Steve Jonas for BuzzFlash: The New York Times on Drugs - And a Proposal for REAL Drug Policy Reform
March 16, 2023
by Steve Jonas, MD, MPH
Recently, The New York Times published a lengthy statement from their Editorial Board, on (recreational) drug policy. I have been working, on and off, in this field for the last 50 years or so. "Recreational drugs" refers here to (among others) the two most widely used, nicotine in tobacco products (far and away the largest killer) and ethyl alcohol in alcoholic beverages. Although I haven't written on the subject recently, in 2016 I published a book entitled: End the Drug War; Solve the Drug Problem: The Public Health Approach, which was also published that year in a Kindle edition. In sum, differing from almost every other analyst of the "drug problem," I see it as a unity, not a duality. I will return to what might be called the Drug Duality Doctrine, and how because of it, the "drug problem" as it is presently visualized and programmatically dealt with, can never be solved, at the end of this column. But first, let us look at the selections from The Times' magnum opus (that's a magnum opus of written words, not a magnum of champagne): "America Has Lost the War on Drugs. Here's What Needs to Happen Next." From The Times, with a Comment for each excerpt.
1. "For a forgotten moment, at the very start of the United States' half-century-long war on drugs, public health was the weapon of choice. In the 1970s, when soldiers returning from Vietnam were grappling with heroin addiction, the nation's first drug czar "" appointed by President Richard Nixon "" developed a national system of clinics that offered not only methadone but also counseling, 12-step programs and social services. Roughly 70 percent of the nation's drug control budget was devoted to this initiative; only the remaining 30 percent went to law enforcement.
"The moment was short-lived, of course. Mired in controversy and wanting to appear tough on crime, Nixon tacked right just months before resigning from office."
Comment: Actually, it was more than "wanting to appear tough on crime." Nixon's "Drug War" was aimed not only at heroin addiction, but at all the then non-legal addictive or habituating drugs, including marijuana, and made their use criminal. Marijuana was roped in because at that time it was a particularly favorite drug of Nixon's favorite minority-group targets (which had been set out by Nixon's electoral "Southern Strategy" of 1969). In fact, in 1973, under Nixon, The National Institute of Mental Health had prepared a new policy proposal for dealing with marijuana, after having found its harms to be minimal, to legalize it under certain controls. Nixon's Attorney General Bill Mitchell (who later went to prison although not for violating any drug laws) immediately put a "no" to that one. And of course, what is called the "Drug War," which of course is actually not a "war on drugs" (which are inanimate products) but a "war on [certain] drug users," has been under way ever since.
2. "It's time to reverse course. Drug use and addiction are as old as humanity itself, and historians and policymakers are likely to debate whether the war on drugs was ever winnable, or what its true aims even were. In the meantime, it's clear that to exit the current morass, Americans will have to restore public health to the center of its approach."
Comment: And herein lies the rub, in fact two rubs, which have made every attempt to "reform the drug laws" or "end [or at least modify] the 'drug war' " come a cropper. A) drug use is as old as humanity itself (or at least it pretty far back: it is discussed in the Old Testament). B) In modern times, the two most widely used and most harmful addictive drugs are perfectly legal, widely available, and relatively inexpensive. In fact, they are not only legal but their use is widely advertised in the case of one and limited in the amount of advertising in the case of the other. Of course, they would be, as noted above, ethyl alcohol in alcoholic beverages and nicotine in cigarettes.
And then, as for "killer drugs," not to diminish the increasing and tragic toll related to the wider available of fentanyl (now over 100,000 deaths per year), despite the National Anti-Smoking Campaign and the resultant drop in the proportion of the population smoking, tobacco use still kills about 480,000 U.S. per year, while alcohol use kills about 95,000.
3. "Amend outdated policies. Criminal justice still has a role to play in tackling addiction and overdose. The harm done by drugs extends far beyond the people who use them, and addictive substances "" including legal ones like alcohol "" have always contributed to crime. There is a better balance to strike, nonetheless, between public health and law enforcement."
Comment: Really? "Criminal justice still has a role to play in tackling addiction and overdose?" For the whole time of the "Drug War," it has had no success in dealing either with the use of the illegals or their criminal outcomes (see Chapter 3 of my book). One might have thought that this country would have learned this lesson from the total failure of "Prohibition," but since the modern "drug war" has been very useful politically for certain forces in U.S. society (see Chap. 4 of my book), that lesson has long-since been forgotten/suppressed.
