Ethan A. Nadelmann, Assistant Professor of Politics and Public Affairs, Princeton University

The drug policy spectrum

It should be clear by this point that drug legalization and drug prohibition do not represent simply radical alternatives to one another and that there is no single version of either one. Virtually all drug control policies incorporate elements of both prohibition and legal availability. Alcohol, for instance, is regarded as a legal drug but it is illegal to sell it to anyone under the age of twenty-one, illegal to drive while under its influence, and illegal, in many states and localities, to consume in public or to sell or buy except from government-controlled or government-licensed outlets. Many of the same prohibitions increasingly apply to cigarettes and other tobacco products. Nicotine gum, which is substantially less harmful than smokeable tobacco, cannot even be purchased over-the-counter. Cocaine and most opiates are typically regarded as illegal drugs, but both are prescribed by doctors, the former for nasal and dental surgery as well as (in a few cases) treatment of pain, the latter as a pres

cribed treatment for pain or, in the case of methadone, as an authorized alternative to illicit heroin. The distinction between legal regulatory policies and prohibitionist policies becomes even more obscure when one surveys the broad spectrum of alcohol control policies that have been employed around the world during the past century; the same is true of opiate control policies and, to a lesser extent, public policies directed at the control of most other psycho-active drugs.

Nonetheless, one can distinguish between prohibition and legalization in at least two significant respects. The sharper distinction concerns whether or not a drug can be purchased over-the-counter, which is to say that it can be purchased legally by adults without first obtaining permission from a government agency or a government-licensed agent such as a doctor. The more ambiguous, but equally important, distinction between those policies that rely primarily on criminal sanctions to control the misuse of drugs and those that rely primarily on the informed choices of citizens as shaped by public health policies, regulatory structures, and honest drug education.

It can be useful to think about alternative drug control policies as arrayed along a spectrum, with the strictly prohibitionist and highly punitive at one end, the unregulated free market at the other end, and a wide array of regulatory policies in the middle. It requires minimal insight, moreover, to recognize that any drug control policy driven principally by public health considerations and stripped of the moralistic and authoritarian impulses that motivate contemporary policy would have little use for many of the more punitive measures in evidence today. The hard questions begin when values such as privacy, tolerance, and a presumption against imprisonment for most non-violent drug-related activities are factored into the analysis of costs and benefits. They become even tougher to answer the further we venture along the policy spectrum into the relatively unknown territory of untested regulatory mechanisms and over-the-counter availability of drugs that can be purchased, if at all, only with a doctor'

s prescription.

Why venture into the unknown terrain of a truly nonprohibitionist drug policy given both the difficulties of evaluating the consequences of a such a policy and the unlikelihood of it being favored by a majority of Americans within the foreseeable future? There are four reasons, each of which are developed below.

First, only such a policy can dramatically reduce the many negative consequences of drug prohibition. Second, it helps us to address fundamental questions about the basic need for a drug prohibition system - in particular long unexamined assumptions about the differences between psychoactive substances and other consumer items as well as the vulnerability of the population to a broader availability of psychoactive drugs. Third, drug policy is one area in which libertarian assumptions regarding the magic of the free market may be more right than wrong. And fourth, the future may bring both new drugs as well as new ways of altering our states of consciousness that are not readily susceptible to government controls and that transform the ways in which Americans think about drugs and consciousness alteration (1).

Thinking seriously and systematically about radical alternatives to current drug prohibition policies requires a degree of intellectual "stretching" that is relatively unusual in policy analysis generally and virtually unknown in the specific case of drug control policy analysis. This stretch is best accomplished by asking two complementary questions: How do we best maximize the benefits of the free market model and minimize its risks? And how do we retain the advantages of drug prohibition while minimizing its direct and indirect costs? This stretch can be visualized by focusing on the extremes of the drug policy spectrum, with the free market at one end, and contemporary American drug prohibition near the other end, and then trying to stretch each toward the other by applying notions of harm minimization to each.

The stretch from contemporary prohibition is, of course, the easier and more familiar one. It begins with a known quantity, the status quo, which is far easier to evaluate than theoretical alternatives - even if many causal relationships resist precise identification. The tendency of policy analysts and policy-makers to focus on options that fall within or close to the realm of politically acceptable options means that far more thought and discussion have been devoted to the more modest revisions of current prohibition policies. Many of the initial steps that one can envision already have been taken in the Netherlands, England, Australia, and elsewhere. And even many of the steps that might be taken beyond what is currently happening abroad still require no radical changes in either the structure or the mechanisms of prohibition.

