13 A Bundle of Peaceful Compromises
IF the idea of drugpeace were to be accepted, then everything is possible for the future. Great ideas and seemingly impossible compromises flourish where peace and love dominate.
We should start with the humble idea that no one has a complete solution to the drug problem. I certainly do not. All I can offer is what writer Peter Passell said in a New York Times editorial comment when he summed up my last book, arguing for a more tolerant view toward heroin and addicts, in these words: "How to turn a disaster back into a problem." That thought expresses the proper frame of mind with which to contemplate the peace process in the drug arena.
The U.S. Constitution of 1787 was a bundle of compromises which gave breathing space for the nation to work out a host of emotional issues peacefully. Similarly, we must begin work on a bundle of compromises on the law and politics of drugs now, before it is too late. We need a set of flexible proposals that can be adjusted over time on the basis of pragmatic experience, one of the better habits ingrained in the American character.
Here are some beginning steps, some pragmatic compromises that might take us into that calmer land beyond drug prohibition.
RECRUIT THE ENFORCERS AS REFORMERS
It would be a major breakthrough—a minor miracle, some might say—if we could somehow convince the enforcers that they were, in a sense, victims, too, and that they had much to gain by becoming drug-law reformers. If I could arrange a quiet summit meeting of all of the major enforcement leaders and the loyal opposition at least to discuss such an apparently improbable goal, I would suggest several major new strategies. They would be aimed both at reducing the continuing sacrifice of our police in the drug war and at evolving a more positive role for all law-enforcement agencies in modern society.
Rather than treating the police like the enemy, like the scum of the drug world, the liberal critics would agree to join hands with them and support increased resources for the FBI, the DEA, and other enforcement agencies on the grounds that we all want violent criminals and organized-crime figures caught and imprisoned for as long as possible. There would be a unified campaign to support a major assault on organized crime, no matter whether the criminals were involved in drug trafficking or any one of a hundred other illegal conspiracies. That unified support would come at a frank political price.
To start with, law-enforcement leaders would have to admit that the role of all of their agencies is considerably more narrow than now claimed. Police and prosecution leaders would have to agree to stop claiming that their enforcement of the laws was saving our people from drugs. They would have to set their sights on a much more limited target: American law enforcement would continue its responsibility to apprehend the often despicable people involved in the illicit drug trade but police leaders would admit publicly that even their best work had no significant impact on regulating the drug-taking habits of the citizenry at large.
The military services would be restricted greatly in drug enforcement, and civilian police would stop using military tactics. Soldiers would concentrate on making themselves more effective fighters and police would seek to rejoin the ranks of a democratic civilian society in the function of friendly protectors. The role and budget of the Coast Guard in drug control would be expanded because in peacetime it is the lead "civilian" agency with responsibility for enforcement of the smuggling laws. Coast Guard officers and men know the rules of search and seizure; members of the other services do not, and it makes no sense to spend time and money to train them in that area.
All personnel involved in drug arrests and searches would be instructed to go beyond the basic requirements in adhering strictly to constitutional rights. In case of doubt, the officers would simply come out on the side of individual freedom. This would mean that military-style tactics in searching American homes and fields would rarely be used, certainly not for a few marijuana plants. Even where many plants were sighted, the police would consider peaceful options, such as asking the landowners to destroy them before unleashing military assaults on American farms. Unless there was no alternative, citizens found in the vicinity of raids would not be searched or detained.
Greater concern would be shown for the physical and mental health of law-enforcement officers involved in drug enforcement, especially undercover work. Commanders would develop better methods of support and guidance to reduce the possibilities of corruption.
The FBI, the DEA, and all major law-enforcement agencies would declare a moratorium on providing drug education for the classroom. Police officers who provide drug-education classes usually propagate harmful myths about the nature of drugs. If police want to tell students about the threats posed by drug traffickers and the nature of drug policing instead of the dangers of drugs, that would be quite appropriate. At the same time, I would hope to see a great expansion in the number of honest drug-education courses taught by trained educators who brought out all aspects of the many conflicting facts regarding each of the most popular drugs, legal and illegal. Drug education is vital and should be carried out by professionals in the field of education who have the knowledge and the guts to tell the whole truth.
The most painful part of this bundle of political compromises for many enforcement officials would be the expectation that leaders of major police organizations would become leaders in drug law and policy reform as part of the liberal-conservative alliance here being proposed. Moreover, even if many drug laws were changed and if some drugs, such as marijuana, were legalized, the police should be made to understand that they will not be reforming themselves out of jobs—as some of them, to my amazement, now fear. However liberal the drug laws become, there will always be limits and people exceeding them, and thus the need for good police officers.
Of course, the best of those officers might, at some happy time in the future when smuggling drugs into the country no longer makes any economic sense, be shifted to more important work—such as attempting to prevent the smuggling of American technology and military secrets out of the country to unfriendly foreign powers, an endeavor in which these officers might for the first time in their professional lives enjoy undivided public support.
SAVE OUR SICK FROM HUMILIATION AND PAIN
Most people of goodwill would agree that our sick must be protected from the excesses of the drug-war mentality. It would follow that this is a good centrist issue on which to focus major initial reform efforts, which might be divided conveniently into proposals to help, first, the organically ill and, second, the addicted. Both groups, remember, under American law are considered to be suffering from diseases.
If the millions of organically ill patients—those suffering from cancer, glaucoma, multiple sclerosis, and heart disease, for example—started to exercise their combined political power, they could move mountains. Even more could be accomplished if some of their friends and relatives took on the role of patient advocates and fought to represent the best interests of each disabled person. In many cases, the advocate would simply intervene with the massive medical bureaucracy so that ordinary civility and comfort were assured.
There are other, more aggressive tactics for patients and their advocates to undertake. These might deal with reform of the laws and practices that impose extra suffering on those who are already suffering too much. Some patients and patient advocates, alone or in organizations, may want to consider new forms of peaceful protest against the current system, which might be combined with lawsuits by committed lawyers. Such tactics have been used by civil rights and women's groups in recent history but never by organized advocates of the sick. Those government officials who have denied sick people access to marijuana, for example, should lose their anonymity and be treated with the moral opprobrium that would be appropriate for comparable deleterious criminal activity. The federal officials responsible are to be found primarily in the White House Office of Drug Abuse Policy; in the Department of Justice, which includes the DEA; in the Department of Health and Human Services, which includes the FDA and NIDA; and among the members and staffs of the key congressional committees that support the cruelty of the present system.