4. "Invest in treatment. There are not enough programs or trained medical professionals to treat substance-use disorders."
Comment: Absolutely true. But those programs should first begin with the most widely used drugs (at least until very recently) ethyl alcohol and nicotine. And the detox for alcoholism should not be left only to volunteer agencies, like Alcoholics Anonymous as successful as it is.
5. "Address root causes. People cannot heal from, or live stably with, substance-use disorders if they lack proper housing or suffer from untreated trauma or mental illness. For harm reduction "" or any honest attempt to address the nation's drug use and overdose epidemic "" to succeed, communities will need to create more housing options. They will also need to provide clear pathways for people struggling with addiction to achieve food security and to have access to basic medical care. Policies that make it easier for people convicted of drug felonies to get benefits from social safety-net programs "" including food stamps and supportive housing programs "" would help. So would the Medicaid Re-entry Act, a bill that would reactivate Medicaid for inmates before their release."
Comment: All true. EXCEPT that the focus here is solely on those addictive substances which have been made, TOTALLY ARTIFICIALLY, the focus of the "Drug War." Under this approach, which has certain, limited, progressive elements, A) the "Drug War" would stay in place (e.g. there would still be "drug felonies"), and B) two of the major drug killers (that is the two until fentanyl made its way into the drug culture) remain completely unattended to in any major way.
Obviously, I believe A) that the "drug problem" is never going to "entirely go away," and B) since drugs like ethyl alcohol and marijuana can be used without detectable harms, and since for most users of the either, that is the case, and, since, not mentioned to this point, the alcohol industry is a major player in the U.S. economy, therefore C) a series of programs aimed at control and where possible de-addiction need to be much more broadly developed than they are present. D) At the same time, exceptions to the minimization of the use of criminal law approaches to drugs such as fentanyl and methamphetamine which have no known positive effects do have to be vigorously implemented.
The Public Health Approach to the Drug Problem
What I have for some time proposed for dealing with the many problems associated with the widespread use of the addictive drugs, both those currently legal and those currently criminalized in our society, I have described as: "The Public Health Approach to the Drug Problem. " They are spelled out in detail in Chap. 5 of my aforementioned book End the Drug War; Solve the Drug Problem: The Public Health Approach. I have summarized them briefly below.
I should note that this is hardly an entirely new idea. For example, in recommending the development of a "Public Health Response to the War on Drugs," in 1989, the American Public Health Association published the following statement (to which, full disclosure, I contributed):
"Alcohol, tobacco, and other drug problems represent one of the most pressing public health issues in the United States today. Despite numerous assaults on these problems, including the current 'War on Drugs,' they remain intractable -"" continuing at epidemic levels and unresponsive to a variety of strategies and public policy initiatives. This intractability is in part a result of a fundamental misunderstanding of and a blindness to the nature of alcohol, tobacco, and other drug problems and the degree to which they are integrated into our so ciety. The purpose of this position paper is to provide a blueprint for a comprehensive policy for addressing the nation's alcohol, tobacco, and other psychoactive drug problems...."
And so, we move on to a consideration of the Public Health Approach in some detail. All of these measures stress helping people to change their behavior in a positive way rather than focusing on "dealing with 'bad' behavior" --- except in the cases of crimes committed by persons under the influence of one RMAD or another. Certainly not every element in the list below need be included for a PHA to be effective. As well, there may be other elements inadvertently left off the list that should be added. But hopefully this list will help to begin what in my view should be the next discussion.
1. The Primary Goal of the Public Health Approach (PHA) to the Drug Problem is to "Reduce the use and abuse of all the recreational mood-altering drugs, to provide, when, as, and if possible, for their safe, pleasurable use, consistent with millennia-old human experience, while minimizing to the greatest degree possible the harmful effects of their use on individuals, the family, and society as a whole."
2. The Drug Problem is treated as a Unity. The drug problem presents as a seam less web. The evidence of the interrelatedness of its various components is clear. If one's true goal is the re duction in overall drug use, it is fruitless to attempt to deal with only one part of the problem, or to deal with one part one way and another part another way. Biologic, medical, and epidemiologic science all tell us that a recreational mood-altering drug is a drug, regardless of its current status in the criminal law.
