if people aren’t aware of the change in their tolerance.) Why was he alone? (Does stigma increase the danger and reduce the opportunities for reversing the overdose with naloxone?) Was uncertain dosage due to prohibition a factor?

Perhaps this will be an opportunity for some good discussion. That would be nice.

Carl Hart has an outstanding piece in The Nation: How the Myth of the ‘Negro Cocaine Fiend’ Helped Shape American Drug Policy

He talks about some of the early demonization:

The author, a distinguished physician, wrote: “[The Negro fiend] imagines that he hears people taunting and abusing him, and this often incites homicidal attacks upon innocent and unsuspecting victims.” And he continued, “the deadly accuracy of the cocaine user has become axiomatic in Southern police circles…. the record of the ‘cocaine nigger’ near Asheville who dropped five men dead in their tracks using only one cartridge for each, offers evidence that is sufficiently convincing.”

Cocaine, in other words, made black men uniquely murderous and better marksmen. But that wasn’t all. It also produced “a resistance to the ‘knock down’ effects of fatal wounds. Bullets fired into vital parts that would drop a sane man in his tracks, fail to check the ‘fiend.’”

Hart goes on to talk about how this racism wasn’t limited to days gone by, but has continued as an integral part of our drug war all the way to today.

This, of course, is no surprise to regulars here, but it’s good to see this piece in The Nation as a reminder.

Lately, I’ve seen some commentary online that seems to be attempting to say that legalization in general is bad for African-Americans, and that the fact that the majority of people in the legalization movement are white is proof of self-interest. However, we know that the racism that has been involved in the drug war has also served to feed the circular desire for “law and order” that fuels prohibition in the inner cities.

Anybody who’s been involved in marijuana policy during the past, oh, 42 years, knows about scheduling. Cannabis was placed into Schedule 1 of the Controlled Substances Act, provisionally, and, despite the Commission report which should have removed it, was left there. Since then, every petition to change the scheduling has been blocked, not by scientific evidence, but by political decisions from the executive branch.

Of course, having marijuana on Schedule 1 has led to serious real harms, including the restriction on using a medical necessity defense in federal courts (US v. Oakland Cannabis Buyer’s Cooperative).

The Schedule 1 status has also had potent symbolic political power, with the DEA holding a death grip on the status to protect their enforcement turf (while simultaneously allowing easy and fast rescheduling for pharmaceutical products like Marinol).

Of course, in recent years, it’s become more and more obvious, to even the general population, how absurd it is to have cannabis classified in Schedule 1 (or, for that matter, to be scheduled at all, when alcohol and tobacco are not).

So it’s not likely to be popular to let people know that you have the ability to change that classification… and haven’t. Which may be why President Obama weaseled his way out of any responsibility for it in his most recent interview.

Confused About Power to Reschedule Pot, Advocates Say (by Steven Nelson in US News and World Report):

“What is and isn’t a Schedule I narcotic is a job for Congress,” Obama told Jake Tapper of CNN. “It’s not something by ourselves that we start changing. No, there are laws under – undergirding those determinations.” […]

Rep. Earl Blumenauer, D-Ore., tells U.S. News it’s “very clear” that the law “actually permits reclassification administratively.”

“I don’t dispute that Congress could and should make the change, but it’s also something the administration could do in a matter of days and I hope they will consider it,” says Blumenauer, who is currently circulating a letter among colleagues asking Obama to do so. Eight members of Congress have signed the letter so far.

I, too, would like to see Congress step up, but there’s no doubt that the President can act independently.

Also pointing out the simple and uncontroversial fact that the President has the power to reschedule, was Jacob Sullum, who wrote: Obama, Who Evidently Has Not Read the Controlled Substances Act, Denies That He Has the Power to Reclassify Marijuana.

Obama often speaks as if he is an outside observer of his own administration […]

That led to this bizarre screed by Mark A.R. Kleiman: Futile pursuits: chasing rainbows and rescheduling cannabis. Kleiman, while not identifying a single inaccuracy in Sullum’s report, nevertheless chose to spew this:

The discussion of “rescheduling” marijuana is confused because most of the people engaged in it don’t know how the law works.

Jacob Sullum, always willing to let his ignorance be the measure of other people’s knowledge, utterly unwilling to let mere facts get in the way of libertarian ideology, and eager to please his paymasters by slagging a Democratic President, illustrates my point in his response to the latest CNN Obama interview.

Those who read Mark Kleiman’s blog on a regular basis know that he suffers from an extreme case of libertarian derangement syndrome. Mark is a big fan of nanny-state government and a strong promoter of intervention into the lives of those whom Kleiman believes are unable/unwilling to make appropriate/proper decisions for themselves. (You see this in his preferences for extremely high regulation of currently illicit drugs and alcohol, particularly as relates to those who abuse them.) One of his biggest fears appears to be a net reduction in government authority in our lives.

While he often criticizes government himself, it is with the idea of reforming or replacing the corrupt or improperly working program. Any attempt to suggest ending/reducing (or even criticizing) a nanny-state program without in the same breath pointing out the value of government intervention is met with this same libertarian derangement syndrome reaction.

Of course, I’m just conducting my own little Psychology 101 experiment in trying to read Mr. Kleiman, but the analysis seems to fit. It goes a way toward explaining the also bizarre decision to recently criticize Radley Balko’s work out of the blue.

Note to Radley Balko: Congratulations on your new gig at the Washington Post. Your criticisms of police excess – often spot-on – would have more cred if, just once, you celebrated police success, or noticed that liberty can be threatened by crime as well as by official misconduct. […]

I’m all for Radley’s exposes of police misconduct. I’d just prefer if he occasionally reminded his readers what the police are there for in the first place.

Many of us in drug policy reform have received the brunt of Mark’s wrath many times for merely being activists. We see our job as being primarily to bring an end to the destruction of prohibition, and don’t all agree that the best replacement for it is heavy regulatory interference, regardless of whether we are liberal, libertarian, conservative, or something else. We also see the discussion of what to do about drug abuse post-prohibition to be its own valuable separate discussion.

And yet, Mr. Kleiman regularly takes honest anti-drug war activism (if it doesn’t also explicitly call for a sufficient level of nanny-statism), and equates it with the corruption and dishonesty of prohibitionists (worse-yet, the corruption and dishonesty of prohibitionists utilizing the power of government). That equation just doesn’t balance.

I have, in the past, pointed out that I believe Mark Kleiman to be quite intelligent and knowledgeable about drug policy, and I have noted numerous times when I have agreed with him.

But to use his own words, I think his policy recommendations would “have more cred” if he was able to accept the fact that there are critiques of specific government actions/programs (by libertarians, drug policy reformers, or others) that can be valid per se, without also providing some shibboleth of supporting governmental intervention.