If tens of thousands of patients and their advocates flooded those officials with protests and demands for relief, their confident arrogance might be dented. I can testify that those officials believe that they have mass public support from the truly decent people of the country in denying sick people access to forbidden medicines. Only persistent protests can change their minds.
Even under current law, there is no reason why all patients suffering from cancer, glaucoma, scleroderma, or other diseases should not be immediately designated as a research subject and provided all of the THC pills or marijuana cigarettes their doctors are willing to prescribe. While the law would allow this, the federal officials do everything in their power to prevent it from happening except when some sick citizen makes such a fuss that he or she cannot be ignored. That, of course, is what Bob Randall did.
Ann Guttentag did so also. The New Hope, Pennsylvania, doll-store owner was suffering from terminal cancer and was one of those patients who could not be comforted by THC pills. In fact, she labeled those pills simply "laughable" as a means of dealing with the nausea brought about by her chemotherapy. "After chemotherapy, you can't even hold a sip of water down," she explained in 1980. This dying patient knew that marijuana cigarettes worked for her—like "a gift from heaven"—but her government in the form of the National Cancer Institute, the FDA, and other agencies insisted that a doctor test whether THC pills worked as well. Ann Guttentag made an emotional statement to the House Select Committee on Narcotics Abuse and Control in 1980 about how only the marijuana cigarettes helped her. After months of battling with many agencies of the federal government, the legal marijuana cigarettes arrived, but the patient died soon afterwards in August 1981 at the age of 50.
Almost all of the multitude of other patients like Ann Gutentag suffer and die in anonymity because few sick people want to go public with their illness and most are ashamed that they need a drug with such a bad reputation as marijuana. In some cases I have encountered, the victims suffered blindness or died while they were fighting and pleading with the federal drug bureaucrats for their medicine. I believe, therefore, that it would be morally justified now for a protest movement to start seeking living substitutes or patient advocates for victims who have died or who for other reasons are no longer in the fight. As it now stands, if the government officials are obstinate enough, their opponents melt away, almost literally. If, however, these officials knew that some advocate bearing the adopted name "Ann Guttentag" or the designation "Patient Advocate of Ann Guttentag" (of course, with the permission of her survivors) was going to keep pestering them to ease the suffering of sick people by allowing them access to hated drugs, as Ms. Guttentag herself would have done, it is possible that progress would be made in protecting our sick even under current laws. For the survivors, there would be the added comfort that this was one method of keeping the spirit and the memory of a loved one alive.
Bills should be introduced into the U.S. Congress and every state legislature that would declare heroin and marijuana "safe and effective" in the treatment of patients suffering from cancer, glaucoma, scleroderma, and other diseases, such as multiple sclerosis, where doctors and patients have found that it provides some benefits. Other feared drugs might be added if evidence of therapeutic benefit was produced. The bills should be drawn up along the lines of the one introduced by Rep. McKinney on the therapeutic uses of marijuana rather than like the Compassionate Pain Relief Act (CPRA) for heroin, an enlightened piece of legislation introduced by Rep. Waxman, which I have also supported. The McKinney bill, however, has the advantage of treating marijuana as a known and reliable drug with a proven history in medicine and placing it immediately into Schedule II of the Controlled Substances Act. No experiment is required, as in the case of the CPRA.
Humane legislators should formulate various versions of an omnibus bill that would be simple and direct in its purpose to reclassify heroin, marijuana, and perhaps other drugs as Schedule II medicines and thus available for any ill person, under the usual strict controls that apply to all medicines in this category, such as morphine. There should be no need for a legal sham that the patients are research subjects and no red tape holding back the healing hand of the physician who wants to help suffering people by prescribing them medicine whose therapeutic value has been demonstrated by long experience. Until such a law is passed, the lawyers of the country must take up the burden and bring suit after suit seeking to establish the right to health and to medical treatment for all of our sick citizens.
These suits often require a good deal of persistence on the part of the lawyers. NORML first sued the DEA in 1972 to force it to allow marijuana and THC to be used as regular Schedule II medicines (potentially addicting medicines used with stringent controls) for sick people. The case, NORML v. DEA, went through a seemingly endless number of appearances before federal administrative agencies and courts over the years, with the government officials continually resisting a hearing on the merits, that is, on the core issue of the medical value of marijuana, and thus obstructing the seemingly simple, compassionate step of allowing the categorization of the natural plant or its distilled essence, the pills, as medicine. The DEA and the FDA then became interested in encouraging the development of a synthetic THC pill, which was composed of a chemical named dronabinol, with the trade name Marinol. It was manufactured by Unimed, Inc., and approved by the FDA for use as a regular medicine to control nausea in cancer patients receiving chemotherapy. To their credit, as we saw, the drug officials made the historic decision to take a marijuana substitute out of Schedule I and for the first time in decades make it available to patients without requiring them to become research subjects. This was a great victory for NORML and for common sense.
NORML requested an administrative hearing on Marinol, however, for a variety of reasons, not least to determine why the natural marijuana could not also be rescheduled. In early 1986, the mountain came to Mohammed. DEA lawyers contacted Kevin Zeese at NORML asking that the hearing request be withdrawn, in return for which DEA would agree to place the core issue of natural marijuana in medicine before a federal administrative law judge. Mr. Zeese agreed. Thus a synthetic THC pill will soon be available to cancer chemotherapy patients, and there is hope for a new full and impartial review of the evidence on natural marijuana as a medicine in a wide variety of cases.
While serving as co-counsel with Kevin Zeese in this case, starting in 1986, I have seen with my own eyes how much work remains to be done to make that hope a reality. At one of the preliminary hearings before DEA administrative law judge Francis L. Young, on December 5, 1986, DEA lawyers argued that the process of actually taking evidence on the central issue of marijuana's medical value should again be delayed until the Food and Drug Administration had considered the matter—a proposal that might result in more years of waiting for the sick people of the country. Moreover, Joyce Nalepka, Mrs. Reagan's ally from the National Federation of Parents for Drug-Free Youth, appeared at the hearing, shooting daggers with her eyes at Kevin Zeese and me seated at the counsel table. She blurted out to Judge Young that he should consider the nature of the petitioner in the matter—that NORML got its money from High Times magazine and from sellers of drug paraphernalia. Judge Young made it clear that he would not be influenced by such talk. While Ms. Nalepka's remarks were deemed irrelevant and almost comical by some onlookers, I fear her cruel views still dominate the DEA and the American government: this suit to provide all forms of marijuana as a medicine to cancer and glaucoma sufferers is a red herring by drug pushers to seduce American youth into abusing pot.
