The War on Drugs

My sentiments on the whole drug question have been influenced by some experience with the medical aspect of the problem. Drugs are slipping out of any control due to developments in synthetic variations of older substances that stimulate brain chemistry, sometimes in unknown ways. The traditional drugs, if we can use that term, are also slipping out of control with Mexican drug wars replacing the Columbian cartels even more violent than their predecessors.

What about marijuana ? It is widely used by the younger generation and, while I do think there are some harmful consequences, especially in potential schizophrenics, the fact is that the laws are widely ignored and do little good and much harm. First, what about the link to psychosis ?

Epidemiological studies suggest that Cannabis use during adolescence confers an increased risk for developing psychotic symptoms later in life. However, despite their interest, the epidemiological data are not conclusive, due to their heterogeneity; thus modeling the adolescent phase in animals is useful for investigating the impact of Cannabis use on deviations of adolescent brain development that might confer a vulnerability to later psychotic disorders. Although scant, preclinical data seem to support the presence of impaired social behaviors, cognitive and sensorimotor gating deficits as well as psychotic-like signs in adult rodents after adolescent cannabinoid exposure, clearly suggesting that this exposure may trigger a complex behavioral phenotype closely resembling a schizophrenia-like disorder. Similar treatments performed at adulthood were not able to produce such phenotype, thus pointing to a vulnerability of the adolescent brain towards cannabinoid exposure.

This suggests that adult use may be less harmful.

The legal situation is actually more serious. The data is disputed and may be influenced by the politics of the drug using public. Two states have “legalized” marijuana. The Federal law still, of course, applies.

In the lead-up to the referenda in Mexico and Colorado, the Mexican Competitiveness Institute released a study estimating that Mexico’s cartels would lose $1.425 billion if the initiative passed in Colorado and $1.372 billion if Washington voted to legalize. The organization also predicted that drug trafficking revenues would fall 20 to 30 percent, and the Sinaloa cartel, which would be the most affected, would lose up to 50 percent.

But that’s a much more severe impact than the one predicted by the Rand Corp., which previously found that cartels would barely feel the pinch from legalization initiatives in the U.S. As Booth reported:

A 2010 Rand Corp. study estimated that legal marijuana use in California, a state that consumes about one-seventh of all the pot smoked in the United States, would cost the cartels 2 to 4 percent of their revenue. So losing consumers in states such as Washington and Colorado that have a smaller population might not affect the cartel bottom line by much.

National legalization would, of course, have a greater affect. Is it politically possible ? Probably not.

What about other drugs ? It has been written by prominent people that we are losing the war.

I have been concerned about the drug issue since I became secretary of labor in 1969, my first cabinet position in the Nixon administration. There was growing worry back then about the damage inflicted on individuals and society by the use of addictive drugs, so an informal effort was started to keep these drugs out of the United States. The late Senator Daniel Patrick Moynihan, a friend of mine who was then counselor to the president, worked diligently on this problem. I was concerned but skeptical about the effectiveness of this approach to the issue, which focused on stopping the flow of drugs into the United States while seeming to overlook the growing demand for drugs from within our country.

Some factors are not mentioned such as the effects of different “traditional” drugs. Heroin has been outlawed since the original Harrison Narcotic Act.

On its face, moreover, the Harrison bill did not appear to be a prohibition law at all. Its official title was “An Act to provide for the registration of, with collectors of internal revenue, and to impose a special tax upon all persons who produce, import, manufacture, compound, deal in, dispense, sell, distribute, or give away opium or coca leaves, their salts, derivatives, or preparations, and for other purposes .” The law specifically provided that manufacturers, importers, pharmacists, and physicians prescribing narcotics should be licensed to do so, at a moderate fee. The patent-medicine manufacturers were exempted even from the licensing and tax provisions, provided that they limited themselves to “preparations and remedies which do not contain more than two grains of opium, or more than one-fourth of a grain of morphine, or more than one-eighth of a grain of heroin . in one avoirdupois ounce.” Far from appearing to be a prohibition law, the Harrison Narcotic Act on its face was merely a law for the orderly marketing of opium, morphine, heroin, end other drugs-in small quantities over the counter, and in larger Quantities on a physician’s prescription. Indeed, the right of a physician to prescribe was spelled out in apparently unambiguous terms: “Nothing contained in this section shall apply . . . to the dispensing or distribution of any of the aforesaid drugs to a patient by a physician, dentist, or veterinary surgeon registered under this Act in the course of his professional practice only.” Registered physicians were required only to keep records of drugs dispensed or prescribed. it is unlikely that a single legislator realized in 1914 that the law Congress was passing would later be decreed a prohibition law.

Thus the Act as originally written was NOT a prohibition. However, it was interpreted as such by law enforcement.

The provision protecting physicians, however, contained a joker hidden in the phrase, “in the course of his professional practice only .” After passage of the law, this clause was interpreted by law-enforcement officers to mean that a doctor could not prescribe opiates to an addict to maintain his addiction. Since addiction was not a disease, the argument went, an addict was not a patient, and opiates dispensed to or prescribed for him by a physician were therefore not being supplied “in the course of his professional practice.” Thus a law apparently intended to ensure the orderly marketing of narcotics was converted into a law prohibiting the supplying of narcotics to addicts, even on a physician’s prescription.

Many physicians were arrested under this interpretation, and some were convicted and imprisoned. Even those who escaped conviction had their careers ruined by the publicity. The medical profession quickly learned that to supply opiates to addicts was to court disaster.

The medical profession quickly learned to avoid addicts and they turned to the illegal market. Heroin, in particular, became the illegal drug of choice. Addiction increased rather than falling as a result of the law.

