10th International Conference on Drug Policy Reform
November 6-9, 1996 • Washington, DC
TEN YEARS AGO, THE DRUG POLICY REFORM MOVEMENT WAS much smaller and met only infrequently. In 1987, DPF held its first annual conference to institutionalize those meetings and to cover a wider array of policy topics. The Foundation's 10th Anniversary Conference last November was one of DPF's largest events, bringing together reformers from around the world to discuss and debate the U.S. election results, the Arizona and California ballot initiatives, treatment and drug education research, international developments, and the overall state of the reform movement. For those who could not attend last year and for those of you who did, here is a sampling of the highlights.
THURSDAY, NOVEMBER 7
THE STATE OF THE MOVEMENT
Arnold S. Trebach • On The Future of Reform
"My thoughts on the future are these: Let us be true to our own foundations, our own moorings. What got us here was hard work, respectability, responsibility. I don't think it is time to gloat about these ballot returns in Arizona and California; they are openings for a lot more work to be done and a lot more attention to be paid to basic American values. We are going to work with our opponents, if they will work with us, to create responsible change and to deal with all the problems that are going to occur. If we don't act that way, we will, as someone once said, manage to snatch defeat from the jaws of victory." — Arnold S. Trebach, President, Drug Policy Foundation
Ethan Nadelmann • On Propositions 200 and 215
"It is the first time since the repeal of alcohol prohibition that some measure of drug reform has won at the ballot box.... Is this the stalking horse for legalization, is this the steppingstone toward broader marijuana legalization, is this some form of Trojan Horse? ... No. Half the people who supported the initiatives do not favor more far-reaching reforms."
"Where we go next is not to legalization, but to other types of reform, such as needle exchange ... fighting the stigma and prejudice that people on methadone face ... opposing the harsh drug sentencing laws — that is where we go from here." — Ethan Nadelmann, Director, Lindesmith Center; DPF Board of Directors
Ira Glasser • On the Obstacles to Change
"The vulnerability of every rights movement that is engaged in a single issue is to insulate itself and isolate itself in this struggle and fail to learn lessons from other similar movements.
"The whole issue of drug prohibition is like our Berlin Wall: We have lived with it all our lives; it is a wall that had seemed for the most part impregnable; it is a wall that has been with us for as long as any of us can remember; it is a wall that, although we beat at it and struggle at it, for most of us it has seemed to be a wall that will be there when we are gone as it was there when we arrived.
"The lessons from all this, is that for those people in rights movements, facing these Berlin Walls, it is very important to ... loosen that first stone. The significance of what happened Tuesday [November 5] is that several stones were loosened that lay at the foundation of the wall of prohibition.
"Big changes start with small incremental things in the history of rights movements.... What is always important when these incidents occur, it is not the incident itself, but what we do next to implement it, to charge it, to take it to the next step, to exploit that crack in the mirror, to take that stone that's been loosened and pull out a little bit more of the foundation of that wall." — Ira Glasser, Executive Director, ACLU; DPF Board of Directors
DRUG POLICY AND THE WHITE HOUSE
Marsha Rosenbaum • On the Clinton Administration
"We have more marijuana arrests after four years of Clinton then we did under Bush, we have more prison time and we have suppression of needle exchange — I feel like I could stand up here and say 'How do I hate the drug war? Let nie count the ways." — Marsha Rosenbaum, Associate Director, Lindesmith Center, San Francisco; DPF Advisory Board
Kenneth Sharpe • On Drugs and the 1996 Republican Presidential Campaign
"Dole used the drug issue in the same way that candidates have always used it — to serve largely symbolic purposes that have very little to do with drug use or abuse or addiction. It was a way to look tough and in particular in this campaign it was a way to go after Clinton's character. A president who joked about inhaling drugs on MTV and permitted former drug users to staff the White House was a perfect fit for the image conservative Republicans wanted to create. Clinton was lax, liberal, irresponsible, a child of the 1960s, and an anti-Vietnam war radical."
