High Price (41 page)

Back in 2001, Portugal took the unprecedented step of decriminalizing all illegal drugs. That’s right, cocaine; heroin; methamphetamine; 3,4-methylenedioxymethamphetamine (MDMA, aka ecstasy and molly); everything. Here’s how it works there. Acquisition, possession, and use of recreational drugs for personal use—defined as quantities up to a ten-day supply—are no longer criminal offenses. Users stopped by police and found to have drugs are given the equivalent of a traffic ticket, rather than being arrested and stigmatized with a criminal record. The ticket requires them to appear before a local panel called (in translation) the Commission for Dissuasion of Drug Addiction, typically consisting of a social worker, a medical professional like a psychologist or psychiatrist, and a lawyer. Note that a police officer is not included.

The panel is set up to address a potential health problem. The idea is to encourage users to honestly discuss their drug use with people who will serve as health experts and advisers, not adversaries. The person sits at a table with the panel. If he or she is not thought to have a drug problem, nothing further is usually required, other than payment of a fine. Treatment is recommended for those who are found to have drug problems—and referral for appropriate care is made. Still, treatment attendance is not mandatory. Repeat offenders, however—fewer than 10 percent of those seen every year—can receive noncriminal punishments like suspension of their driver’s license or being banned from a specific neighborhood known for drug sales.

How has decriminalization been working out for the people of Portugal? Overall, they have increased spending on prevention and treatment, and decreased spending for criminal prosecution and imprisonment. The number of drug-induced deaths has dropped, as have overall rates of drug use, especially among young people (15–24 years old). In general, drug use rates in Portugal are similar, or slightly better, than in other European Union countries.
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In other words, Portugal’s experiment with decriminalization has been moderately successful. No, it didn’t stop all illegal drug use. That would have been an unrealistic expectation. Portuguese continue to get high, just like their contemporaries and all human societies before them. But they don’t seem to have the problem of stigmatizing, marginalizing, and incarcerating substantial proportions of their citizens for minor drug violations. Together, these are some of the reasons that I think decriminalization should be discussed as a potential option in the United States.

“So, why isn’t decriminalization of all illegal drugs given serious consideration in this country?” yelled a deceptively aged man standing in the center of the room. The salt-and-pepper hair and creases in his face suggested he was in his late forties or early fifties, but his skinny jeans and Chuck Taylor Converse sneakers implied he was much younger. I replied, “Of course, the answer to this question will vary depending upon who is being asked to address it. And consideration of all of the possible answers is beyond the scope of this talk.” In the preceding pages, however, I have tried to provide the reader with information that can allow one to address this question in a more critical manner. Briefly, we’re too afraid of these drugs and of what we think they do. Our current drug policies are based largely on fiction and misinformation. Pharmacology—or actual drug effects—plays less of a role when policies are devised. As such, we have been bamboozled to believe that cocaine, heroin, methamphetamine, or some other drug du jour is so dangerous that any possession or use of it should not be tolerated and deserves to be severely punished. Decriminalization is inconsistent with this misguided perspective.

In order to begin a serious national discussion about decriminalization, first, the public will have to be reeducated about drugs, separating the real potential dangers from monstrous or salacious fable. While I hope this book is a significant step in that direction, others (for example, scientists and public health officials) will also be needed in our reeducation efforts. And given how entrenched some drug myths are, one should not expect change to occur within a short period. This will engender considerable disappointment and frustration. I am reminded of the words of my dear friend Ira Glasser, former director of the American Civil Liberties Union, when he was asked how long it will take for us to see meaningful drug policy reform. Ira responded, “The fight for justice is not a sprint . . . it’s a marathon relay race. You can’t see where the track ends. You can just take the baton and run as hard as you can and as fast as you can and as far as you can. . . .”

Ira’s comments also remind us that reeducation of the public about drugs will take a team effort. For one, scientists who study illegal drugs can be extremely helpful in this process. But you should also know that scientists are not all equal in their ability to think critically and rationally about drugs. For example, a researcher who studies the neurotoxic effects (causing damage to brain cells) of MDMA in rodents is not necessarily the best person to educate the public about that drug’s effects on people. In their experiments, these researchers typically inject very large amounts of the drug several times a day, for consecutive days. In many experiments, the animal is given as much as ten times the amount of drug that a human would take. So it wouldn’t be surprising that MDMA, given in these large doses, can cause damage to brain cells. What is surprising, however, is that some scientists, on the basis of these results, communicate dire warnings to the public that MDMA should not be used even once because it causes brain damage. With teammates like this, you don’t need opponents. I assure you that if you administered similar excessively large alcohol or nicotine doses to animals, you would observe similar or even more toxic effects. But these findings are probably not relevant to human drug use because we take considerably smaller amounts of drug.

Given the vast amount of conflicting information, I recognize that it can be difficult trying to determine who is a credible drug expert. In your attempt to evaluate the drug information presented, it might be helpful to ask a few simple questions: (1) How much drug was given to the animals and is it similar to amounts used by people? (2) Was the drug injected or swallowed and do people use the drug in this way? (3) Were the animals first given smaller amounts of the drug to allow the development of tolerance, which prevents many toxic effects, or were naive animals just given larger amounts initially? (4) Were the animals housed in isolation or in groups? All of these factors potentially influence drug effects on the brain and behavior. You should be skeptical when “experts” attempt to extrapolate data collected in laboratory animals to humans without appropriate consideration of these critical factors.

Law enforcement is another profession that is frequently called upon to educate the public about drugs. Few efforts have had a more harmful effect on public education and health. In general, police officers are trained to apprehend criminals and prevent and detect crime, in the service of maintaining public order. They don’t receive training in pharmacology, nor do they receive any in psychology or any other behavioral science. As I have consistently pointed out within these pages, the effects of drugs on human behavior and physiology are determined by a complex interaction between the individual drug user and her or his environment. Without the appropriate training it’s extremely difficult to draw conclusions about how a particular drug might have influenced someone’s behavior.