Lawyers from major law firms can help overcome these hysterical views that are so harmful to our sick. In this case, it has been a comfort to see Frank Stillwell seated at the next counsel table, beside his client Bob Randall. Frank is a lawyer with Steptoe and Johnson, the firm which continues to represent Bob Randall's Alliance for Cannabis Therapeutics, also a party in the suit to reschedule marijuana.
LOVE THY NEIGHBOR EVEN IF HE IS USING HATED DRUGS
The essence of a war is hatred, hatred to the death of the enemy and of those who give him aid and comfort. To carry out a drug war successfully requires the persistent application of hate toward users of hated drugs. The principle could be stated thus: hate thy neighbor if he is using bad drugs.
The difficulty with that principle is that the majority of drug abusers are decent people who are often deeply troubled by their compulsion to take drugs so often. They are not helped by being treated with hate. The essence of dealing with people in trouble with drugs should be love, compassion, and care. The reverse principle, then, might be stated: love thy neighbor in spite of the fact that he is using hated drugs—especially if he is acting decently in other ways. Persistent application of the reverse principle by large numbers of people would undermine the drug warriors who are so harming our country and our families.
In fact, the first place for concerned citizens to begin making a contribution to drugpeace in the nation and even in the world is right in their own lives and own families. Parents and children personally interested in learning about drug abuse, however, must invest a good deal of time in study of this subject because the experts are in such conflict. There is no one source for unbiased advice. Certainly not the U.S. government, nor any single group of doctors or drug-abuse experts.
However, there are many experts now working in the country who advocate moderation, calm, and tolerance in dealing with drug abusers. They believe, as do I, that while the nation has serious problems of drug abuse, neither this generation of our adults or our children is in danger of being destroyed by chemicals. Individual citizens and groups of concerned parents should turn to the proponents of moderation and tolerance for educational information rather than to the alarmists who dominate national drug policy and the parents' movement today.
A group of mothers in rural Wasco County, Oregon, did just that in 1982 when they formed Mothers Against Misuse and Abuse. MAMA was created in reaction to the misinformation promulgated by the parents' movement supported by the White House. The group seeks to provide a full range of unbiased information about legal and illegal drugs to citizens of all ages, including the elderly, who often have trouble with prescription medicines. It has supported a school curriculum that teaches students how to make responsible decisions about important matters in their lives: managing stress, controlling time, and using drugs, among others. Led by an indomitable farmwoman, Sandee Burbank—who asserts, "It takes ovaries to do what we do!"—its members have become a powerful political and educational force in that state. Interest in the unique down-home, frontier honesty of MAMA has spread throughout the nation. It serves as one excellent model for rational community action by parents who are both concerned about drug abuse and turned off by the extremism and hypocrisy of drug-warrior educational programs.
Another model for guidance in approaching the subject of drug abuse may be found in the manner with which America has historically dealt with conflicting religious creeds: virtually all are accepted as decent moral options that ought to be available for those people who believe in them. The subject of drugs should be approached in the same spirit—more like religion than science. My wish is that law and medicine recognize the personal and nonscientific nature of the drug-abuse arena by enacting some form of First Amendment guarantee of freedom to select a personal drug-abuse doctrine, but limited somewhat by enlightened principles of medicine.
This freedom from an established ideology ought to be applied to the treatment arena so that the telephone directory Yellow Pages of any major city could contain listings for a full range of drug- and alcohol-treatment specialists. That legal list could include physicians who give no drugs whatsoever and rely only on psychotherapy; physicians who use oral medicinal opium for heroin addicts and Valium for alcoholics; social workers who believe in rapid detoxification and group or individual therapy; lay therapists who rely upon religious conversions and religious books as the answer to all addictions; and physicians who provide long-term maintenance with injectable drugs, such as heroin and Dilaudid, for narcotic addicts. Some of these approaches may be found today; some are still illegal, for irrational reasons.
In the absence of that wide freedom granted by law and practice, thoughtful people will seek to work out the greatest possible freedom within existing regulations. They will recognize that current Established Drug Abuse Doctrine makes little practical sense in another way—since some powerful members of that Establishment define drug abuse as involving even one use of any illicit drug or even the use of a licit drug, such as Valium or Darvon, outside of medical supervision. They might accept another definition, advocated today by many more sensible treatment experts, which comes closer to the mark: drug abuse is the use of any drug, including alcohol and tobacco, in such a way as to affect seriously health, work, or loving relationships. Having accepted that, or some other reasonable substitute, they will discover that there is no scientific method for even the most enlightened medical experts to determine if that condition exists in themselves or a loved one. While they can provide guidance, in the end thoughtful individuals must make a personal decision as to whether or not they or someone they love is in trouble with drugs and whether or not to start looking into treatment possibilities.
If they do decide that treatment is needed, rational citizens will beware of the popular cults like Straight or Toughlove or any institutional permutation that has hate and rejection at its core. I have cross-examined several recovering addicts on this point and just went over it again with Ned (who is doing splendidly now months after I first wrote about him). It has taken this fine young man years to get over "feeling like a junkie" in part because his body and emotions still remember the powerful narcotics that used to dominate them. That internal memory is almost gone but another lingers more powerfully: the lack of respect and the discounting of his worth as a human being that he felt from some physicians and also from some lay people who knew about his drug problem. Therefore, in seeking diagnosis and treatment of a drug abuser in the family, concerned citizens should look for professionals who seem to display compassion rather than disrespect toward that person. Such treatment professionals are to be found in every large community, but it takes personal effort to discover them because they do not walk around with "competent and compassionate" labels on them.
