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ALTERNATIVES FOR DRUG CONTROL PDF Print E-mail
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Books - Drugs & The Public
Written by Norman Zinberg   

Freud was convinced that "the voice of the intellect will be heard." But no one understood better than he that if reason is to triumph, it has to sound above the clamor of conflicting emotions and the roar of primitive desires. As long as drugs remain primarily a police problem, with the emphasis on condemnation rather than treatment, they will continue to occupy a position of exaggerated prominence, and the costs of drug use will be unchecked. It is the criminal-deviant aura enveloping drugs that attracts the wrath and anxiety of the public and stirs the rebellious longings of many drug users. In short, the very fact that drug use is criminal exacerbates the conflict and serves perhaps more than anything else to keep drugs a symbolic issue.

Hence, in this chapter we will discuss four essential features of any drug program: credibility, capacity for change, research and assessment, and provision of medical care. Then we will postulate several legal alternatives to the present laws on marijuana. We suggest a number of programs in the certain knowledge that each one creates as well as solves problems. Our guiding principle has been to choose those that offer the greatest degree of informal social control over drug use.

We shall emphasize changes in the law concerning marijuana rather than any other drug because there are probably over 20,000,000 users2 in the United States, and it seems likely, and even necessary, that changes will be made in this area first. If our goal of awareness is achieved, changes in the marijuana laws could serve as pilot schemes and perhaps stimulate the development of rational programs for the use and control of all mind-altering drugs.

CREDIBILITY

At the core of a credible drug program must be principles of honesty and justice. This statement would seem like a truism if we did not have a long history of blatantly discriminatory treatment of drug users in the United States. Some of the functions of refraining from making this assessment were discussed in Chapter 2; it is not banal to point out that in connection with drugs, principles that we accept almost without question must be consciously instrumental. Every facet of drug policy must inspire trust—its responsiveness to other related social issues, its methods of collecting and processing data, the facilities it provides, its assessing body, its dedication to justice, the integrity of its administrators. In practical terms this means that we must take into account the program's impact on the black ghettos and political activists and assess the possibility that the program might appear provocative or discriminatory to special-interest groups. Data must be based on accurate sampling; at present most guesses about marijuana use are based on numbers of arrests and quantities of the drug seized by the police. Arrests are a poor gauge because only the flamboyant and the unlucky are arrested on marijuana charges. So data must also be based on those who do not get arrested. Data processing must be performed with strict impartiality, and the statistical methods used in discussing such factors as drug progression and contagion must be free of prejudice.* Conclusions about social good and social harm must have the convincing backing that the medical profession was able to amass about the effects of thalidomide, and must be accepted or rejected on their merits.

If facilities are said to be available, they must be available. Britain shifted to drug-control clinics for heroin users without making adequate preparation; the result was disillusion and a setback in the treatment of addiction.3 We should profit by this example. If the program includes, say, counseling centers to help youngsters, these centers must be accurately listed and rigorously maintained. Civil commitment programs were introduced in the United States with much fanfare as radical alternatives to criminal processing of addicts. It turned out that few treatment facilities of any kind were provided,4 let alone any new and ingenious approaches; trust in the credibility of legal and political authority diminished still further. By giving a pseudomedical respectability to what was, in fact, an ill-organized attempt to keep the addict off the street, the authorities acted hypocritically and only worsened the conflict.

Mistrust of government agencies has grown so great that the administration of a program controlling marijuana use would probably have to be carried out by an independent bodY and funded by a private foundation or professional organization. We doubt that an agency like the Food and Drug Administration could now serve as assessors or administrators of a new drug program. When James Goddard, head of the FDA, testified before a congressional committee in favor of a government bill increasing drug penalties,5 it was hard not to suspect political coercion. Commissioner Goddard's earlier public statements indicated a different attitude toward marijuana control, as did his statements after resignation.

CAPACITY FOR RAPID CHANGE

All proposals for a new drug program must emphasize the need for reliable evaluation and be designed for technological, social, psychological, and historical change. There can be no permanent "solution" to the problem of drug use. The program must be able to incorporate into current practice what is learned from the recent past. The organization itself must have a temporary quality and built-in protection against institutionalization.