On Why Clinton Isn't a Reformer
"Clinton's failure to fight for drug policy reform reflects an informed assessment that there is little political capital to be gained and much risk in pushing even modest initiatives. The reasons lie in the drug war's deep roots in American political institutions and in the punitive political judgement, the punitive conventional wisdom about drug use." Kenneth Sharpe, Chairman, Dept. ofg Political Science, Swarthmore College, PA
Diana Gordon • On Clinton's Second Term
"The potential of distracting the public and other politicians with get-tough drug policy is very powerful — distraction from the really intractable problems of underemployment, unemployment, poor education, and poverty. But also distraction from Clinton's personal and professional peccadilloes — of which he will need a powerful strategy of avoidance if the rumors of Republican vengeance are to be believed." — Diana Gordon, City University of New York, Graduate Center
Dan Baum • On Nixon, Carter, and Marijuana Policy
"I expected when writing my book that Nixon was going to be the anti-Christ and Jimmy Carter would be a great guy. Well, it turns out that Nixon's drug policies in retrospect — I mean his rhetoric was horrible — were actually sane and humane and constitutional. Whereas, Jimmy Carter comes into office in 1976 asking Congress to decriminalize the personal use of marijuana — his first statement to Congress — and he goes out of office having turned the full fury of the drug war against marijuana for the first time. Which, I argue is the crisis we face now, because the war on drugs depends entirely on marijuana prohibition. Marijuana is the political drug. Marijuana is where the war on drugs lives." —Dan Baum, Author, Smoke and Mirrors: The War on Drugs and the Politics of Failure, Missoula, MT
Joe Davidson • On Dole, Clinton, and Juvenile Justice
"You can wrap up the philosophy of both Clinton and Dole on juvenile justice as believing that some kids are too bad to rehab. They think that some kids, as young as 13, are beyond any help so they should be tried as adults and sentenced as adults."
On the Military's Involvement in Drug Enforcement
"We may be falling down a slippery slope when it comes to the military. The military is not trained to deal with domestic law enforcement the way police are. And, having grown up in Detroit and lived in Washington I'm not so sure the way police are trained is the best way. Nonetheless, the military is trained to destroy an enemy with massive force. The military is not trained the way police are supposed to be trained to use minimum force to apprehend the suspect, all the while keeping in mind that person's constitutional rights. So, there is this potential for conflict and we needn to watch out for federal proposals to increase the use of the National Guard in the war on drugs." —Joe Davidson, Reporter, Wall Street Journal, Washington, DC
An Invitation to the Leaders in Medicine
The following invitation was presented at the conference by Dr. David Lewis on the morning of Thursday. November 7.
The leaders of the medical establishment must play a more vital role in the debate over current U.S. drug policy. Outside of a handful of addiction medicine and addiction psychiatry experts, the U.S. medical establishment has been virtually silent on our national drug policy, particularly as it concerns illegal drugs. An obvious need for medical input into this policy exists. We hereby invite our fellow physicians to join us in an open and frank discussion on how to reduce the harm caused by the misuse of drugs in our society.
None of the signatories of this invitation advocates the adoption or rejection of any specific drug policy. Rather, we advocate the need for serious and informed discussion on the part of medical leadership.
The drug policy debate today is unbalanced. Money, research, legislation, and leadership overwhelmingly focus on the criminal aspects of the drug problem. The threat drugs pose to our society requires more than just a public safety approach, it requires an equal partnership with a health approach.
Medical input is especially important in discussions about whether our current approach uses the most effective methods for prevention, care of the addicted, and deterrents to harmful drug use. Medical leadership will also help to examine if our present drug policies further or inhibit the nation's larger health goals such as restraining health care costs and encouraging social and medical research into the harmful effects of drugs.
Medical leaders need to add their perspective to U.S. drug policy because these issues, including the stigma surrounding addiction of all types, affect the day-to-day practice of medicine. This day-to-day practice includes the prescription of medication for the treatment of pain and the responsibility of all physicians to intervene in a helpful and healthful way with patients and families who have problems with alcohol and other abused substances.
The role of physicians must include more than just treating their patients, because current drug policy greatly influences our health policy. Attempts to pursue our current policy have not led to solutions, but to a vigorous effort to blame persons, families, politicians, or the media for our "drug problem." We reject that pursuit.
Instead, we must craft a proper balance between prevention and treatment, between regulation and education, between the use of the criminal justice system and other forms of control. Let us follow more closely a major ethical tenet of medicine — "do no harm" — and analyze not only the harmful effects of drugs, but also the harmful effect of the failure of physicians to analyze and comment on current policies and possible alternatives.