Never turn the alleged abuser over to a facility, as Fred Collins's parents did with him, breathe a sigh of relief, drive away, and simply leave the treatment of the so-called druggie up to the experts. The most important force in recovering from drug abuse is the maturing internal will and understanding of the patient, as the best treatment experts well know. Family members should play a role as both patient advocates and as caring members of an extended treatment team. They can see to it that the patient is not kept in an institution needlessly and at the same time they can help impose reasonable demands for responsible behavior. Moreover, they can also commence reflecting on their own behavior and on what piece of the action they had, if any, in setting the stage for drug abuse in the patient now in treatment.
If these guidelines are followed, then any one of a wide variety of existing programs may be chosen to help the drug abuser. None of them has a quick cure and relapse is the rule. There is no known doctor-induced cure for drug abuse. However, so long as the patient feels kindly treated and believes that he or she is being helped, involvement with a program should be continued. Preference should be given to programs, such as Alcoholics Anonymous, Narcotics Anonymous, and reputable individual professional counselors, where the participants can walk in and out at will, are not inmates, and thus bear full responsibility for their own fates. The imprisonment of alleged drug abusers, even in good psychiatric hospitals, should always be viewed with suspicion in a democracy.
Drug abusers and their families should seek to better understand the dynamics of addiction. Those dynamics are difficult to comprehend, even for experienced professionals. That search should be conducted by talking to drug users and reading about their experiences—and by quiet reflection on one's own inner feelings, especially by the drug abuser in question at the moment. The rewards of the search itself seem to be worth it for some people. Recently, a student came to me to say that for three years he had been a marijuana addict (the first such addict, by the way, I have ever met, although I have long claimed that abusers of this drug existed). He had taken my course, he told me, to come to grips with his problem.
At the beginning of the semester, we had discussed the dynamics of heroin addiction and treatment. Marijuana was barely mentioned. Yet the young man claimed that he started to understand how marijuana was dominating his life, how he had lost control, and how he might regain control through reflective insights into the role it played in his emotions. He was particularly affected, he said, when I talked about the positive power of heroin addicts to heal themselves when they, and not a doctor or a police officer or a judge, were "ready." Over a period of weeks, the student tapered off from five joints a day to the point where he quit totally; the day he came to me marked a month of being totally free of marijuana. In the previous few weeks, he said, he came to understand some simple truths: the drug played a powerful role in his life, as I had suggested in the case of heroin, because it was a form of self-medication for a variety of severe emotional stresses. Now that the medication was gone, he was more in touch with his feelings and had just made a decision to seek professional psychiatric help to deal with those stresses. The young student knew now in his guts that he had the personal power to do so. You could see it on his face: this kid was flying high, but without drugs.
Yet knowledge does not always lead to abstinence. With all of his knowledge, Kenny Freeman, and multitudes like him, believe they are better off with drugs. Remember, however, that the reverse principle should still be applied to alleged drug abusers: love them despite their drugs. While that principle may sound irresponsible, it is more in line with humanity's great traditions than current martial ideology. In a world dominated by drugpeace, we would approach users as decent, rational people and help them think out what was best for them, whether or not that involved continued drug use.
One of the great tasks of this new peaceful era would be to separate the status of being a narcotic addict from the status of being a predatory criminal. Crime and violence on the streets of America would be greatly reduced. We can start working on that task by adopting the new ideology about the essentially decent nature of addicts.
The most shining personification of that compassionate principle in action that I have ever discovered was the late Reverend Terence E. Tanner, a Catholic priest and director of a unique London association for the housing and care of narcotics addicts. He believed that perverse social biases had made such addicts "the scapegoats of our age." Being irrationally abused by society, they returned the favor. Terry Tanner believed, on the other hand, that if addicts were treated with trust and compassion, they would act as if they deserved that treatment. The outspoken cleric took a neutral position on the use of drugs—a heretical position in most expert drug-abuse circles—coupled with a strong moral demand that users live decently. "We do not encourage them to use drugs but equally we do not discourage them," Father Tanner wrote in 1976. "We encourage them to responsibility in every department of life and, as they begin to acquire responsibility, they limit their use of drugs or give them up altogether." Those addicts who continued the use of drugs, however, were treated with the same love as those who quit.
The implementation of Tanner's principles in America would require major changes of laws and attitudes, changes which seem to be much further in the future than legal reforms that would help only the organically ill. However, we should start working now toward a system under which doctors and their addict-patients would be left almost completely alone to work out ways of living responsibly with or without drugs. In those cases where drugs were chosen as part of the treatment, there is no reason why oral methadone should continue to be legally mandated as the only proper long-term maintenance medicine. If there is some scientific reason why addicts cannot be maintained on a wide variety of narcotics, including heroin, I have yet to discover it in the medical records of centuries.
What I have discovered is that many doctors and allied staff find it difficult to deal with addicts receiving so-called maintenance doses of drugs for long periods of time. There is no scientific manner in which to determine the proper dosage. Five milligrams of pure heroin a day will hold some addicts; a few need and function on 500 milligrams. Some addicts complain repeatedly that their current dosage is too low. Doctors and their staffs often find the whole business tiresome and frustrating. Their feelings properly reflect the nature of the disease of addiction—chronic, recurring, virtually incurable. A major task of the future is to come to grips realistically with issues of proper maintenance, issues which cannot be dealt with unless the initial legal right is fully established.
In the absence of statutes giving addict-patients the right to choose their medicine, and to commence working out ways of living legally with the drug, bar associations should encourage the lawyers of the country to bring suits to guarantee those rights. It is a violation of basic legal reasoning—and seemingly of the constitutional rights to due process and equal protection of the laws—to prohibit an addict to, say, Darvon from obtaining a legal maintenance prescription of that relatively weak narcotic while allowing access to the more powerful methadone.
We will know that the new era of drugpeace has arrived when police are trained to recognize that one of their most important duties is the protection of the rights of doctors and patients involved in legitimate drug-maintenance programs—and especially when addicts regularly start coming to DEA offices for help when their legitimate drug supplies are interrupted for some reason.
I NEVER SAID WE SHOULD LEGALIZE HEROIN AND ALL OTHER DRUGS
Up to now in this book, I have not argued that we should legalize all drugs nor that we should give heroin addicts all the heroin they want. However, if past experience is a guide, that is precisely how my position in this book will be summarized by scholarly experts and by journalists, friend and foe alike, as has occurred frequently in recent years. Allow me to state once again that I never have taken that position. Never. And I do not now.