The further one stretches from the contemporary prohibition model, however, in terms of reducing criminal justice and other coercive controls on the distribution of drugs, the more difficult it becomes to evaluate the consequences. It is, for instance, not that difficult to estimate the consequences of making marijuana, heroin, and other strictly prohibited drugs available by prescription, or of legalizing the sale and possession of syringes and other drug paraphernalia, or of extending the limited decriminalization of marijuana possession enacted by eleven states during the 1970s to the entire country. There are powerful reasons to believe that each of these policy changes would substantially reduce the undesirable consequences of drug prohibition and present only modest risks in terms of public health. But it is quite another thing to estimate the consequences of making cocaine, amphetamine, morphine or heroin more readily available to registered addicts, and surely an even greater intellectual challenge

to evaluate the consequences of making these drugs legally available over-the-counter. That challenge cannot be met, I suspect, by taking contemporary prohibition, and the patterns of drug use that have emerged under it, as the starting reference points.

Evaluating the "supermarket" model

Starting from the alternative extreme of the policy spectrum, the free market, obliges us to focus on the question that lies at the heart of the debate between legalizers and prohibitionists of all stripes: What would be the consequences for American society of having virtually no drug control policy whatsoever? Imagine, for instance, that Congress passed a law granting the freedom of drug consumption and even production and distribution the same legal protections as the rights of freedom of speech, press, religion, and assembly. And imagine that "supermarkets" existed all around the country in which drugs of every variety could be purchased at prices reflecting nothing more than retailers' costs plus reasonable profit margins and sales taxes. This is, of course, the nightmare scenario portrayed by the opponents of legalization - even if it is not the policy favored by virtually any of those identified as proponents of legalization apart from the most hardcore libertarians (2). But it also bears a close res

emblance to the relatively free market in drugs found in late nineteenth-century America - a period characterized by a fairly high rate of opiate and other drug consumption but dramatically fewer drug-related problems than we see today (3).

The great advantage of this model is that it eliminates virtually all of the direct and indirect costs of drug prohibition: the many billions of dollars spent each year on arresting, prosecuting, and incarcerating hundreds of thousands of Americans, the diversion of scarce governmental resources from dealing with other, more immediately harmful, criminal activities, the tens of billions of dollars earned each year by organized and unorganized criminals, much of the violence, corruption and other criminal activity associated with the illicit drug markets, the distortion of economic incentives for inner-city residents, the severe problems posed by adulterated and otherwise unregulated drugs, the inadequate prescription of drugs for the treatment of pain, the abundant infringements of Americans' civil liberties, and all the other costs detailed in the extant literature on drug prohibition and legalization.

The great disadvantage of the supermarket model is its invitation to substantial increases in both the amount and the diversity of psychoactive drug consumption. What needs to be determined as best as possible are the magnitude and nature of that increase and its consequences. Among the more explicit assumptions of the legalization analysis is that the vast majority of Americans do not need drug prohibition laws to prevent them from becoming drug abusers. By contrast, prohibitionists typically assume that most Americans, and at the very least a substantial minority, do in fact need such laws - that but for drug prohibition, tens of millions more Americans would surely become drug abusers. The supermarket model provides no immediate insights into which perspective is closer to the truth, but it does suggest two important approaches on analyzing the implications of a free market.

First, it is imperative that analysts broaden their horizons to examine not just potential changes in the consumption of drugs that are currently illicit but changes in the cumulative consumption of all psychoactive substances. Virtually all human beings consume psychoactive substances. Alcohol and caffeine are certainly the two most common in the United States today, followed by nicotine, marijuana, and a variety of the more popular prescription drugs used to alleviate feelings of depression and anxiety. With the notable exception of alcohol, which has retained its preeminent position throughout the history of American psychoactive drug consumption, all other drugs have witnessed substantial changes in their levels of consumption. Some of these changes have been a result of changes in drug laws. Others have reflected the emergence of new drugs, or new formulations of familiar drugs, as well as changes in medical prescription practices, new marketing techniques, changing fads and fashions in recreational d

rug usage, and broader changes in popular culture as well as particular subcultures. The notion of a truly free market in drugs obliges us to consider what would happen if alcohol, nicotine, and caffeine no longer were artificially favored over other drugs by virtue of their legal status. One strong possibility is that other drugs - including some that are common in other societies, some that were once more popular in America than they are today, and some that have yet to be designed or discovered - would compete with and substitute for those drugs that are most familiar to Americans today.