This is neither a blame game nor a moral crusade; this is an issue where science and health should be prominent, not only in the discussion, but in the implementation of policy.
If the leadership of medicine believes that we already have a prudent and effective policy, those leaders should come forth and say so; if they have reservations concerning our current approach, then it is their obligation to contribute to reformulating our drug policy. To those medical leaders who have previously taken no particular position on these issues, we ask: Will you join with us, become informed about the issues, the science, and the direction and influence of our drug policy, so that we can add a useful and essential medical perspective to drug policy decision making?
Over the next few months we will plan a process for consensus building among medical leaders and, with your help, establish a forum for open-minded discussion of our drug policy.
If you are interested in participating in this dialog, contact any one of us.
David C. Lewis, MD, Prof. of Medicine & Community Health, Brown University, fax: (401) 444-1 850; email:
Joycelyn Elders, MD, Professor of Pediatrics, University of Arkansas
Robert Newman, MD, President, Beth Israel Medical Center, New York City
JUDGES AND THE WAR ON DRUGS
Judge James Gray • On the Cost of the Drug War
"In my court, I have seen an bysystem that churns people through it for no good purpose whatsoever. We are expending enormous quantities of money in that process as well as our moral and human resources. I have seen some down-and-out man, 50 or 55 years old, pushing a shopping cart with all of his possessions in it, bottles and cans and everything else — just a down-and-out fellow. That was one day. The next day he was found selling a $10 bindle of cocaine to an undercover officer. At that point, with great fanfare, he's been arrested, we have three police officers waiting outside to testify, we have a public defender, a prosecutor, the judge, the staff ... spending thousands and thousands and thousands of dollars to prosecute him and put him in prison for $25,000 a year. And it just doesn't make sense."
"I wish I could stand before you saying that this was going to change because we finally became compassionate, we finally understood that this war on drugs has become and is a war on our people — in fact mostly our minority people. People will not act because of that; I wish they would and some will. But it is going to be a pocketbook issue, in my opinion, and the pocketbook issue will carry the day. We're broke, we can no longer afford to continue to spend these resources."
"If we continue as we have for the past 20 years in California, in the year 2020, everybody in the state will either be in prison or running one." — Judge James Gray, Orange County Superior Court, Santa Ana, CA
Judge Volney Brown Jr. • On the Futility of Drug Law Enforcement
"There is only one thing wrong with drug law enforcement, just one — it doesn't work. And when I tell you this, I want you to believe me because I have done it." — Volney Brown Jr., Federal Magistrate-Judge (ret.), Los Angeles
Judge Pamela Alexander • On Racism and the Drug War
"I am here because I am the first judge in this country to say, in 1990, that the war on drugs was racist. It still is and that hasn't changed."
On the Judiciary and Sentencing Guidelines
"It is very difficult for judges to stand-up and face reelections on controversial issues. My colleagues all whisper in the back room, 'Judge, you know we think you're right, but we're never going to say that, because, if we say that, then we'll get challenged as well.'