Nor have I ever said, as claimed by The New York Times on September 14, 1984, that "the United States should give up on drug control." (I did say, as the newspaper reported, "We just don't have the power to solve the problem," and that some drugs, notably marijuana, should be legalized and taxed heavily, with the proceeds allocated to educational and treatment programs.) As so often happens in this emotional field, the twisted truth of the Times story was twisted even more in another harmful product of the awful summer of '86: a book by one of the leading drug-abuse scholars in the country, James A. Inciardi, the director of the Division of Criminal Justice at the University of Delaware. In The War on Drugs, Professor Inciardi presented the most complete scholarly apology for the modern war on drugs, including a call for greater application of police and military power, that has yet appeared in print.
To fashion that apology, scholar Inciardi found it necessary to demean the research and common sense of most drug-war critics in scathing terms, one being that they were "atavistic liberal thinkers." He dismissed out of hand any discussion of the British option in terms reminiscent of drug-enforcement leaders Anslinger, Mullen, and Lawn because that situation had "gotten out of control," a conclusion he supported with even new distortions. "Finally," Dr. Inciardi wrote, "there is legalization, or what might be called the Trebach model." He then went on to give a bowdlerized version of the misinformation that had already appeared in that 1984 Times story. To add insult to injury, he declared that this approach had failed in England.
I barely know where to begin to straighten out the mangling of the truth contained in these few lines. The British have never legalized heroin nor have I, for the umpteenth time, recommended it. The Trebach model of legalization exists only in the imagination of some misguided reporters, scholars, and officials. As I have already pointed out in this book, I plead for moderation and compromise, for better laws, not wholesale repeal of them. Moreover, in my last book, The Heroin Solution, which I immodestly hope that Professor Inciardi and his allies will read, I argued that if the law relented and allowed medical doctors the option of providing narcotics, including heroin, to some addicts, this would open up the drug-abuse treatment field to the consideration of a whole range of new initiatives. I never said that the ultimate solution to virtually all problems of hard-drug abuse would be medically prescribed heroin. In fact my use of the term "solution" was a play on words because in old-fashioned American terms there is no way we can win total victory over heroin or any drug. I did say, and still believe, that real progress in breaking the vicious connection between addiction and crime is impossible without "medicalizing" heroin—allowing it to be prescribed by doctors for some addicts.
However, once that giant step is taken, we would have to confront a whole set of new issues that would emerge then, and only then. That is a long way from saying that heroin is the ultimate solution or that we should simply give up on all drug-law enforcement so that anyone who wanted a shot could simply put his money down on the bar and name his brand of poison. Medicalized heroin will get us through the gate and into a new, innovative ball park. It will not win the game.
The availability of prescribed heroin would mean that multitudes of addicts would be able to function as decent law-abiding citizens for the first time in years. Their health should be much improved because their drugs would be clean and measured in labeled dosages. The number of crimes they commit should drop dramatically. By implication, addicts to other narcotics, such as morphine and codeine, would also reap the same benefits. They would be eligible to receive maintenance doses of the drugs on which they were dependent. Hordes of potential crime victims would, accordingly, be denied the pleasure.
Many drug users, however, would not benefit at all—chippers or occasional users, for example. Since they are not addicted, they are not sick and would not be eligible for a prescription of medicine.
Of greater significance, many addicts tell me that they do not want to obtain prescriptions of legal narcotics. A significant proportion of the many addicts I have come to know in recent years view the very idea of drugs from doctors as obscene. "Here I am struggling, going through agony, to stop taking these damn chemicals and here you are telling me it's good for me to take them," they say.
Some even scream such remarks at me, like the woman from the Roxbury ghetto who was in the audience on a Boston television show in November 1982 and who shouted accusingly, "You want me to take drugs!" I yelled back, "No, I do not! Stop this instant!" More calmly, I added that I simply wanted her and her doctor to have the option of prescribed drugs if it helped her and if she felt it did not, she would, of course, never be forced to take them.
During the next year, on one hot day in July, Warren Weitzman, one of the American students attending my London institute, came into my room at the Imperial College of Science and Technology. Warren was in his thirties and had a long history of addiction to narcotics. In recent years, he had been clean. Warren paused, looked as if he had something important to say, and then said it. "You always told your classes that in cases of heroin addiction, permanent cure is the exception and relapse is the rule. [Actually, those were not my words but those of the British Rolleston Committee of 1926.] Well, I'm afraid I've relapsed."
After commiserating with Warren, I asked him what he wanted to do. He said he wanted to get locked up so he could kick, because he simply could not seem to rein in this run of drug taking. After a series of telephone calls around England, I managed to get him admitted to one of the best private psychiatric hospitals in the country, which happened to be only a few miles away in Chelsea. The addict was injecting hundreds of milligrams daily of pure heroin and Diconal, that synthetic narcotic much favored by English addicts. He desperately wanted to stop. It would have been the height of irresponsibility for me or anyone else, including his doctors, to have even suggested to him that he should take maintenance doses of heroin.
The option of medicalized heroin demands a complementary responsibility: the development of a finely tuned clinical judgment as to when to use that powerful option and when not to. That judgment demands the sensitive application of the art of human relations, which can rarely be delineated in a computer model or in inflexible principles of law and medicine.
In this case, what influenced me and the doctors I consulted was that Warren was taking a large amount of injectable drugs, he claimed that he was out of control, and he directly asked that he be institutionalized and withdrawn. He seemed quite in control of his mind and determined to seek help in staying away from drugs. All of these factors affected my judgment to support his request to be "locked up" in a closed ward. My decision was not based upon immutable principles of science but upon a weighing of a number of imponderable factors. In other circumstances, I might have suggested that an addict continue taking the narcotics until he had better thought out what he wanted to do. But not in this situation.
I took my suffering student by the hand, one might say, to that clinic where he was detoxified and treated with great kindness. He now claims that my intervention and the compassionate care of his doctor, the great Max Glatt, and of the clinic staff, saved his life. Now, several years later and back in the United States, I am still in touch with Warren, who has gone through eight months of treatment in a rigorous drug-free therapeutic community program. He has graduated and seems to be doing fine now without drugs. However, at times, I still hold his hand and tell him, yes, he can make it without heroin because he surely cannot make it with it. I remind him that he made a lousy junkie when he was using. He ruefully agrees.