Indeed, one of the silver linings on the black cloud of greater drug use under different legalization regimes is the prospect that less dangerous drugs would drive out the more dangerous ones. By most accounts, alcohol and tobacco represent two of the most dangerous drugs that have ever entered into common usage in human society. Between them, they present a high proportion of all of the harms associated with other drugs that have experienced widespread usage at one time or another. Tobacco, especially when consumed in the form of cigarettes, is both highly addictive and readily identified as a cause of cancers, cardiovascular diseases, and other ills. Alcohol can be highly addictive for some users; consumed in abundance, it can cause death by overdose in the short-term and cirrhosis of the liver and other diseases in the long-term. It is also associated with violent behaviour and accidental injuries in a great variety of societies. There is no reason to assume that their predominant position in the hiera

rchy of psychoactive substances will persist forever, and good reason to believe that the desirable functions they serve can be replaced by other substances that pose far fewer dangers to the health of consumers in both the short and long-term. The same may be well true of relatively less dangerous drugs, such as caffeine, which may well lose out in the competition to other psychoactive substances, such as low potency coca and amphetamine products, that may improve performance more effectively with even fewer negative side effects.

The possibility of dramatic substitution effects under a free market regime suggests that the most important issue in evaluating the consequences of such a model is neither the overall magnitude of drug consumption nor the number of drug users under such conditions, but rather the magnitude of the negative consequences that would result: the immediate effects of drug misuse on the health and behaviour of the user; the debilitating effects of sustained misuse; and the deadly effects of sustained consumption. Each of these effects may also be of consequence for the nonusers ranging from those who love or live with drug abusers to those who depend upon them in the workplace to those who encounter them on the roads. The evaluation of these consequences, and the assessment of which are more or less serious, inevitably involve ethical judgements. But it is important to recognize that public policy can seek to shift patterns of drug use and even abuse in safer directions by favoring drugs, sets, and settings that c

ause less harm to users and others. It is, in short, possible for the undesirable effects of drug use to decrease significantly even as the amount and diversity of drug consumption increase substantially.

Indeed, if we really seek to be truly objective in our assessments, what needs to be calculated are not just the cumulative negative consequences but the positive ones as well (4).

Proponents of the public health perspective as well as substantial segments of the American population are reluctant to speak of the positive benefits of psychoactive drug use except to the extent they conform with conventional notions of physical health and medical treatment. Alcohol's benefits, for instance, are defined primarily in terms of their potential to reduce heart disease, and those of prescription drugs entirely in terms of their capacity to alleviate pain, depression, anxiety, and feelings that disrupt normal functioning. Yet most people use drugs because they enjoy the effects and many perceive a variety of personal benefits that are rarely measured by physical, medical, or social scientists. Some of these resemble the effects approved by medical and public health criteria, but they typically are not interpreted as such either because they involve an informal form of self-medication or because they confront the common value judgement that one should not have to use psychoactive drugs to be or f

eel a certain way. The moderate consumption of alcohol as a social lubricant, and of coffee or other caffeinated beverages as a mild stimulant to increase alertness, are probably the most easily accepted and widely acknowledged non-medical benefits associated with non-prescribed psychoactive drug consumption. But it is also the case that millions of Americans justify their past use and/or explain their current use of marijuana, cocaine, hallucinogens, and a variety of other drugs in terms of the benefits that they have derived from their consumption of those substances. Such claims are easily belittled in a society that adopts the notion of "drug-free" as its motto, and are often dismissed by scientists who find such benefits particularly difficult to measure. Nonetheless, it seems inherently unreasonable to dismiss entirely the perceptions of consumers, especially when the negative consequences of their consumption are not apparent. We thus have no choice but to calculate the consequences of changes in dru

g consumption not just in negative terms but as a net calculation that incorporates both positive and negative consequences.

The second perspective suggested by the supermarket model is that the potential negative health consequences of a free market, or of any other substantial change in policy, are best assessed by considering the respective susceptibilities of different sectors of the population to such changes. I proceed from two assumptions: that it is possible to distinguish among sectors based on their susceptibility to drug abuse and hence their vulnerability to changes in drug policy; and that close examination of both current and historical patterns of drug use and abuse, as well as other patterns of human behaviour, provide important clues into the nature and degree of susceptibility under alternative regimes. Implicit in the second assumption is the recognition that Americans, and most other people, already live in a society in which powerful psychoactive substances are widely available to both adults and children. One need only to consider the easy availability of alcohol, tobacco, and caffeine virtually throughout

the country; the continued ease of obtaining marijuana and other illicit drugs in much of the country; the extensive presence of powerful psychoactive substances, generally prescribed by medical practitioners, in the medicine closets of American homes; and the entirely uncontrolled availability throughout the United States of many other psychoactive substances, ranging from gasoline and glue to the wide array of drugs available over-the-counter in pharmacies.