"There is a growing concern among judges about sentencing guidelines and taking away the independence of the judiciary in terms of how we sentence people. And I think that is going to be the hook, to hook in otherjudges, to finally say that some of this is going to have to stop." —Judge Pamela Alexander, Hennipen County District Court, Minneapolis, MN
DRUG EDUCATION: PROGRAMS BASED ON SCIENCE
Jerome Beck • On Harm Reduction and Education
"There was a movement and a realization of harm reduction techniques, harm reduction prevention approaches, strategies that took hold in this country and flourished at least for several years. Organizations like Moth ers Against Misuse and Abuse and the Do It Now Foundation in Arizona — in the '70s, there were many of them — had like-minded purposes of preventing substance abuse harm and unintentional misuse, rather than the unrealistic idea of trying to prevent all use." — Jerome E. Beck, Co-Director, Educational Research Consultants, Berkeley, CA
Rod Skager • On Drug Education's False Premises
"I believe that there is a drug problem in America and it does effect significant numbers of the young. But, drug education is shaped by a false analogy about the nature of the problem — this analogy was drawn for political purposes, not pragmatic or humanitarian reasons. And its premise is amazingly simple — drug use is a disease that is carried by drug users. This hyperbole, this hysteria, fuels the drug war and it corrupts drug education utterly." — Rod Skager, Professor, University of California, Los Angeles
Joel Brown • On Exclusion of At-Risk Youth
"Federal and state dollars are provided to school districts and schools based on how many kids are in need. Yet, these very youth are excluded from the educational system through detention, suspension, and expulsion. The ones not excluded have told us that they look elsewhere for credible drug information." —Joel H. Brown, Co-Director, Educational Research Consultants, Berkeley, CA
Jordan Horowitz • On Increased Drug Use by Youth
"Recently, findings from the national high school senior survey have indicated increased use rates of many substances among America's youth. These increases in use noted in the last three years occur among those students who have received more prevention education under the current model than any other group since the advent of prevention education in our schools — this is over 100 years. These youth started school in the early '80s and are now seniors in high school. Now these increases in use have lead to calls for increases in prevention education. Increases in prevention education as currently practiced will not lead to decreases in use. More of the same will not have significant impact on use rates. What we need is a qualitative change, not a quantitative change, in prevention education." — Jordan E. Horowitz, Project Director, WestEd, Los Alamitos, CA
FRIDAY, NOVEMBER 8
DRUG POLICY IN ASIA AND THE PACIFIC RIM
Jennifer Gray • On the Shift in Drug Use Patterns in Thailand Hill Villages
"I came into the picture in 1991.... I found, number one, that the Thai government was saying there are no injecting heroin users in the hills and, number two, that HIV is not a problem. We did testing and found out that 50 percent of those people injecting were HIV positive and that in a space of a few years — from 1989 when injecting drug use was first introduced in these hilltop villages to 1993 — up to 50 percent of the male users had gone from smoking opium to injecting heroin." — Jennifer Gray, AusAidProject, Chang Rai, Thailand
Nick Crofts • On the Rapid Spread of HIV in Asia
"Injecting drug use throughout Asia has meant that HIV has spread throughout the whole region enormously quickly. Countries have gone from having no HIV to having a pool of several thousand people — sexually active, childbearing — within a matter of months."
On the Role of Fundamentalism in Asia
"It's fundamentalism that provides one of the biggest barriers to working effectively to stop the spread of HIV, among injecting drug users, among sex workers, among gay men. That's because of the policies that fundamentalism prescribes, which are policies of exclusion. And that is the very strong response from most of the countries in Asia." — Nick Crofts, MD, Director, Asian Harm Reduction Network, Fail-mid, Australia
Sujata Rana • On Injection Drug Use and HIV
"People in the developed countries thought that injecting drug use did not exist in most developing countries. And we in the developing countries didn't want to accept the fact that HIV had anything to do with us. This idea — that somehow our culture will protect us — is very dominant. Slowly, that has been changing as we have seen more and more people getting infected. Asian governments have been unable to deny that there is a problem." — Sujata Rana, MPH, Lifegiving and Lifesaving Society, Kathmandu, Nepal
Luke Samson • The Western Influence on Indian Drug Policies
"Western political reactions to narcotics have left us with a huge public health problem. Why the hell was drug use criminalized in India in the first place, and how was it classified? Nobody has even asked that question to date. How have we decided when to classify drug use as problematic or chaotic? I believe we can go back to our parliamentary debates of the '50s to say, look at the benefit for revenue, look at the benefit for treatment, maybe we can come back to the point of making opium and cannabis legal again." — Luke Samson, Society for Serving the Urban Poor, New Delhi, India
DRUG POLICY IN SOUTH AMERICA
Coletta Youngers • On the Effectiveness of U.S. International Drug Control
"International drug control policies have had little, if any, impact; there is no indication that there is less cocaine or heroin coming into this country. On the contrary, what is estimated to be stockpiled according to the DEA, in fact, has increased."
"In Colombia and Peru, the United States is forging close ties with what may be the most abusive police and military forces in the hemisphere today, greatly exacerbating human rights problems. In Bolivia, United States pressure to eradicate coca crops has
generated significant social unrest, political conflict and violence. In the Andes, this is a real war."— Coletta Youngers, Senior Associate, Washington Office on Latin America, Washington, DC
Jack Riley • On the Economics of Drug Importation
"The amount of coca leaf that it takes to make a kilogram of cocaine, that would resale for about $135,000 in this country would cost about $750 at the farm in Colombia, Bolivia, or Peru."
