Sunday, May 15, 2016

Legalize Production and Sale of Recreational Drugs

I’m quite happy to see that criminal justice reform is a major political issue and drug legalization is becoming more respectable. There is a serious push to fully legalize marijuana. There is also serious talk of decriminalizing other drugs and treating their abuse as a public health issue rather than a criminal justice issue. My concern is that reforms will stop short of the reforms truly needed to clean up the drug problem: legalizing the production and sale of all currently illegal drugs.

So-called “drug-related harms” are most often effects of prohibition, not effects of the drugs per se. Heroin is deadly because the users do not know what dosage they are taking. They are also unaware of any adulterants, and that has very recently become a serious problem. The heroin overdose death rate has spiked in very recent years because suppliers have been spiking their product with fentanyl, which is something like 500 times as powerful as heroin. The margin for error with such a product is small, and it’s being mixed by amateurs. That’s a deadly combination. The spread of HIV/AIDS in IV drug user communities is the effect of a prohibition on the sale of clean needles. The problem has been mitigated in recent years because the government has allowed grey-market (technically illegal but tolerated) needle exchange to operate, but an IV drug user *still* can’t walk into a nearby Walgreens and buy a clean needle. Intravenous drug use is itself an outcome of drug prohibition. Prohibition drives the market price of heroin very high (an *intentional* outcome of the drug war), and the result is that IV drug use is the only economical way of actually getting high. American soldiers in Vietnam had nearly unlimited access to extremely pure heroin, and they mostly snorted rather than injected it. If that were the world we lived in today, where heroin was cheap enough that high-seekers could easily purchase a snort-able dose at Walgreens, IV drug use would be a fringe phenomenon or would cease to exist at all. 

Other drugs that kill significant numbers of people are cocaine and meth (amphetamines are listed as “Psychostimulants with potential for abuse” in CDC death data, lumped together with similar prescription drugs like Adderall). These aren’t typically taken intravenously, but many of the harms related to these drugs could still be mitigated under a legalization regime. The existence of crack cocaine owes itself to the drug war’s efforts to increase the market price of the drug; this is exactly analogous to the IV heroin use phenomenon. The price of the drug is driven so high that the only economical way for users (particularly poor users) to get high is to smoke it. The harms related to these drugs are grossly exaggerated, but it’s certainly the case that they could be made safer. The production side in particular could be made much safer. Instead of having thousands of meth labs in residential buildings, you could have one or two large meth factories supplying the entire US market. You wouldn’t have residential properties being poisoned (along with their inhabitants) by the chemicals used in meth production, and you could (once again) ensure that the final product is free of adulterants.

There are probably people who are so impulsive and so prone to self-harming behaviors that they will still use drugs to hurt themselves, even under a legalization regime. Our goal should be to make these people *safer*. We should make it *harder* to accidentally overdose. The current regime makes it far easier. The drug warriors have effectively tried to deter drug use by making the drugs far more lethal than they would otherwise be. I don’t know how many of them explicitly state this as their goal, but given that this is a predictable consequence of the policy they’ve visited upon us, I think it’s appropriate to blame them for a large share of the overdose deaths that happen every year.

We will never achieve the goal of reducing drug-related harms without legalizing them. Imagine if you could purchase heroin from a pharmacy. The box could be labeled with the exact dosage, which was mixed by professionals in a regularly audited factory. A clean vial could be sold in the same box as a clean needle, and a disposal center for the previous needle could be right there in the same pharmacy. “This product does not contain fentanyl!” could be printed on the box, and that promise could actually be made credibly. The box could remind users “Do not take with alcohol, benzodiazepines, or the following other drugs… Tell the pharmacist if you are taking any medications.” Naloxone, the antidote to an opioid overdose, could be available for sale along with clean heroin. Of course, the pharmacist could ask for ID, possibly a prescription or a licensing card certifying that you’ve taken the mandatory safety course (a harm-mitigation policy that’s once again *only* feasible in a regime of legalization).

Perhaps you could pick up a few other items while at the store. You could pick up some coca tea, mixed at a concentration low enough to get you just shy of the buzz you’d get from a Starbucks coffee. Or perhaps you get the same active ingredients in a lozenge. You may as well pick up a low-dose amphetamine while you’re at it. There is nothing inherently dangerous about any of these chemicals, and there is nothing inherently harmful or immoral about using them recreationally. But the full slate of harm-reducing measures can only be implemented in a regime of legalization on the supply side.

“Decriminalization”, the impotent little sibling of legalization, won’t get us there. Not even close. Decriminalization would certainly be an improvement over what we have now, but it will leave most of the major drug-related harms in place. Half-hearted reformers who wish to decriminalize only possession (but not production and sale) are not very compassionate. It’s as if they recognize that recreational drug users are walking through a mine field and they insist on digging up only a fraction of the mines. It’s as if they think the remaining mines only detonate when suppliers and dealers step on them. No, those mines meant for suppliers hit the consumers, too, through the mechanisms described in the above paragraphs. This is what false compassion looks like.

The voting public needs to get over its puritanical belief that it’s wrong to make a profit from someone else’s vice. I think many people, drug warriors and reformers alike, have a sense that drug users are victims and the suppliers are evil people who harm the users against their will. This is mistaken. It is the user who chooses to consume a recreational drug. Even if you insist that the user is an addict who can’t control their behavior, they at least made the choice to risk becoming an addict the first time they indulged. The real vice here is moral posturing, and the public is indulging this one to the hilt. And people are dying because of it.

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