3. For those addictive/habit-forming drugs which can be used safely the primary goal is Responsible Use/Safe Use.
4. A Rational Classification System for the RMADs shall be developed
5. The focus of the PHA is on the Demand Side of RMAD Use
6. There shall be a Single National Policy
7. A central element of the PHA is the Understanding that Drug Abuse in any individual is a problem with a natural history, for that individual.
8. Incorporating Law Enforcement, Used Intelligently (with the concept of "intelligent use" spelled out in some detail in the book, e.g., dealing with violent crime (alcohol use is very significantly involved in murders, drunk driving, sale to minors, drug-related intra-family violence).
9. For the PHA, legalization, e.g., of marijuana, goes hand-in-hand with the comprehensive approach to Solving the Drug Problem.
10. The Regulated Sale Model, for all addictive/habit-forming drugs, has a variety of possible formulations. One would be the much wider adoption of the "package store" approach to their sale. (The "package store" system, which has been around for decades, is still used in several states for the limited sale of alcohol.) This could significantly affect the control of the "fentanyl" problem. At this time, fentanyl is often an adulterant for addictive drugs, which adulteration, among other things, significantly increases their lethality. If such substances were sold in "package stores" which could guarantee that they did not contain fentanyl, they would become much safer.
11. Rational Price/Tax Structure
A rational price structure and tax policy for all drugs would be implemented. It would be aimed both at raising funds to pay for the program and at reducing consumption. To assist in the overall public health campaign against drug abuse, the taxes should not be referred to as "sin" taxes, but rather as "risk-reduction" taxes or some similar appellation. Furthermore, drug tax revenues would not go to the general fund. They would not be used as a substitute for income, property, capital gains, or other progressive taxes, but only supporting the Public Health Approach.
12. National Policy Education Campaign
The top national political and health leadership will be called upon to educate the public on the new policy and stimulate their participation in and cooperation with it. The educational campaign will recognize the drug culture and the gateway drug effect as significant causes of the total drug-abuse problem and thus will focus major emphasis on dealing with them. The campaign would explain that recreational drug use is indeed a unity; that it can become a medical/health problem, but use alone is neither a crime nor a sin; that many recreational drugs, other than cigarettes, can be used safely if used responsibly; and that (this cannot be emphasized enough) the leading recreational drug-related health problems are produced by tobacco products and alcoholic beverages.
13. Assault on the Drug Culture
A clear assault would be made on the Drug Culture. This is a critical part of the program. The public must be ed ucated to understand the interrelatedness of the use and abuse of all the recreational mood-altering drugs. Public health-focused advertising policy is central to this effort.
14. Advertising Policy
First, in the PHA there would be no future expansion of RMAD advertising beyond that which is presently permitted: no reintroduction of radio and television cigarette advertising, (it being highly unfortunate that the advertising of spirits on radio and television has recently been re-introduced), and no advertising of any kind for any presently illicit drugs for which the legal status would be changed. Second, it is possible that a complete ban on pro-drug-use advertis ing could be undertaken, as recommended (for exam ple) by the Committee on Public Health of The New York Academy of Medicine. Significant constitu tional questions would be raised by such legislation. If it were to be concluded that a complete advertising ban were neither desirable nor constitutional, as mentioned above, permitted pro-drug-use ad vertising could be taxed.
15. Treatment
Comprehensive treatment, rehabilitation, and job-training programs for those who are addicted to or who are abusers of any of the recreational mood-altering drugs would be made available. The matters of the appropriateness of "on-demand" treatment, the role of the law enforcement system in placing drug abusers in treatment, and who would pay for what, would have to be worked out. Individual treatment can be very helpful. So can group programs, like Alcoholics Anonymous.
16. Assistance for Displaced Drug Workers and Farmers
Subsidies, relocation assistance, and retraining opportuni ties for the tens of thousands of workers and small farmers who would be put out of work in the United States by a sig nificant decline in the legal recreational drug trade and/or the ending of various crop subsidy programs would be provided.
17. National Domestic Spending
The very important programs of national domestic spend ing to deal with the identified political, economic, and social causes of the illegal drug trade in those inner-city neighborhoods that are scarred by both legal and illegal drug use and the War on Drugs would be implemented. Much of this money could come from the vast sums that are currently being spent on the "Drug War" itself.