"Temporary control, i.e., disruption of production, is possible — that much is obvious. We can impose some costs on them [the traffickers] and we can diminish production temporarily. The problem is that that kind of temporary control comes with unanticipated costs that can't be guarded against — and, because of the economics, costs that ultimately erode the policy's effectiveness." — Jack Riley, Analyst, National Institute of:justice, U.S. Department of Justice, Washington, DC
Francisco Thoumi • On the Effects of the Drug Trade in Colombia
"In the case of Colombia, we have found an increasing number of actors in the drug industry. There is no question that the military benefits, the police benefit, [and] the guerillas benefit [because] the emerald traffickers shifted some of their knowhow and Mafia organizations to the drug trade. There are also links with international organized crime, and all of this has left Colombia in a mess. The biggest problem is that only 15 percent of the violent-deaths can be attributed to political or human rights violations. The rest of the deaths are related to this illegal trade." — Francisco Thoumi, Fellow, Woodrow Wilson International Center for Scholars, Washington, DC
Nkechi Taifa • On the Feds and Crack Cocaine
'During heated debate on the floor of the House of Representatives on the crack-cocaine issue last year, Rep. Maxine Waters conveyed comments of frustration from her constituents disparaging the prevalence of crack-cocaine in their communities. They said to her, 'Ms. Waters, why do they not get the big drug dealers? Why is it that large amounts of drugs keep flowing into inner-cities? Where do they come from? Why do they not get the real criminals? Ms. Waters, 19-year-olds are not the big drug dealers, why is it that they end up in the federal system? Why is it that they end up with these five-year, 10-year, 15-year mandatory-minimum sentences? Why can you not get the big guys?' She said, that they say, 'We believe that there is a conspiracy.' This is what mothers in these communities say: 'We believe there is a conspiracy against our children and against our communities.' They say, 'Ms. Waters, we do not understand and we do not know why a first-time offender, who happens to be black or Latino ends up with a five-year sentence. They are targeting our communities from the federal level.'" — Nkechi Taifa, Director, Howard School of Law Public Service Program, Washington, DC
CALIFORNIA'S PROPOSITION 215
Chris Conrad • On the Movement and Proposition 215
"We had to go through this process in California ... of going from a movement — in which everybody's idea, everybody's little group was of equal importance — to one where they had to walk together, at the same pace, to the same location, which was this victory in November.
"To do that, we had to get past a lot of infighting. We had to not let people raise side issues, to subjegate some of their own agendas, and set them aside, and it caused a lot of divisions. However, we had this wonderful situation in our hands because we were dealing with a plant that was here for the healing of the nations. And so, by virtue of this, it gave us a way of bringing the activists together. And it created problems for some of us. For example, my agenda had not changed — I'm still for industrial hemp and I'm still for setting an age of consent [for marijuana use] for adults. What I have had to do is not to advance certain parts of my overall agenda, not because this is a stepping-stone process, but because, in the best interests of the patients and the suffering people of California, we made a decision to sacrifice some of our other activities that we were moving forward on." — Chris Conrad, Business Alliance for Commerce in Hemp, El Cerrito, CA
THIS IS YOUR BRAIN ON DRUGS: RESEARCH IN NEUROSCIENCE
Ernest Drucker • On the Politics and Nature of Drug Addiction
"If we begin to be more effective in our ability to deal with addiction, I'm absolutely certain it will begin to decompress the political construction of drugs, which has been so damaging to our ability to do public health work. Insofar as we understand the nature of drug action and addiction better and become more effective in dealing with adverse consequences of drug use, I think politicians can start letting go of it a bit." — Ernest Drucker, Director, Division of Community Health, Albert Einstein College of Medicine, Bronx, NY; DPF Advisory Board
Sidney Schnoll • On Science and Policy
"I think all of us here at this meeting realize that there is this problem we have in this country trying to define addiction. Many of us have felt comfortable in defining it our own ways, but societally we haven't done that very well. We need to look at these issues, and what, if anything, science has contributed to this. Many of the people who make policy around these issues have, in fact, been anti-science. So, they are not willing to look at the science to see if it can contribute at all to what is going on in drug abuse." — Sidney Schnoll, MD, Professor, Internal Medicine and Pharmacology, Medical College of Virginia, Richmond
SATURDAY, NOVEMBER 9
DEBATE: TREATMENT VS. NON-TREATMENT
Stanton Peele • On the Dark Side of Treatment
"In the reform movement, you [reformers] want greater freedom, you are against the police-state mentality that motivates and sustains the war on drugs. Instead, as treatment expands, we will get more coercion...."