What conclusion can be drawn from an analysis of the cumulative consumption of psychoactive drugs in this country? First, virtually all Americans consume psychoactive substances - and even the small minority who appear to abstain entirely, such as the Mormons, seem to compensate by consuming substances that are not traditionally viewed as psychoactive, such as sugar and caffeinated soft drinks. Second, a substantial majority of Americans consume these substances only in moderation, suffering little or no harm as a result. Third, the drugs that prove most addictive to most Americans are those, such as cigarettes and caffeinated beverages, that can be easily integrated into everyday life with minimal hassle or disruption. Fourth, virtually all drugs, even heroin, cocaine, and other drugs most associated with destructive patterns of consumption, are consumed in moderation by most of those who use them (5). Fifth, a substantial majority of those who enter into destructive patterns of drug consumption eventu

ally pass to either abstinence or moderate patterns of consumption (6).

When we focus on those who appear most susceptible to destructive patterns of drug consumption, further conclusions are apparent. First, while certain types of drugs are more difficult to use in moderation than others, the principle determinants of destructive drug use patterns involve not the pharmacology of the drug but the set and setting in which the drug is consumed. That is why alcohol consumption among conquered aboriginal groups and cocaine consumption among some inner-city populations have more in common with one another than either does with patterns of alcohol or cocaine consumption among less vulnerable sectors of the population. Indeed, no set and setting is more conducive to extensive and severe drug abuse than the combination of poverty and maladjustment to a mainstream society. Second, those who engage in destructive patterns of consumption with one drug are the most likely to repeat that pattern with other drugs; conversely, those who demonstrate an ability to consume alcohol and common pr

escription drugs responsibly, or who have succeeded in either stopping or dramatically curtailing their consumption of tobacco, are much less likely to engage in destructive patterns of consumption with other drugs.

Consider the results of recent polls on drug use in the United States. Approximately one-third of Americans over the age of twelve claim that they have not used alcohol in the past year, and close to half report that they have not consumed any alcohol in the past month (7). In December 1990 Gallup poll, 43% of those polled described themselves as abstainers from alcohol - up from 29% in the years 1976-1978 (8). Among African-Americans, the proportion who claim to abstain from alcohol is 58% (9).

Of those Americans who did drink within the past month, only one in ten (or about 5% of the household population) reported that they had drunk heavily during that time (10). Approximately 75% of all Americans over the age of twelve had smoked at least one cigarette; slightly less than 30% report that they smoked within the past month, of which half consume about a pack or more a day (11). With respect to marijuana, about 33% of Americans have used it at least once, 11% in the last year, 6% in the past month, and about 1% on something resembling a daily basis (12). There is reason to believe that there is substantial overlap not only between those who drink heavily and those who smoke heavily, but also between those groups and those who use illicit drugs heavily - although detailed cross-tabulations of available surveys are required to reach more exact estimates. Indeed, one also finds substantial overlap with those who engage in compulsive gambling and other harmful activities. The principle exception to t

his substantial overlap may involve the misuse of tranquilizers and other prescriptions drugs, especially among women. Even if we assume that self-reports of alcohol and tobacco consumption tend to underreport actual consumption by 30% to 50%, we still conclude that at least 70% of Americans are resistant to the sorts of temptations and risks posed by the easy availability of cigarettes, and more than 90% either refrain from powerful drugs altogether or else consume them responsibly and in moderation. This conclusion strongly suggests that a very substantial majority of Americans are immune to any far reaching liberalizations in drug availability for the simple reason that they do not really need drug laws to prevent them from entering into destructive relationships with drugs. .

The important question is thus not whether or not millions of Americans would change their patterns of drug consumption under a radically different drug control regime - since there is good reason to assume they would - but rather whether those patterns would be more (or less) destructive than their current patterns of drug consumption. Among the tens of millions of Americans who abstain from alcohol consumption, it seems reasonable to assume that they would have little interest in, and perhaps substantial moral reservations against, consuming other powerful psychoactive drugs. Among the even larger number of Americans who consume alcohol in moderation, despite the great potential for that drug to be consumed in a destructive fashion, it is also reasonable to assume that the same individual and societal restraints that protect them against alcohol's seductive powers would control their consumption of other substances. For the vast majority of Americans, therefore, the principal danger posed by a free mark

et in drugs has little to do with drugs like crack cocaine, since so few Americans would be likely either to try it in the first place or, if they did try it, to continue to use it. (Public opinion polls consistently reveal that few Americans believe they would consume cocaine, heroin or even marijuana if those drugs were legally available) (13).