My personal acquaintance with him and with dozens of other addicts during recent years has impressed upon me that they vary tremendously in their aspirations and inner emotional resources. Some want drugs. Some hate them, especially while they are compulsively seeking them. Some could lead decent lives with drugs. Many could never adjust to a steady supply of legal medicine. In these respects, addicts vary almost as much as nonaddicts.
Addicts to other drugs, such as alcohol and tobacco, which, though legal, are inherently more organically hai niful, could never benefit from a steady supply. All they would receive would be more damage to their minds and bodies.
THE RIGHT TO AFFORDABLE TREATMENT AS OFTEN AS NEEDED
It is not simply a question, then, of providing drugs for addicts, but rather of creating a new right to treatment for addicted human beings that is affordable, suitable to the particular needs of each patient, and available to deal with relapses. This new right will require a vast infusion of government funds that will support treatment for the poor and also experimentation into more effective types of rehabilitation, utilizing new techniques often without any drugs whatsoever.
One of the ironies of the great drug war of the Eighties is that the Reagan administration actually cut treatment funds (from about $334 million under the Carter administration to a low of $225 million in 1982, rising slightly to $234 million in 1986) while it was pouring money into enforcement. At the same time, the drug-war hysteria gave great encouragement to the most venal elements of the drug-abuse treatment industry to increase their already huge fees to absolutely unconscionable levels. As medical writer Toby Cohen revealed in the Wall Street Journal in July 1986, at the profit-making Fair Oaks hospital group "the current cost of a hospital day is $1,000, which exceeds the cost of a full day in the coronary care unit of Massachusetts General Hospital. The cost of a full inpatient term of treatment at these centers—four weeks to six months—ranges from $28,000 to $160,000, with an average of $56,000." Two of the prestigious leaders of this highly profitable growth business are Dr. Arnold Washton, who argued with me on national television that it was time to get hysterical about crack, and Dr. Mark Gold, who founded the famous 800-COCAINE hotline, calls to which are taken at the Fair Oaks headquarters in New Jersey.
Fortunately, many good treatment centers for drug and alcohol abuse charge much less than Fair Oaks. The average at the Betty Ford Clinic in California is $5,000 and at Hazelden in Minnesota, $4,000. Even at the lower rates, as Ms. Cohen points out, the expense of drug-abuse treatment is beyond the means of most people in trouble with drugs and alcohol. Moreover, the total drug-abuse bill today drives up the costs of everyone's health insurance premiums. Based on typical current fees, projections as to the probable future cost to treat a large segment of all of our abusers—including those who abuse cigarettes and food as well as alcohol and narcotics—reach a staggering $240 billion a year. However, there are models in use today, such as one developed by Harvard Medical School, that could provide treatment to that wide variety of abusers of all substances at less than $6 billion per year, the amount now spent on health insurance. The Harvard model charges even less than Ford and Hazelden.
Operating in Cambridge and Somerville, it provides a wide variety of assistance, much of it delivered by nonphysicians, including a 24-hour walk-in clinic, outpatient groups, groups for families, women's groups, a detoxification unit, and three halfway houses. Over the past 16 years, it has treated approximately 20,000 patients a year at an annual cost of $1 million. The Harvard program also faces up to the likelihood of repeated relapses and expects patients to return on several occasions. As Dr. George Valliant, formerly at Harvard and now at Dartmouth Medical School, observed, "What's important is that treatment be available for everyone as often as they need it." That simple statement by Professor Valliant should be the major goal of the country in seeking to deal realistically with all types of addiction problems. To reach that goal will require a vast commitment of energy and resources—and a vision that goes far beyond conventional drug-war strategies, far beyond narcotics, far beyond any of the illegal drugs.
The right to affordable addiction treatment would mean, for example, that I might have provided some helpful guidance to the cigarette addict who called me from Baltimore several years ago. He was a construction worker who had found that he had difficulty climbing scaffolds because he had become so short of breath. The man also had some insights into the toll of tobacco on his body: "This stuff is killing me. I've gotta get locked up somewhere, soon! Where can I go?" While I suspect that there may be many facilities around the country, I knew of only one residential program that focused on tobacco addicts, and that was in the Far West. All of the other inpatient treatment programs I knew about dealt primarily with alcohol, cocaine, and other narcotic addicts, many of whom chain-smoked tobacco while experiencing the stress of attempted rehabilitation. The creation of a network of low-cost residential treatment facilities for tobacco users would, therefore, be a major advance in fighting drug abuse, would save billions in medical expenses for cancer and heart disease, would reduce a vast amount of human misery, and would in the end save countless American lives.
Yet this new innovation for tobacco addicts would be only one advance that the new right to comprehensive affordable treatment would involve. I do not claim to know the full dimensions of what is involved in implementing that new right. That is why I feel funds must be granted for experimentation and research on new methods. However, I feel certain that it will demand billions in federal funds and the imagination of our best thinkers in the treatment field—and that the rewards to the country and its people will be well worth the money and the effort. Also, I am morally sure that all forms of addiction will be dealt with more effectively than under the current drug-war regimen.
NEW PROTECTIONS FOR PERSONAL PRIVACY
The zeal of the drug warriors to search the homes, fields, property, and bodily wastes of free citizens for chemicals is unrelenting. Their zeal is being supported by powerful institutions across the land, from the Supreme Court to the White House to the executive offices of leading corporations. Opposition is slowly developing, but it will be a difficult fight for those who come down on the side of freedom.
A whole new fabric of personal protection will have to be created because the searchers are so numerous and so powerful. This fabric must contain many strands, including lawsuit challenges to invasions of personal privacy, state laws and local ordinances, provisions in collective bargaining agreements between management and labor, and the development of habits of restraint on the part of those in power. The fact, for example, that a Customs agent at the border has the power under a Supreme Court decision to conduct almost unlimited searches of bodies and bodily wastes does not mean that this awesome power should be used except in those cases where there are reasonable grounds to believe that a specific person is carrying illicit drugs.
Indeed, the basic rule should be that an invasion of privacy of any individual who lives under the protection of the United States Constitution should always be considered an exception to the rule which presumes innocence. This presumption of privacy and innocence should apply to everyone, to our children in school, to all employees, and to travelers in our airports.