Congress responded by tightening up the Harrison Act. In 1924, for example, a law was enacted prohibiting the importation of heroin altogether, even for medicinal use. This legislation grew out of the widespread misapprehension that, because of the deteriorating health, behavior, and status of addicts following passage of the Harrison Act and the subsequent conversion of addicts from morphine to heroin, heroin must be a much more damaging drug than opium or morphine. In 1925, Dr. Lawrence Kolb reported on a study of both morphine and heroin addiction: “If there is any difference in the deteriorating effects of morphine and heroin on addicts, it is too slight to be determined clinically.” President Johnson’s Committee on Law Enforcement and Administration of justice came to the same conclusion in 1967: “While it is somewhat more rapid in its action, heroin does not differ in any significant pharmacological effect from morphine.”

In fact, these laws allowed the use of existing stocks of heroin and Johns Hopkins Hospital used heroin for labor pain until the stocks ran our about 1928. Heroin does seem to have a euphoria effect which was useful in labor.

The Wall Street Journal had an excellent article about 25 years ago on why cocaine use declined in the 1920s. It was social pressure rather than law enforcement which resulted in a decline to low levels until the 1970s. I remember patients asking me if there was any harm in using cocaine in the middle 70s. They did not realize that it is far more addictive than heroin or morphine. They thought it was harmless. It is also a problem for legalization as it makes heavy users hyperactive and paranoid, a bad combination. Fortunately, its use seems to have declined in recent years although a study from Germany in 2006 suggests heavy use in urban centers world wide. Cocaine produces a metabolite for a month after use which can be identified in sewage water. This metabolite in the urine is useless legally as it persists for some time after use.

But the “World Drug Report” says the average user, at least in Central and Western Europe, consumes only 35 grams of pure cocaine per year. Unless the appetite of the average American is considerably greater, present estimates of overall consumption are likely to be too low. Either there are more coke-heads than reflected by the official statistics, or they snort far more Charlie per year than yet realized.

And there’s more. IBMP Director Fritz Sörgel says there are a number of further lessons provided by his study:

Good news for Germany — cocaine consumption has, according to his data — stagnated.

New York continues its reign as the Cocaine Capital of the World. One is almost tempted to upbraid them for wasting the stuff. Nowhere did researchers find as much pure cocaine as they did in the Hudson River.

Europe is catching up in cocaine consumption, with Spain bravely leading the way. The British and Italians also display a ravenous appetite for blow.

These are gross numbers based on the concentration in water with very rough estimates of per capita consumption.

It does suggest the hopelessness of prohibition. The report from Schultz has a conclusion:

These efforts wind up creating a market where the price vastly exceeds the cost. With these incentives, demand creates its own supply and a criminal network along with it. It seems to me we’re not really going to get anywhere until we can take the criminality out of the drug business and the incentives for criminality out of it. Frankly, the only way I can think of to accomplish this is to make it possible for addicts to buy drugs at some regulated place at a price that approximates their cost. When you do that you wipe out the criminal incentives, including, I might say, the incentive that the drug pushers have to go around and get kids addicted, so that they create a market for themselves. They won’t have that incentive because they won’t have that market. . . .

I find it very difficult to say that. Sometimes at a reception or cocktail party I advance these views and people head for somebody else. They don’t even want to talk to you. I know that I’m shouting into the breeze here as far as what we’re doing now. But I feel that if somebody doesn’t get up and start talking about this now, the next time around, when we have the next iteration of these programs, it will still be true that everyone is scared to talk about it. No politician wants to say what I just said, not for a minute.

What about the synthetic drugs ? This is a growing and, thus far, uncontrollable problem. Many of these drugs do not even have known chemical composition.

“Ivory Wave,” “Purple Wave,” Vanilla Sky,” and “Bliss” are among the many street names of so-called designer drugs known as “bath salts,” which have sparked thousands of calls to poison centers across the U.S.

These drugs contain synthetic chemicals that are similar to amphetamines. Some, but not all, of the chemicals used to make them are illegal.
What Are Bath Salts?

“Is this what we put in our bathtubs, like Epsom salts? No,” says Zane Horowitz, MD, an ER doctor and medical director of the Oregon Poison Center.

These drugs have nothing to do with real bath salts — or “jewelry cleaner,” or “plant food,” or “phone screen cleaner,” which they’re also sometimes called, according to the National Institute on Drug Abuse.

Exactly which chemicals are in the drugs isn’t known.

“The presumption is that most ‘bath salts’ are MDPV, or methylenedioxypyrovalerone, although newer… derivatives are being made by illegal street chemists,” Horowitz says. “Nobody really knows, because there has been no way to test for these substances. However, that is changing, and some tests for certain of these chemicals have been developed.”

There is no hope of legalizing these concoctions. Should we consider legalizing some less dangerous drugs ? I think so. Marijuana, aside from its risks in schizophrenia, is relatively harmless. It has social costs like lack of ambition but these characteristics may be less an effect of the drug than characteristic of the user.

Misuse of prescription drugs is beyond this discussion. Misuse of some OTC drugs, like the cough syrup ingredient, dextromethorphan, is a real problem in some areas. In the southeast, there is wide use of a concoction made up of cough syrup, sweetened drinks like Arizona Iced Tea grapefruit flavor and sweet candy, like Skittles. It is called by various names, like Purple Drank, or “Lean” or Sizzurp. The similarity of the ingredients to those purchased by Trayvon Martin I will leave to the reader. It is widely popular with rappers, sometimes with lethal results.

Maybe it’s time for an honest discussion on options on drugs. I’m not optimistic.

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