D. The Public Health Approach: In Summary
Solving the drug problem requires: (a) recognition that it is a continuum occupied by all three RMAD categories: the tobacco products, the alcoholic beverages, and the currently illicits); (b) setting rational, achievable goals for its control, goals that are consistent with human experience with the mood-altering drugs, achievable by the methods to be used in the program, and separate from the goal of crime reduction; (c) clearly understanding that its causes in this country go far beyond the simple availability of drugs upon which current policy focuses so much of its attention (while recognizing that applying certain restrictions of time and place to availability can lead to a reduction of use); (d) recognizing that the "Drug War" has not only consistently failed to meet its own stated objectives while at the same time causing many harms, but by its very nature cannot in any way be successful in dealing with the drug problem because of its totally distorted focus away from the most commonly used RMADs; and (e) turning major attention from the supply side to the demand side, to the drug culture, to the gateway drug effect, to the centrality of tobacco product and alcoholic beverage uses to the drug problem, and the specific present causes of the inner-city illicit drug trade: unemployment, poor housing, poor education, and hopelessness.
This Public Health Program is designed to significantly reduce drug use in our society. Illegalization/criminalization has produced a record of fifty-plus years of failure. The major polit ical downside of the Public Health Approach is that it requires a major assault on the tobacco and alcohol industries and the abandonment of the "Drug War" as an instrument of social oppression and a political weapon. But it can be done. Based on the record achieved by the Public Health Approach so far in dealing with cigarette smoking, limited as it has been by the past wide-spread use of cigarettes, it would meet with success.
Conclusion
The "Drug War" has been a failure for the 50-plus years it has been underway. Why should one think that tinkering with its tactics will achieve a better result when what is needed is an entirely new strategy? Well, The Times' Editorial Board does. Why? Well, your guess is as good as mine. But for sure nothing much is going to happen unless an entirely new way of "thinking about drugs" is introduced.
Postscript on Fentanyl. Fentanyl has very quickly become a major killer, right up there with ethyl alcohol in alcoholic beverages: about 90,000 deaths per year. It is a synthetic opioid, 50-100 times more powerful than morphine. It may be prescribed for severe pain (which it is very good at relieving). It is both sold directly without prescription and, often added to doses of addicting drugs sold by street dealers. Why they do this needs to be further studied, as indeed does the whole realm of fentanyl usage, sales, and its market. There is no magic answer to this one, but we do know that the traditional "drug war" approach to it will not work any better than it has for any of the other "illegals." One approach that could be tried is as part of the "package store" approach, described briefly in "10" above. That is, if the legalized addictive drugs were sold legally in licensed, regulated "package stores" (which would become the only places for the purchase of alcoholic beverages and tobacco products as well) it could be arranged to have them sold as "fentanyl-free."
Steven Jonas, MD, MPH, MS is a Professor Emeritus of Preventive Medicine at StonyBrookMedicine (NY) and author/co-author/editor/co-editor of over 35 books. In addition to his position on OpEdNews.com as a “Trusted Author,” he is a regular contributor to BuzzFlash.com. His own political website, stevenjonaspolitics.com, is an archive of the 1000 or so political columns he has published since 2004, with the current columns being added to it as they appear. He was also a career triathlete, 36 seasons, 256 multi-sport races, and writer on the sport (books and articles). He now is officially retired from racing.
Among Dr. Jonas’ books of note on political science and history are: Ending the ‘Drug War’; Solving the Drug Problem: The Public Health Approach, Brewster, NY: Punto Press Publishing, (Brewster, NY, 2016, available on Kindle from Amazon, and also in hardcover from Amazon); a “future history” of the United States (originally published in 1996) entitled The 15% Solution: How the Republican Religious Right Took Control of the U.S., 1981-2022 (Third Version published by Trepper & Katz Impact Books, Punto Press Publishing, 2013, Brewster, NY, and available on Amazon).
His most recent book-set is Trump's Presidential Years: As They Happened, 2015-2021. It is in six volumes, consisting of the 191 columns Dr. Jonas published on Trump, primarily on OpEdNews.com and BuzzFlash.com, from “Hair Trump or Herr Trump?” (10-6-15) to “Xenophobia and Racism: They're in the Republican Party's DNA” (3-19-21). The six volumes are each available separately on Kindle (2022), under “Trump’s Presidential Years: As they happened, 2015-2021.”
Dr. Jonas has a blind-copy distribution list for his columns. If you would like to be added to it, please send him an email at sjtpj@aol.com.
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