Any laws concerning drugs would be passed for a period of two or three years, and before they could be renewed evaluation would be mandatory. The organization administering the program would have as its goal the elimination of its present function, so that bureaucratization could be avoided.

ASSESSMENT AND SOCIAL RESEARCH

Any new program must constantly test new ideas, assess current practices, and incorporate its findings into policy. Even to decide what is effective and what is not is a major problem; we must work out which factors to weigh in the scale and how to weigh each one.

These problems must be attacked as soon as possible, and we suggest that the only useful approach is to devise a series of social experiments. This social research would be designed to gain information not just about drugs—we already know a great deal more than we like to admit—but about the impact of different control systems. A few tentative steps are being taken in the United States and abroad to test out alternatives for controversial social issues. The existence of the social clubs Paradisio and Fantasia in Amsterdam amounts to the licensing of specific premises for drug use. There are counties in the United States where such sweeping welfare reforms as the negative income tax are being tried, and Nevada's relaxation of the law prohibiting prostitution could also be studied as a social experiment.

It is argued that the drug problem is too critical to wait on anything as complex as social experimentation. This line of thinking will prevent us from salvaging a bad situation. If we had accepted that social experiments were necessary and begun to devise them five years ago, we would be far better off now. Late though it is, our best course is to press ahead as quickly as possible.

However, we are under no illusions that it will be easy. Our methodology must provide us with data about the short-term and long-term effects of drug use on both individual and group psychology. We must obtain information about the effect of drugs on personal relations and on trust in social institutions. And, of course, we must investigate further the psychological effects of drugs. Not the least of our difficulties will be the Heisenberg effect (the so-called uncertainty principle whereby the accurate measurement of one of two related quantities produces uncertainties in the measurement of the other). If, for example, the government permits drug use in a certain place as an experiment for research purposes, we will have to take into account the impact that the research has on the pattern and effects of use. This is especially important with a drug as sensitive to set and setting as marijuana. Will the user feel that he is in a laboratory rather than in a social setting, and what effect will this have? How much of the research should be communicated to the public, and when? Should the mass media be permitted to conduct their own formal and informal research, and put out a stream of stories on the experimental area? If their activities are to be limited, how may this be done without infringing the freedom of the press? These and similar questions will have a bearing on research design.

COMPREHENSIVE MEDICAL CARE
In this book we have focused on the millions of new drug users, the second (drug-experimenting) group, who for the most part use marijuana; but we are also keenly aware of the first (dependency-prone) group, whom we regard as a medical problem.

A new program should make provisions for comprehensive medical care for this group, and for whatever incidental medical care is necessary for the other group. In the United States, federal, state, and local government agencies, staggering under the burden of other social problems, have tackled the medical problems of addicts in only the most rudimentary way. Until recently, imprisonment and cold turkey was the usual method for withdrawal. The most popular method at the moment is a system of methadone detoxification and maintenance, by which addicts are given methadone`legally at low cost, usually on a daily basis. This synthetic narcotic is reputed to block the desire for heroin. Certainly the methadone program has returned more hard-core addicts to their usual social roles than any other attempt so far,6 and it is far cheaper than any group-living situation, with or without group or individual psychotherapy.

One can argue with some justification, as its opponents have done, that methadone maintenance is suspiciously like the British system. Dole and Nyswander, who developed the idea, insist that addiction results from a physiological, probably metabolic, deficiency and that methadone operates physiologically, not psychologically. Nevertheless, it is the first breakthrough in medical care that has received sufficient acceptance to enable relatively large numbers of addicts to receive some form of direct attention. The system of methadone prescription is flexible enough to permit useful comparison between samples of addicts who get methadone and therapy, methadone but no therapy, methadone with or without job retraining, and so on.

In the absence of a body of well-documented findings, such as we would hope to gain from extensive research, we depend to a large extent on ex-addicts for information and guidance. In the present legal situation, adequate research is difficult if not impossible, and the emotional atmosphere surrounding drug use makes the ex-addict a natural choice as leader—we want an oracle, and who better than the man who has been there?

Undoubtedly, we can learn a great deal from ex-addicts, but we have lost sight of one of the lessons of Alcoholics Anonymous. Every member of AA recognizes that he has a doppelganger who will want a drink every day of his life. By projecting that undesirable "twin" onto another afflicted soul, he can wrestle with him more successfully. Members of AA usually refrain from engaging in public controversy about alcohol while they are engrossed in this personal struggle; they know that their vision is limited because of their psychological handicap.