Traditional democratic principles should guide the justification for searches and testing. There should have to be probable cause or some rational relationship between the search and the evil that ought to be prevented. Thus urine testing of airline pilots or addicts in treatment under proper controls might readily be accepted. Testing of baseball players or children in school seems much less reasonable. It is all a matter of sorting out our national priorities in the face of hysterical calls to fight an invasion by the chemical people.
If pushed to make a choice, however, I would argue that our society will be less harmed by the presence of more drug abusers than by the greater erosion of our freedoms. Moreover, there is little evidence that if we allowed the zealots of the urine test and the body search to realize their fondest dreams, the overall problem of drug abuse would be diminished. There are always practical limits to the impact of the most invasive methods of search.
FIRST EXPERIMENTAL STEPS
Those of us who see ourselves as members of the loyal opposition to the drug war should be shopping for any sensible compromise that will start taking the passion and hysteria out of the drug war. We should not demand the unconditional surrender or mass conversion of the drug warriors. But we must demand that some practical compromises be made now lest the drug war continue to erode American freedoms and to impose greater suffering on our people and those of other countries.
It might be wise to look into the experience of one of those other countries so as to get into the proper frame of mind to think peacefully about drug problems. While England is still instructive, these days I recommend Holland. It is the only country where the government itself calmly supports peaceful approaches to drug problems and openly opposes the very idea of a war on drugs. The Dutch seem to have dealt largely with the marijuana issue but have still not solved all of their difficulties with drugs. Yet, their spirit of moderation and experimentation is unmatched. They have tried a variety of approaches to supplying legal drugs to addicts through doctors and have kept adjusting their methods. A few years ago, the city government of Amsterdam came up with a proposal to experiment with medicalized heroin for addicts. The national government resisted and stopped it for the time being. When I was in Amsterdam in September 1986, however, Mayor Ed van Thijn sought me out at a reception he was holding at the Vincent van Gogh Museum to tell me that his government was going to propose the experiment again.
The city government is already showing its support for innovation in a variety of ways. I saw a small piece of that experimentation when I visited the Amsterdam chapter of the national addict union, or "Junkie Bond." The very existence of the union was breathtaking proof of how refreshingly different many Dutch leaders were in thinking about the fundamental nature of the drug problem. The union and another organization devoted to the interests of addicts, known by the initials MDHG, are greatly assisted by an annual contribution of approximately :0,000 from the city government. These related organizations, working side by side, provide a form of day hostel for addicts, along with information, advice, and friendly support of all kinds. On the day of my visit in 1986, members told me of a small book they were writing, which contained the reminiscences of addicts who had kicked the habit. The tentative title: "Each in His Own Way."
While at their headquarters in a decent-looking house not far from my hotel in downtown Amsterdam, I was seated in a room with three members of the group: Thijs van den Boomen, a nonuser and the organization's administrative director, and Willem and Mike, both drug addicts. As we talked about all of the services offered by the organization, I was surprised to see a picture of Martin Luther King, Jr., looking out over high stacks of big cardboard boxes. I was told that the organization was started by a Dutchman who was a disciple of King's because of the minister's great respect for human rights.
As for the boxes, they happened to contain "shooters," Mike told me. Many thousands of them. "Hypodermic needles?" I asked. Mike replied, "Yes, we call them `shooters.' " All three then proceeded to explain that they conducted a major educational campaign to prevent disease among injecting addicts and prostitutes in the city. In addition, they provided free needles which could be obtained by turning in used ones. For the prostitutes, they also provided free condoms. I learned a few days later that the Dutch authorities were aware of only a few cases of AIDS among all of the 15,000-20,000 narcotic addicts of the country.
When New York City authorities suggested providing needles to prevent the spread of AIDS a few months later, the proposal met much resistance. However, this is precisely the type of pragmatic, humane compromise we should be experimenting with in America. It would not solve the drug problem but it would control some of its worst features and it would begin telling addicts that we view them as decent human beings.
We can look to the American experience for other examples of compromises, some of them on a grander scale. We should consider invoking a venerable conservative concept: states' rights, which was used to get this nation out of the disaster created by alcohol prohibition. In 1933 the federal government was backed out of alcohol control and each state allowed to determine its own policy. * In light of the abysmal failure of the federal government in the control of other drugs, a good basic principle would be to declare that in all matters pertaining to drugs, each state will have the power to make its own rules.
Federal laws and regulations would apply where national rules were absolutely necessary, however, such as the regulation of drug use during interstate travel. One of the worst forms of drug abuse, for example, is smoking tobacco on airplanes because of the health hazards for other passengers and crew—and also because of the danger of fires. Yet, strangely enough, the White House and the federal government lose their martial spirit when it comes to issuing a strict prohibition of the use of any smoking material on an airplane, which is the only logical step.
At some point in a more rational, peaceful future, the nation should consider enacting a federal drug-control statute similar to the Twenty-first Amendment regarding alcohol. This would mean that federal law would generally defer to state law in regard to the control of all drugs, not simply alcohol, within the borders of each state. If conservative Utah, for example, wanted even stricter controls on marijuana and cocaine than now exist, so be it. If California and Massachusetts wanted more liberal laws, as they usually do, then again federal law would support those states in their sovereign decisions. This vision of future grand compromises entails a mix of conservative and liberal concepts, of old and new American ideals. It also provides the ground for social experimentation: the empirical results in one state may turn out to be superior, and thus set a constructive example for others to follow.
As we pulled the criminal law and the hard-line enforcers back to the borders of the drug-abuse arena, we would invite other, more tolerant thinkers and experimenters to come in. Drugpeace does not mean the absence of laws and morals but the creation of a more peaceful and effective system of laws and morals. We would call upon the ingenuity of lawyers, police leaders, political scientists, doctors, and enlightened lay people to devise new and more humane policies regarding drugs. I would accept any idea that made the situation more civilized so long as it met the pragmatic American test of creating more social gains than losses. If California wanted to expand the tough San Francisco ordinance controlling smoking tobacco in public places so that it applied throughout the whole state, then this would be an experiment worth encouraging. If Arizona wanted to allow experiments on maintaining heroin addicts on oral opium—an idea proposed by one of its most enlightened citizens, Dr. Andrew Weil—that effort should also be welcomed. If the District of Columbia, aware of the high incidence of cancer and heart disease due to alcohol abuse among its black citizens, wanted to ban all local media promotion of alcoholic beverages, this also should be followed with great interest and perhaps tried elsewhere.