The greatest danger of a free market in drugs, I suspect, is the possibility that a drug, assumed at first to be relatively safe, becomes popular among millions of Americans and then is revealed to be far more harmful than initially believed. This danger is one that has proven commonplace in the annals of pharmaceutical innovation, medical prescription practice, and inebriation, from morphine and cocaine during the nineteenth century to cigarettes, barbiturates, amphetamine, tranquilizers, and many nonpsychoactiv drugs, including steroids, during the twentieth. It is one that has continued to frustrate the regulatory efforts of the Food and Drug Administration in recent decades, and that promises to persist into the future regardless of whether or not the drug laws change substantially. But it is fair to assume that the dangers would be greater if far more products were to become legally available.

The most common fear of legalization, however, is usually of a different sort, and it must be taken seriously. It is that there are millions of Americans for whom the drug prohibition system represents the principal bulwark between an abstemious relationship with drugs and a destructive one. Under a free market regime, it is feared, many of those who currently abstain from, or consume in moderation, alcohol and other powerful intoxicants would become drug abusers, and many of those who have already demonstrated either a potential for, or a pattern of, drug abuse would engage in even more destructive patterns of drug use. Underlying this fear are a variety of assumptions: that the only things which prevent many current users of illicit drugs from engaging in far more destructive patterns of drug use are the high price and lower availability of those drugs under the current prohibition regime; that at least some of the illicit drugs are more seductive than those that are currently legal and/or available;th

at a free market regime would inevitably invite greater levels of drug experimentation, which in turn would lead to higher levels of use and abuse; that many people would be more likely to complement their current drug use with newly available drugs than to substitute those for their current preferences; and that the heightened societal tolerance for more varied psychoactive drug use that would likely accompany a free market regime would lend itself to higher levels of drug misuse.

Even if we assume that the vast majority of those who now consume psychoactive drugs safely would continue to do so under a free market regime, and further assume that a substantial proportion of those who currently misuse illicit drugs would be no worse and quite likely better off under a free market regime, the fact remains that there is a relatively small, but indeterminate, proportions of Americans for whom the drug prohibition system provides not just the image but the reality of security. Figuring out, with some measure of confidence, the magnitude and composition of this vulnerable population is among the most important intellectual challenges confronting those who take seriously the need to estimate the consequences of alternative regimes. And designing policies that minimize the magnitude of this at-risk group without resorting to criminal justice and other coercive measures is surely an even greater challenge.

Most of those who would suffer from the absence of the current drug prohibition regime can be found among those who currently smoke cigarettes and/or abuse alcohol. The first group includes both those adolescents and adults who have demonstrated a willingness or ability to disregard the well known consequences of cigarette smoking, as well as those adults who have demonstrated an inability to abandon a dangerous habit. The second group, which overlaps substantially with the first, includes those adolescents and adults who have demonstrated an inability to control a powerful pschoactive substance, i.e., alcohol, despite the existence of increasingly strong social controls. There are certainly others who neither smoke cigarettes nor abuse alcohol who would enter into destructive relationships with other drugs if they were more readily available, but there is (as I have already suggested) good reason to doubt that their numbers would prove substantial.

In trying to predict which drugs will prove most popular in the future, who will use them responsibly and who will do so destructively, it is important to keep in mind why people use drugs and why they use the drugs they do. The choice of drugs for most members of most societies can barely be described as a choice at all. Dominant cultures strongly favor some drugs over others, hence the preferred position of alcohol throughout much of the world, with different societies evidencing a preference for beer, wine or distilled liquors, or of coffee in most Islamic societies and quat in some, of kava in some South Pacific islands and coca in the Andes. Alcohol's dominant position no doubt stems as well from the fact that its simple means of production was easily discovered millennia ago by a wide diversity of societies, so that it was not merely readily available in most societies but also provided with substantial opportunity to entrench itself (14).

Tobacco's second position somewhat similarly can be attributed to its great success in sweeping the globe and becoming entrenched in a great variety of societies before the emergence of any international capacity for its suppression - although its powerful addictive qualities must also be given credit for ensuring that markets once penetrated remained markets thereafter. As for substances such as kava, betel nut, coca, cannabis, opium, and various hallucinogens, each has benefited, not unlike alcohol, from being an indigenous product.