Ex-addicts are denied the outlet of an Addicts Anonymous because of the legal situation and transfer their personal struggle to some of the inadequate treatment and rehabilitation programs that do exist. They bend every effort to stamp out the drug taking that so stirs their inner twin. This has tended to result in repressive programs, and innovations that appear to ease the repression have been resisted.

Although we question the wisdom of relying solely on ex-addicts in treatment programs, we do not wish to limit employment only to doctors and social workers. Many disciplines and skills, some of which may be non-professional, should be enlisted, and the support of the community sought. Successful users, who can offer very little advice under present conditions, could be a valuable source of information about the psychological and physiological hazards that must be overcome if drugs are to be used without damage.

In dealing with the problems of the dependency-prone, there will be casualties, usually minor, among the drug-experimenting group. Under any system in which drugs are more easily available, adverse drug reactions will increase. These reactions may be allergic, idiosyncratic, or psychological, and we must systematically develop procedures for coping with them. Hence, minimum standards of medical care will have to be laid down as part of the basic structure of any new drug program.

ALTERNATIVES FOR MARIJUANA CONTROL

The preceding chapters have shown how neither the known facts about the effects of drug use on user or society nor the results of punitive legislation justify existing drug laws. Public attitudes reflect a distorted and unrealistic picture of drug use which stems partly from the law, and each sustains the other. We have asserted that the law undermines effective regulation of drug use and control of harmful drug effects, and produces important social debits of its own.

While some legal change is necessary, it is not obvious what form or scope the change should take if we are to avoid the mistakes of the past and keep drugs suitably leashed. The need for change is actually greatest in the laws related to heroin. The social costs frpm keeping heroin illegal are more direct and obvious—addicts die from overdosing and contaminants, they commit crimes, the black market is prosperous—and the problem of dysfunctional effects is crucial. But moral attitudes toward heroin as the devil drug, its potential for causing physiological dependency, and the fact that it is used among groups without political power make reform unlikely. Heroin maintenance, which has worked so well in England, is not being seriously considered by policymakers.

Some drastic change in the marijuana laws, however, appears probable within the foreseeable future. Many minor shifts are already occurring. Dissatisfaction with marijuana policy, its high costs and dubious benefits, has reached a point at which removal of all penalties for personal use and possession is being urged in reputable quarters. We shall consider a number of alternatives for new legislation, without speculating about which is likely to be passed. The problems encountered here, and the premises on which the law is based, apply to the whole range of drug control.

In one form or another the premises underlying the following discussion have been discussed earlier in this book. Essentially, we feel that there are valid goals, consistent with individual liberty and social responsibility, to be achieved through drug regulation. Heavy reliance on criminal sanctions, however, frustrates these goals and creates serious problems. The question then becomes one of finding a legal framework that, on the one hand, does not unduly restrict freedom, subvert legal authority, or lead to unsaory police practices, but, on the other hand, discourages or ameliorates the effects of harmful drug use.

Proposals for marijuana legislation can be divided into two groups: (1) where general possession for personal use is a crime and (2) where possession for personal use carries no penalty. These groups can be further subdivided, each alternative having certain costs and benefits. We offer the following speculations about the strong and weak points of each one. We do not endorse one as the definitive answer, but some are obviously preferable.

A.

1. Status quo: One possibility is to do nothing at all. This alternative seems unlikely. After Leary v. United States invalidated the possession sections of the federal Marijuana Tax Acte this alternative for Congress ceased to exist. Now that new federal legislation (Controlled Dangerous Substances Act of 1970) has reduced marijuana penalties, many states are sure to produce changes of their own. There is a growing consensus that the existing regulatory scheme is unjust, unwarranted, and unworkable. The loss of effectiveness incurred in drug programs and the social costs of a law derided and flouted by millions make the status quo a very costly alternative. Its advantages are that it expresses clearly the public condemnation of mood alteration through drugs. It draws a line, albeit blurred and uneven, between the acceptable and nonacceptable, and may be of some service in defining a cultural norm about drug-taking.