"In the reform movement, you are hoping for some sort of futuristic society where people and their relationship to substance use is self-regulated, where people are clear and internally defined on their use of substances. Instead, in the treatment model system, you are going to get more ambivalence by the user and more self-labeling of people as being dependent on drugs." —Stanton Peele, Independent Researcher and Writer, Princeton, NJ
Robert Millman • On Treatment Models
"The sad thing about the treatment field is that, at Betty Ford, they think the disease model is right, at Yale they think the psychiatric model is right. The truth is, all the models are correct. It isn't fair to attack one. You've got to look at every patient as the result of a combination of these different models." — Robert B. Millman, MD, Director, Alcohol and Substance Abuse Services, Payne Whitney Psychiatric Clinic, The New York Hospital, NYC
WHY DRUG POLICY REFORM WON'T WORK
Steven Jonas • On Why the Drug War Will Never End
"The true goals of the drug war, unstated though they may be, are not concerned with drug use.... The goals of the drug war are concerned rather with the control of ethnic minorities at which it, the drug war, is aimed. The primary tools of the drug war are violent in nature. Ostensibly, they are employed in an attempt to affect a change in human behavior related to the use by a relatively small number of persons of an arbitrarily determined subset of the recreational mood-altering drugs. However, in dealing with much more widely used drugs, the uses of which have had much more devastating effects on society than does the use of drugs on which the drug war focuses.
"These facts are all essential to revealing the real agenda of the drug war. That agenda is sharply highlighted when it is noticed, as stated above, that drug war violence actually is aimed not only at an arbitrarily determined minority subset of the already recreational mood-altering drugs ... but also at a minority subset of the relatively small subset of users of those drugs. That subset is primarily defined by skin color and ethnicity. Despite these contradictions, the violent enterprise called the drug war serves major political, economic, social, and corporate ends. Given that there is no significant opposition to the drug war based upon an understanding of its true nature..., it can be safely said that the drug war will never end." — Steven Jonas, MD, MPH, Professor, Department of Preventative Medicine, State University of New York at Stony Brook Medical School; DPF Advisory Board
Imani Woods • On the Real Problems
"The reform movement does a lot of talking about legalization and decriminalization, access to clean needles, and access to clean drugs. But we do not discuss the real problems in these communities — people born into these kinds of situations: joblessness, hopelessness, hate.
"Most people have never even seen what we see in the black and Latin communities.... Many people in the majority community have not seen what it looks like to have people intoxicated on your street corners and sleeping in the hallways of your public housing tenements; have never seen homeless people who go out and beg all day and use every penny they have in order to purchase drugs and alcohol; have never seen what it looks like to have people selling drugs in your neighborhood, on your corner, and influencing your children on the way to school; have never even seen it. Yet, you want to talk about reforming." — Imani Woods, President, Progressive Solutions, Seattle, WA
BENEFITS OF ILLICIT SUBSTANCES
John Morgan • On the Effectiveness of Marinol, the Synthetic THC Pill
"In a recent study, the scientists gave patients 20 mg of Marinol by mouth to see if it increased their appetite. Not only could they not detect much appetite-increasing effect, but they learned the interesting fact that, in one-third of people who take Marinol by mouth, you have no blood levels at all. The drug is so poorly bio-available it's surprising that it got on to the market. There may well be some reason to believe there are individuals in our government who are interested in getting Marinol on to the market to diminish the pressure for smoked marijuana." —John P. Morgan, MD, Professor of Pharmacology, City University of New Advisory Board
Alexander Shulgin • On Drugs as Tools
"There's a whole world outside of the benefit of drugs to the user and that is the development of tools to benefit research and a benefit to understanding and exploring. Not as a personal gratification or exploration or curiosity, but something that, in turn, could be used to explain the mysteries of why we are who we are." — Alexander Shulgin, PhD, Independent Researcher and Writer, Lafayette, CA