The Oregon Marijuana Initiative was recently debated in that liberal western state. A persistent campaign by committed local citizens produced 87,056 signatures on petitions and a place on the ballot for the first statute that would have made fully legal the growth and possession of marijuana by adults for personal use. That proposition was defeated by about 70 percent of the electorate in November 1986. However, there still is a good deal of public support in Oregon and throughout the country for the legalization of this drug. Should that support grow to majority status, we would soon see both sale and use fully legalized in many states. At the same time, great support is growing for stricter controls on tobacco.
Because of this congruence of powerful historical, political, and scientific factors, therefore, some states might embark on an experiment in which the two drugs, both normally smoked, would be placed in the same category by the law. Both would be legal, highly taxed, pure, and sold in packages carrying a variety of explicit health warnings. Advertising of both would be strictly limited; some states might allow agate-print listing as with stock market prices today. Billions in new tax revenues would thus be raised, a major portion of which would go into special funds devoted to the treatment of persons harmed by the use of any drug, especially tobacco—and, as contradictory as it sounds, to publicity campaigns that provided realistic information to the public regarding the value of abstinence and of methods of achieving high states in life without drugs.
This proposal illustrates another principle of the drugpeace era: greater controls would be placed on the currently legal drugs, fewer on those currently illegal, especially marijuana, cocaine, and heroin, for both medical and recreational use. The civil law would, moreover, be used whenever possible rather than the criminal sanction.
The whole plan would seek out the middle ground between the extremes. As sages throughout the centuries have known, the truth is always in the middle.
More attention might well be paid in this new era to sound treatment programs for tobacco and marijuana addicts. Few such programs exist today, in part because of ideological conflicts. A true marijuana addict may well end up in a rigid institutional program run by one of the cults. Tobacco addicts seeking a well-run program will discover that most of their fellow patients are alcohol, cocaine, and other narcotic addicts who smoke tobacco incessantly. Rethinking our chemical ideology, therefore, may result in much more assistance to millions of addicts, especially those dependent on the deadly tobacco, now generally slighted by the professional treatment community.
The creation of good treatment programs for tobacco and marijuana addicts requires first that the need be recognized. Once that is done, then many of the ideas that have worked in other programs could be applied to those addictions.
Under a system of states' rights, some states might well fully legalize marijuana like alcohol while they medicalize heroin by allowing doctors to treat it as an ordinary medicine. What about cocaine? Should doctors be allowed to provide addicts with prescriptions, which is legal for specially licensed physicians in England? Should possession but not sale be decriminalized? Should it be fully legalized? I would authorize states to choose freely any of these options—medicalization, decriminalization, or full legalization—regarding any of the currently illegal drugs, including cocaine, rather than continue to risk the lives of our police and innocent bystanders in the war to control the lucrative and deadly traffic in drugs.
In this new era of legal and medicalized drugs, there is the risk that there would be greater abuse of previously prohibited drugs. If that occurred, the damage created would be balanced by the reduction in the abuse of the legal drugs, alcohol and tobacco, which might well result from a reduction in legalized pushing and in greater public education of the dangers of those substances. That situation would constitute an excellent social trade-off for the nation, and for those many other countries that will certainly follow the American example. The reduction in the per-capita use of alcohol and tobacco has already started. It is possible that we can continue to reduce use and abuse of those legal drugs, although we cannot prevent their use totally.
However, there is little likelihood that there would be an explosion of, for example, marijuana and cocaine use. Experience shows that there is a natural limit to the number of people who would try any drug no matter how easily available it might be. Easy availability is only one factor in personal decisions to use a drug. The largest reductions in the use of any drug by Americans have been of tobacco. The percentage of smokers in the population dropped from 41.7 percent in 1965 to 32.6 percent in 1983. During this same period, there was a dramatic drop in death rates from tobacco-related organic diseases. While tobacco remains our most addictive and destructive drug, all of this progress was accomplished without a war on tobacco, without locking up any tobacco users or dealers, but with education and persuasion that told the true facts about the drug.
When I was in northern California, the friendly citizens there would gladly have kept me knee-deep in world-class sinsemilla joints. I was no more interested in them than in rutabaga, which is also freely available there. The thought bored me.
If a pound of the best Colombian cocaine dropped out of an airplane in the Washington sky today and fell in my garden, I would wash it away with my garden hose, lest it affect my dog and the neighbors' cats. Even though millions of citizens use illegal substances, the great majority of Americans still share my attitudes toward these and other currently illegal drugs. Rutabaga. If the laws change, we are not going to become druggies or gorge ourselves on rutabaga, even if we retain our right to change our minds at some time in the future and sample some pot, cocaine, or turnips on occasion when the mood strikes.
In the end, we must rely on the wonderful old democratic faith. The role of government and of our wise men and women is to tell the truth, conflicting and full of warts as it is, so that the citizens may be fully informed. On balance, over time, we can rely on those citizens in a functioning democracy to make all sorts of stupid errors, but we can also be sure that in the final accounting, they will make more good decisions than bad.
That faith must now be applied to drugs as it has been to other areas of our national life. As we saw sheep living peacefully and happily with cattle, growing stronger together than apart, we could have seen sheep herders living peacefully with cattle herders in the Old West. Someday in the New America we may see American citizens, left to their own devices, working out ways either to ignore or to tolerate the peculiar drug habits of their neighbors, which, in any event, no power on earth can forcibly change.
All of the human species in our social pastures may well become more prosperous and happy under this peaceful arrangement.
* The Eighteenth Amendment prohibited the manufacture, sale, or transportation of intoxicating liquors in the United States. It was proposed in 1917 and ratified in 1919. The Twenty-first Amendment repealed the Eighteenth and also provided that "The transportation or importation into any State, Territory, or possession of the United States for delivery or use therein of intoxicating liquors, in violation of the laws thereof, is hereby prohibited." In this convoluted fashion, a powerful coalition of sensible Americans in the center of the political structure managed to return the authority over alcohol to the states. The amendment was proposed in 1933 and, remarkably, ratified the same year. It was the only amendment ever to have been ratified by state conventions rather than by legislatures.