2. Misdemeanors: The federal law and several states have recently reduced the penalties for marijuana possession from a felony to a misdemeanor. A federal offender now may receive up to a year in jail and a fine of up to $1,000. The advantages of this law are fourfold. First, it ensures that no one is punished by severe jail sentences; second, the majority of users will very likely get off without going to jail; third, it maintains the condemnation of marijuana use and possibly discourages those who are deterred by criminal sanctions from experimenting; and fourth, it distinguishes marijuana from dissimilar drugs.

This law also has certain disadvantages, however. First, there is no guarantee that a judge will not send users to jail, and there is still the possibility of suffering the unpleasantness, embarrassment, and expense of being apprehended and labeled a criminal Second, it may have no appreciable effect on police processes. John Ingersoll, director of the Bureau of Narcotics and Dangerous Drugs, endorsed the pending proposal as a means of encouraging more law enforcement and penalizing marijuana users.7 We should then expect the police to continue enforcing the law, perhaps more assiduously. All the detrimental effects of the legal system discussed previously will be undiminished. Third, the symbolic overtones of such a change are likely to backfire. Rather than reduce the credibility gap and renew faith in government by showing the state's willingness to recognize and rectify an intolerable situation, it will confirm the features that generate hostility and disrespect throughout the system. The change appears to be a major reform, yet the major premises of drug policy have not been altered one whit. In fact, the de facto situation in force, where few users go to jail, will not be improved and, if Ingersoll's prediction is true, might even be worsened.

Fourth, retention of criminal penalties does nothing to deal with those patterns or instances of marijuana use that are rightly of concern to the state. There is no education to help people make an informed decision about whether or not to use marijuana, no instruction on avoiding adverse effects, no facilities to deal with them when they occur. There is nothing to help alleviate the real problems, and yet this should be the basis of legal concern about marijuana use.

3. A final alternative, based on a model of criminal sanctions, would limit penalties to fines.8 The main advantage appears to be that the imposition of a fine withholds the social endorsement that is implied by removing all penalties from marijuana use. It thus maintains the norm against drug-taking, but lessens the likelihood of the criminal process impinging unjustly—there is considerably less incentive for the police to enforce the law when the penalty is small. However, while this would reduce legal and general social costs, it would still lessen respect for the law.

B.

Legislative schemes that do not penalize the possession of marijuana also take several forms. The basic problem here centers around distribution. Should legal possession be coupled with some legal form of distribution? If so, in what circumstances and by what criteria should the distribution take place? This set of alternatives rests on the notion that the dangers of marijuana slo not justify the criminalizing of users, and that even if dangers exist, criminal penalties are dysfunctional.

1. One alternative would allow the possession of marijuana for personal use, but maintain the illegality of production and distribution. Whether possession was for personal use would be determined by one of three legal techniques: first, an arbitrary quainity limitation, e.g., two ounces to distinguish the personal user from the one who possesses with intent to sell; second, a presumption in favor of personal use, with the burden on the other party of proving the contrary; third, a separate crime of possession with intent to sell. The suitability of these three devices depends on a consideration of law-enforcement factors, evidentiary questions, and the smooth administration of justice. To a large extent, this is a technical problem, and we will not discuss it further at this point.

When possession for personal use is not subject to criminal penalties, many of the existing defects in the law are cured. The arbitrary and unjust features of enforcement are for the most part eliminated, police resources are freed for other matters, and social tensions are relaxed. In conjunction with reasonable and informed drug education, the aim of the program is to divert from harmful use patterns, to minimize adverse drug effects, and to ameliorate them when they do occur. Strict control over distribution might limit availability sufficiently to avoid a national marijuana habit, pending further investigation of the drug, although given our present situation this seems doubtful. The argument for control over distribution rests on the fear that later knowledge will reveal a potential for serious individual or social harm, which will then be difficult to counter.

The disadvantage of this approach is an apparent inconsistency in legalizing possession but not sale. If marijuana poses no threat to state interests, it seem contradictory to ban sale (this charge was leveled at the Wootton Report) .9 Furthermore, legalized possession will increase demand and, thus, sales. It appears contradictory to say, "You may have x," and then deny access to x. This criticism highlights what is perhaps the most subtle and difficult point to grasp about drug control—its tentative nature. Removal of penalties is not supposed to be a positive endorsement of marijuana use or a bill of good health, merely that criminal sanctions are inappropriate and positively harmful and that other means of control are to be employed.

