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We're unlikely to evolve toward a more effective and humane drug policy
unless we begin to change the ways we think about drugs and drug
control.
Perspective can be had from what is truly the most pervasive drug
scandal in the United States: the epidemic of undertreatment of pain.
"Addiction" to (i.e., dependence on) opiates among the terminally ill
is the appropriate course of medical treatment.  The only reason for
the failure to prescribe adequate doses of pain-relieving opiates is
the "opiaphobia" that causes doctors to ignore the medical evidence,
nurses to turn away from their patients' cries of pain, and some
patients themselves to elect to suffer debilitating and demoralizing
pain rather than submit to a proper dose of drugs.
The tendency to put anti-drug ideology ahead of compassionate treatment
of pain is apparent in another area.  Thousands of Americans now smoke
marijuana for purely medical reasons: among others, to ease the nausea
of chemotherapy; to reduce the pain of multiple sclerosis; to alleviate
the symptoms of glaucoma; to improve appetite dangerously reduced from
AIDS.  They use it as an effective medicine, yet they are technically
regarded as criminals, and every year many are jailed.  Although more
than 75 per cent of Americans believe that marijuana should be
available legally for medical purposes, the Federal Government refuses
to legalize access or even to sponsor research.
Drugs are here to stay.  The time has come to abandon the concept of a
"drug-free society." We need to focus on learning to live with drugs in
such a way that they do the least possible harm.  So far as I can
ascertain, the societies that have proved most successful in minimizing
drug-related harm aren't those that have sought to banish drugs, but
those that have figured out how to control and manage drug use through
community discipline, including the establishment of powerful social
norms.  That is precisely the challenge now confronting American
society regarding alcohol: How do we live with a very powerful and
dangerous drug - more powerful and dangerous than many illicit drugs -
that, we have learned, cannot be effectively prohibited?
Virtually all Americans have used some psychoactive substance, whether
caffeine or nicotine or marijuana.  In many cases, the use of cocaine
and heroin represents a form of self-medication against physical and
emotional pain among people who do not have access to psychotherapy or
Prozac.  The market in illicit drugs is as great as it is in the inner
cities because palliatives for pain and depression are harder to come
by and because there are fewer economic opportunities that can compete
with the profits of violating prohibition.
Prohibition is no way to run a drug policy.  We learned that with
alcohol during the first third of this century and we're probably wise
enough as a society not to try to repeat the mistake with nicotine.
Prohibitions for kids make sense.  It's reasonable to prohibit drug-
related misbehavior that endangers others, such as driving under the
influence of alcohol and other drugs, or smoking in enclosed spaces.
But whatever its benefits in deterring some Americans from becoming
drug abusers, America's indiscriminate drug prohibition is responsible
for too much crime, disease, and death to qualify as sensible policy.
There is a wide range of choice in drug-policy options between the
free-market approach favored by Milton Friedman and Thomas Szasz, and
the zero-tolerance approach of William Bennett.  These options fall
under the concept of harm reduction.  That concept holds that drug
policies need to focus on reducing crime, whether engendered by drugs
or by the prohibition of drugs.  And it holds that disease and death
can be diminished even among people who can't, or won't, stop taking
drugs.  This pragmatic approach is followed in the Netherlands,
Switzerland, Australia, and parts of Germany, Austria, Britain, and a
growing number of other countries.
American drug warriors like to denigrate the Dutch, but the fact
remains that Dutch drug policy has been dramatically more successful
than U.S. drug policy.  The average age of heroin addicts in the
Netherlands has been increasing for almost a decade; HIV rates among
addicts are dramatically lower than in the United States; police don't
waste resources on non-disruptive drug use but, rather, focus on major
dealers or petty dealers who create public nuisances.  The
decriminalized cannabis markets are regulated in a quasi-legal fashion
far more effective and inexpensive than the U.S. equivalent.
The Swiss have embarked on a national experiment of prescribing heroin
to addicts.  The two-year-old plan, begun in Zurich, is designed to
determine whether they can reduce drug- and prohibition-related crime,
disease, and death by making pharmaceutical heroin legally available to
addicts at regulated clinics.  The results of the experiment have been
sufficiently encouraging that it is being extended to over a dozen
Swiss cities.  Similar experiments are being initiated by the Dutch and
Australians.  There are no good scientific or ethical reasons not to
try a heroin-prescription experiment in the United States.
Our Federal Government puts politics over science by ignoring extensive
scientific evidence that sterile syringes can reduce the spread of AIDS.
Connecticut permitted needle sales in drugstores in 1992, and the
policy resulted in a 40 per cent decrease in needle sharing among
injecting drug users, at no cost to taxpayers.
We see similar foolishness when it comes to methadone.  Methadone is
to street heroin more or less what nicotine chewing-gum and skin
patches are to cigarettes.  Hundreds of studies, as well as a National
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