It’s true that cops make numerous drug arrests, but it would be a mistake to assume that they become knowledgeable about the effects of drugs as a result. Being pursued or arrested by the police is an aberrant situation. This, in itself, even without any drugs, can cause heightened suspicion, anxiety, fear, and the fight-or-flight response in the suspect. Consider also that some people who are arrested for drugs have preexisting psychiatric disorders, while others may be intoxicated from using multiple drugs, including alcohol. When all of these complexities are added to an already abnormal setting, it is often difficult to tease apart the effects of a particular drug from those of nondrug influences. Yet, in some public education campaigns carried out by police officers, the disturbing behaviors are uncritically attributed to certain illegal drug effects. This is an important vehicle through which drug-related myths are perpetuated. The point is that law enforcement officials are not qualified to serve as drug education experts simply because they make arrests that may involve drugs.

Both the scientists who study toxicity in animals and the police who arrest users and sellers often have a limited view of the complexity of the ideas I have presented to you. No one whose professional experience focuses only on one aspect of illicit drug use can be considered a real expert in the sense of being able to imagine all the intended and unintended consequences of continuing our current policy of treating illicit drug use primarily as a criminal issue.

The media, too, is another major source of drug misinformation. Throughout this book I have provided multiple examples of how the media has generally fanned the flames of drug hysteria. It seems as though there’s a “new deadly drug” nearly every year. And invariably some police officer or politician is interviewed, warning parents about the dangers this drug poses to their children. (Of course, neither cop nor elected official should be the professional educating the public about the potential effects of drugs.) Usually, after the hysteria has subsided, we discover that the drug in question wasn’t as dangerous as we were initially told. In fact, it wasn’t even new. But by then the new laws have been passed and they require stiff penalties for possession and distribution of the so-called new, dangerous drug. I am not optimistic that the media will change its reporting on drugs anytime soon. Drug stories are just too sexy, and sex sells everything from newspapers to documentary films.

Nonetheless, you should know that scientists have studied nearly all of the popular recreational drugs in people. We have learned a great deal about the conditions under which either positive or negative effects are more likely to occur. Unfortunately, this knowledge is rarely disseminated to the public, primarily because of the irrational belief that it might lead one to engage in drug use. In light of the fact that there are already more than 20 million Americans who use illegal drugs regularly, it seems that a rational approach—one that aims to reduce drug-related harms—would be to share what we’ve learned with drug users and those in positions to help keep them safe. Otherwise, it seems that we do society a major disservice.

If more people were aware of a few simple facts that we’ve learned, this would substantially enhance public health and safety. First, inexperienced drug users should be discouraged from taking drugs in the manner in which experienced users do. Experienced users tend to take drugs in ways that get them to the brain quickly, that is, by smoking or intravenous injection. Because smoking and shooting drugs intravenously produce more potent effects, the likelihood of harmful consequences is increased with these methods. Alternatively, taking a drug by mouth is usually safer than other ways of consuming drugs for two reasons: (1) the stomach can be pumped in case of an overdose, which isn’t possible with smoked or injection overdoses; and (2) some of the drug will be broken down before reaching the brain, resulting in fewer drug effects.

Second, healthy sleep habits should be stressed for all drug users because prolonged sleep loss can cause deterioration of mental functioning. In severe cases, even without drugs, hallucinations and paranoia may also occur. Because amphetamines and cocaine reliably reduce fatigue and offset performance decrements, some may repeatedly take these drugs to lessen problems associated with sleep loss. This is a less than ideal approach. One of the most consistent effects of stimulants is the disruption of sleep, which means that repeated use can exacerbate problems related to sleep loss. Given the vital role that sleep plays in healthy functioning, regular users of stimulants should be mindful of their sleep durations and avoid drug use near bedtime.

Finally, certain drug combinations should be avoided because they increase the risk of overdose. The heroin-alcohol combination and oxycodone-diazepam combination are two popular examples. While it is theoretically possible to die from an overdose of any of these drugs alone, in practical terms this is extremely rare. But each year there are several thousand deaths in the United States in which the use of these combinations is mentioned. In virtually every overdose death involving an opioid, for example, some other substance is present. Most of the time it is alcohol. One should always take care when combining two drugs or any drug with alcohol.

“Thank you for your time and thoughtful questions and comments,” I said to the secret-science clubbers as I prepared to exit the stage. But before I could leave, dozens of people lined up and huddled around me. Some had pressing follow-up questions, while others wanted to share their stories, seek advice, or just say thanks. It was reminiscent of a time when I used to watch my DJ mentor and brother-in-law, Richard “Silky Slim,” skillfully convey to each person that his or her opinion mattered. Unfortunately, Silk didn’t go on to become the well-known entertainer that we all thought he would. Instead he was convicted of a drug charge and served more than a decade in federal prison.

Since his release, he and I have spoken at great length about his experiences with the justice system and the unfairness of our current drug policies. To be honest, his story is one that provides motivation for me to do my best to change the way we regulate the illegal drugs discussed in this book. Whenever I write something relevant on the topic, I send him a copy. Here’s a recent text message I received from him in response to an op-ed that I published calling for the elimination of the sentencing disparities between powder and crack cocaine:
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“Hey brother Carl, Great fucking piece you wrote man. That made my heart start racing again just thinking about the injustice I had to endure. Thanks man, that was beautiful! God Bless.” I sincerely hope that my efforts help to prevent many of the policy mistakes that were made in the past.