2. A second control alternative would be identical with the first, except that there would be no distinction between possession for use and possession for sale. One additional point is relevant. The sale provisions would be more difficult to enforce, since no kind of possession could be used to distinguish sellers. While this might prevent certain offensive police practices aimed at procuring evidence and the arrests of those possessing for sale, it would increase pressures on police. The final result would be either no enforcement of sale provision—and hence, no control—or enforcement through the use of such distasteful devices as electronic surveillance, spies, and informers.

3. A third set of alternatives would provide a legal source of marijuana, as well as remove penalties for possession. The virtues of this alternative are consistency between possession and sale, quality and dosage control, elimination of most police activity and the black market (none of our earlier proposals have tackled the black market). Specific pluses and minuses will be discussed under two of the forms legalized distribution could take:

(a) Alcohol model. Marijuana could be regulated by permitting certain grades and quantities to be sold under license at specific places and times. If this system were run by private enterprise, profits could be limited by law; or if under state monopoly, profits could be used to support drug research and medical care. Advertising would be forbidden, only a limited quantity of marijuana would be sold to each buyer, and place of use might be regulated—for example, there might be a restriction against marijuana use in public.

We may assume that under this scheme illegal marketing would be minimal and enforcement problems consequently of little concern (a difference from the second alternative, which follows). Such a system will, of course, require the creation of bureaucratic machinery, ranging in complexity from local licensing boards supervised by a state agency—the case with alcohol fir most states—to a state licensing authority that grants pharmacists the right to sell marijuana.

(b) Licensing users. The problem of isolating certain groups or individuals who might use marijuana detrimentally raises the possibility of a system that licenses certain people to use marijuana. Upon attaining a certain age, anyone desiring to use marijuana could apply for a permit or license. The permit would enable him to purchase and possess marijuana legally. One variation would simply make the permit a prerequisite for obtaining marijuana legally, but not penalize one who is in possession without a permit. Similarly, the age requirement does not make it impossible for minors to obtain liquor; however, they are not punished for possession of alcohol, though the seller is. The license might be issued on condition that the applicant could demonstrate his fitness in a number of ways. For example, he would have to show that he was equipped with a minimal level of knowledge concerning marijuana, its effects, mode of use, methods of handling bad moments, activities that cannot be performed well, etc., and that he suffered from no serious psychological problems that the drug would worsen.

The chief difficulty would be in determining the criteria for granting and withholding permits. Further difficulties might be expected from those who were not granted licenses, no matter how sound the reasons for denial. This group might, nevertheless, use marijuana, and several possibilities would arise. First, severe penalties could be attached to selling to unlicensed persons. A second possibility is that no penalties would be imposed on those caught in possession, to avoid problems with law enforcement. Or, third, the harm users might experience could be minimized by the information they have been exposed to and the availability of treatment and other preventive or ameliorative programs. Much will depend on the number of those excluded, the efficacy of education and treatment programs, and changes in attitudes toward drugs.

A licensing system entails a major bureaucratic organization with administrators, examiners, and inspectors. Even if the present law is maintained, we recommend that an agency be created to monitor drug trends, to keep abreast of new knowledge, to sponsor research, and to evaluate the operation of the law. Further functions should include the development of drug education programs and tréatment facilities. By "education" is meant, of course, information about what marijuana will actually do, how to use marijuana to avoid known difficulties, and finally, what to do if experiencing difficulty. Adding a licensing function would not necessarily alter the existing orientation significantly but would vastly increase the duties and functions of such an agency.

Three variations on the licensing model are to some extent already in effect. Permitting the use of marijuana on prescription (which happens in England10) is actually a licensing system on a small scale. But as it affects only a few people, the major social costs from the law remain, with few of the benefits of diverting harmful use. Licensing research subjects, of sufficient number and for suitable periods, might produce important data about patterns of use and social effects, but will not alleviate existing social problems. Finally, licensing all use in clearly defined places or localities (the Fantasia and Paradisio model) alleviates none of the problems from the drug and the law that arise when used elsewhere» Outside the permitted zone of use, similar problems of law enforcement and control of harmful uses will still exist. Nor is this device likely to yield good data about marijuana and its changing patterns of use. Finally, influx or migration to the permitted zone raises problems.

Each proposal should contain a provision to deal with the following questions: advertising, driving after consumption of marijuana, research, and use in a public place.

PROBLEMS OF LEGALIZATION

If criminal sanctions are removed from the possession of marijuana, what problems will arise? The first, voiced on all sides by the public, is that harm may come to the individual and to society from increased use. Second, there will still be the question of law enforcement for other drug use. Undoubtedly the changed legal position of marijuana will have numerous other social ramifications. When discussing these problems, we must keep in mind the overriding necessity of establishing informal social control over drug use and of developing honest social discourse on the subject.

Most people expect that any relaxation of the law on marijuana will result in a vast increase in use, and that this will inevitably do a great deal of damage. It is not, in fact, clear to what extent a change in law will increase use. Marijuana is already easily available, especially among young people. The legal penalties probably deter only those who are so cautious and law-abiding that they must be considered an extremely low-risk group. Nevertheless, it is indisputable that the removal of penalties will eventually lead to widespread use, ultimately changing the drug habits of the country.

Other drug use—alcohol, for example—shows a fairly consistent percentage of users who suffer deleterious physiological or psychological effects. There is no reason to doubt that the effects of marijuana will show a similar distribution curve. However, following Howard Becker's work,12 there is evidence that with the social and psychological acceptance of use, some untoward reactions will be prevented. Given the large number of people now using marijuana in an illegal, and thus anxiety-provoking, situation, this is no small consideration. Also, with the removal of criminal sanctions the medical profession could be encouraged to study methods of preventing or alleviating deleterious effects.

No major study has been made of the relation between extent of use and dysfunctional effect, but a certain amount of knowledge has been gathered from both formal and informal investigations. Formal studies have shown that huge doses of marijuana can cause disorientation and psychosis (Harris and Isbell" ). Some chronic users can still function in society (Zinberg and WeiP4), but others, such as those we saw at the Fantasia and Paradisio, drop out and appear to be very severely handicapped. It is also well established that people can use the drug in moderation and remain well under control. Thus, we know that marijuana, like so many other drugs, has potential for both damaging and controlled use, although most studies rate it as rather mild.15

We must also consider what use may properly be made of the other parts of the cannabis plant ( the leaves, stem, and stalk), of the various forms of resin derived from it (hashish, charas), and of synthetic tetrahydrocannabinols. Should they come under the same legal heading as marijuana; or because the synthetics are certainly more potent, should they be regulated under separate legal provisions? It is certainly conceivable that if marijuana alone were legalized, these and other forms of cannabis might be used much more widely, undermining the good effects of the legal change.

In our discussion of social costs we indicate that the safest course is to accept an unavoidable amount of non-medical drug use. The damage done to society under the present system outweighs the damage that will certainly result from increased use. But the latter can be kept within reasonable bounds by the establishment of social controls and realistic discourse.

The second problem arising from the removal of criminal sanctions for marijuana is that of law enforcement. If penalties for possession are excluded but those for sale or distribution remain, the police will still be faced with the need to devise operational techniques for detecting illegal transactions. There will be the same encroachment on privacy, the same tendency to expand police powers beyond constitutional limits (with the real danger of overlapping into other areas). Indeed, for the police, the problem will be worse, since arrest for possession will no longer be a weapon against sellers.

When sale and distribution are legal, as under an alcohol model or a personal licensing system, the police must still enforce laws against control violations, such as selling below the age limit or selling to an unlicensed person. From a purely operational point of view this would be an extremely difficult police problem unless there was mass social acceptance of the control regulations.

Although not condemning an activity is a far cry from 9ondoning it, a legal change in the status of marijuana in the present climate of opinion could well be seen as an endorsement of drug use. One of the curiously ambivalent social problems about marijuana reform is its effect on our thinking about other drugs. It seems unlikely that marijuana could be accepted without some change occurring. Moreover, if the present trend toward iner4eased leeway for each individual to make decisions concerning his own body continues, legalizing marijuana alone will hardly be satisfactory. The comparison with alcohol is always faulty because in Western countries alcohol has never been thought of as a drug (we "take a drink," but we "use a drug"). Also, alcohol use emphasizes the process and ritual of drinking as much as the final effect, while in spite of elaborate rituals with rolling and passing joints and roach holders, the object with marijuana is primarily to get high. You don't share an occasional puff with someone and let it go at that.

A legal change would indicate that the use of a drug, nonmedically, in a private social or recreational setting is basically a matter of individual discretion. When the noncriminal status of such drug use is recognized, it will be difficult to distinguish the use of other illegal drugs. The effects of LSD, amphetamines, barbiturates, and opiates do vary greatly from marijuana, but the quality of the individual act in each case is the same. Use of any of these agents is a deliberate attempt to manipulate mental states to arrive at what the user finds more desirable, which may in some cases produce harm. The arbitrary barrier between private social drug use (deviant and antisocial) and medical or socially acceptable use would break down.

Many of the public are anxious to prevent the decriminalization of marijuana use for just that reason. For others, one great advantage of marijuana legalization is that it might be the lever to force us as a society to reconsider the entire question of drug use. We may be sure that drug use, medical and nonmedical, will increase, and we must face the issue and discuss it without pious mouthings.

A LICENSING MODEL

Our recommendations are based on the proposition that a system that permits drug use but does not encourage it, and that accepts restrictions based on age and on psychological or physiological incompatibility with the drug is the best balance of social and individual interests. In short, we propose a system that accords drugs the healthy respect and regulation that we accord that mighty potential weapon, the automobile.

Society must learn to tolerate a reasonable amount of drug use by those members willing and able to make that decision. If marijuana reform did not reduce emotionalism toward other drugs further legal revisions would be in order. Should marijuana be legalized under controls akin to that for alcohol, one might still need a personal licensing system for other drugs. A rational approach would recognize that the controls for one drug may not work well for another. One advantage of the licensing system is that it imposes some selectivity on who gets to use drugs without denying everyone that right. It thus makes the work of the informal control mechanisms easier by discouraging those users who, on the basis of certain criteria, appear most likely to be harmed by drug use or lack the capacity to use drugs wisely.

The second advantage of a licensing system—an advantage that varies with the precise form such a system takes—may be the greater receptivity it meets with the public. The public may be more ready to accept nonmedical drug use under a system that openly recognizes the possibility of harm from drug use, filters out the most obvious instances of harm, and is prepared for harm that does occur, than one in which no attempt is made to prevent susceptible persons from using drugs. This advantage may lie more in the public's perception of differences in the two alternatives than in differences that are actually there, but that is a factor not to be ignored.

All the bureaucratic problems we mentioned earlier in this chapter in connection with marijuana licensing, and more, would arise with this system. The applicant would receive a leaflet detailing the regulations, use, effects, and dangers of any drug that interested him. Before he received his license he would have to be familiar with its conditions. Exclusions would be kept to a minimum, but certain people would be denied licenses: they would probably include anyone convicted of violating licensing statutes, driving under the influence, selling a drug allotment, or giving it to someone below the proper age. Probably people with a demonstrated physiological or psychological sensitivity to certain drugs, or who had recently been in a mental hospital or prison, would be denied licenses, unless they had an appropriate document from a physician or penal authority. As with motor-vehicle operators' licensing, the system would be overseen by civil servants who at best would 'have little professional expertise. Thus, the system needs to be fairly standardized, requiring its administrators to make as few complex decisions as possible.

There should be no advertising, and profit margins would be fixed for those designated to supply the licensed amounts. This should virtually eliminate crime surrounding drug use. While the intention would be to keep legal restrictions to a minimum, there is no doubt that the drug-dependent group would present problems. Such cases should be detected as soon as possible, and appropriate treatment provided (in some cases this could be a form of drug maintenance).

Resale of licensed supplies would be strictly prohibited. As most people would be able to get reasonable amounts of what they want, there should be little incentive for resale and transfer, as violations would imperil drug access for oneself and, if violations became flagrant, for others. Nevertheless, there will be violators, as there always are. The general philosophy of the program should be to find violators only in order to minimize dangers for themselves and the public. The emphasis is to keep the system heading on a reasonable tack. Troublemakers would be of interest only when they cause trouble, not because they are there. Various interested groups such as police, chemists, doctors, and hospital personnel would be alerted to symptoms of sensitivity or toxicity so that Avise could be detected early.

Another bureaucratic problem that a licensing system must overcome is the creation, financing, and running of a new institution, "The Bureau of Drug Control." Costs, for example, might be paid out of license fees or out of revenues from legal distribution centers, and the excess used to sponsor research and education and provide treatment facilities. Such an institution could serve many diverse purposes, and would certainly cost less than current expenditures on the enforcement of drug laws.

Obviously we have a great deal to learn. That is the basic reason for conceiving any policy temporary. The impact of the program must be studied and the results assessed by an impartial commission. Once credibility is reestablished, we imagine that even far-reaching changes can be made with impunity. After all, if it were discovered today that gin contained cyclamates, it could be withdrawn from sale without too much of a fuss, leaving us to make do with vodka, rum, bourbon, and scotch. After our system had been in operation for two years, we would have conducted a number of studies and could convincingly demonstrate what are now only hypotheses. If it should turn out (as we expect it would) that regular use of amphetamines by adults causes massive psychic disturbance and offers little redeeming pleasure, either personally or as a vehicle for improving social interaction, then they would be removed from the market. However, users would still be left with a cornucopia of other drugs to choose from.

It is not easy for us to advocate making the amphetamines, besides whatever other terrifyingly powerful drugs technology has in store for us, available to 18-year-olds who will take them "for a gas." But it is just because a healthy respect is due these drugs that we believe that they must be made available. If restrictions are removed from marijuana, or all cannabis preparations, drug use would remain a symbolic issue, although now a drug other than marijuana would be the symbol for other social concerns. We are aware that unrestricted use of marijuana could produce in a few years problems similar to those of alcoholism. But this does not mean that marijuana is bad, any more than alcohol is bad; it simply means that in the present argument about harm versus harmlessness we are fighting the wrong battle.

Our final position about drug use, in which we advocate careful and restrained availability of drugs, depends on our seizing the initiative. In this muddled area, where things are seldom what they seem, the psychological significance of change must be carefully weighed. If concessions about marijuana use are wrung from an unresponsive majority, we fear resentment and the repeat of the bitter controversy between generations displaced to another drug. One could argue that the ease with which stringent legislation classifying marijuana with narcotics was passed in the early 1930s resulted from just such a shift of feelings following, the repeal of Prohibition.16 Should, however, a bold new plan be introduced, and both sides agree that innovation and experiment are necessary before a bad situation becomes an impossible one, we might avoid repeating history.

Advocating a licensing system for all drugs is not intended to further the permissive society. Our psychological hunch is that if concessions occur after vicious and losing battles by the average voter—middle-class, middle-aged, and extreme only about being in the political center—it will seem part of the decline of respect for authority. Such a view perverts our aim. The establishment of a national licensing system aims for a social consensus that endows the new authority with legitimacy. Permissiveness, like everything else in this field, is in the eye of the beholder, but we intend to establish firm baselines. A minimum age limit, detailed strictures on transfer and resale, rehabilitation facilities, and, above all, a healthy temerity about this new phase of our social life, can be agreed upon by everybody (or almost everybody). Thus, a social standard is established that gives its legal statement validity and accepts authority as a deterrent, not as a symbolic club.

Hence, waiting for more information, for more education, for more understanding, for a better climate of opinion, can subtly defeat the vital aim of legitimizing the proposed program's authority. The United States has a long history of this particular psychological error, evidenced most clearly now in relation to the Indo-China War. At least some of the present policy is based on concerns about retribution from the far right ("Who lost China?"), and all tries for fresh, bold approaches are scorned for fear they will be thought of as giveaways. There are both a psychological and a pragmatic difference between assessing what may benefit most people (though is ideal for none) and throwing up one's hands in despair. Boldness and initiative must change the status quo, and if that is enough to be considered a giveaway, so be it. But when change is offered freely and rationally, it is not permissiveness or defeat of authority but the fulfillment of the highest function of that authority: the common good.

* In New Society (April 1968) a statistician with no interest in drugs could not restrain himself from showing the bias in Professor Paton's use of statistics in an article that attempted to show a causal link between marijuana use and heroin addiction. Of course, it is common to use statistics in this way in many other fields besides drug use.

 

Our valuable member Norman Zinberg has been with us since Sunday, 19 December 2010.

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