To the extent that drug consumption patterns and preferences can really be described as a choice, it is fair to say that people choose those drugs that give them what they want. Most people can in fact be described as rational consumers even in their choice of psychoactive drugs. They use drugs because they seek or like their effects, whether those involve relief from pain, reduction of stress and anxiety, release from inhibitions, stimulation of the senses and the intellect, enhancement of physical or mental performance, or any of the many other psychoactive effects of drugs. Most people, moreover, tend to limit their consumption in order to minimize the negative consequences, whether those involve hangovers, heart disease or cancer. The evidence from a broad variety of cultures suggests that the single most important determinant of a drug's popularity is its capacity to be integrated into ordinary lives with minimal disruption.

It is important to recognize that the same notion of rational drug consumption applies to some extent even to those who are engaged in highly destructive patterns of consumption. For many hard core drug users in the inner cities and among aboriginal populations, their intensive involvement with powerful drugs provides a powerful source of relief from emotional and other psychological pain, some excuse for isolating themselves both from mainstream society and difficult personal responsibilities, and (particularly for those most engaged in the day to day hustling for the means to procure their expensive drugs) a source of self esteem and motivation to keep getting out of bed in the mornings despite the absence of any promising prospects in their lives. This is not to say, of course, that the destructive drug use patterns of those living on the edge of despair can be described as entirely rational. But it is to say that even hard core drug abusers tend to prefer drug consumption options that minimize the ris

ks of death in both the long and the short-term; the growing evidence about the willingness of intravenous drug addicts to take modest steps to reduce the likelihood of contracting the HIV virus attests to this (15). Relatively few hard core drug addicts can be described as truly committed to an early death. It is thus reasonable to assume that even most current and potential hard core drug users will, if given the choice, opt for drugs that are, at the very least, no more dangerous than those consumed today.

One can supplement the notion of rational drug consumption, which focuses on the individual's preferences, with another notion also drawn from libertarian philosophy. It is that societies, like individuals, generate nonlegal social norms in the absence of governmental prohibitions and other restrictive laws. Societies, simply stated, are not entirely at the mercy of free markets, but retain the potential to create self-protective mechanisms designed to minimize the risks presented by such markets. Indeed, some libertarians argue, one of the more significant costs imposed by governmental prohibitions is the withering of social norms that often operate more powerfully and effectively than governmental interventions. Evidence in support of this argument can be found in anthropological and sociological studies of traditional and modern cultures alike, wherever patterns of human intercourse are allowed to evolve in the absence of significant governmental prohibitions. Particularly reassuring in this regard a

re the many decriminalizations that one can point to throughout civilized human history that were opposed by those who feared for the civility and even the survival of society but that turned out to be far less destabilizing than was feared. Such fears impeded efforts to do away with restrictions on speech, press, religion and assembly, on relations between people of different classes and races, on sexual and familial relations, and on the availability of psychoactive drugs that are now integrated into modern society (16). The same sorts of unjustified fears now stand in the way of efforts to do away with current drug prohibitions.

The arguments of the libertarians are both powerful and, at least with respect to the majority of society, quite convincing. They confront, however, three counterarguments that most Americans currently find compelling. The first is simply that drugs and drug consumption are fundamentally different than all other commodities and activities - so different that ordinary libertarian assumptions do not apply. The second, like the notion of rational drug consumption, derives from economic reasoning. It is the evidence that suggests that levels of consumption of desirable consumer items tend to increase as their availability increases and their price decreases. And the third is the epidemiological evidence suggesting that the negative consequences associated with the use of any drug in a society are a direct function of the overall level of use of that drug. Of these three arguments, the first represents the weakest in terms of logical analysis but the most powerful from an emotional and political viewpoint.

It can be repudiated by reference to the many ways in which other commodities and activities generate the same sort of behaviour as do the consumption of drugs, be it the alteration of consciousness, the transformation of social behaviour or the creation of dependent relationships (17). But the belief in the unique power of psychoactive drugs is so entrenched in our society that even prominent liberal theorists, including those with strong libertarian inclinations, either avoid the subject altogether or else carve out awkward exceptions to their otherwise more coherent philosophies. The second and third arguments, by contrast, present far more powerful reasons to refrain from placing one's faith entirely in libertarian assumptions.

There are other reasons as well to put the purist libertarian assumptions and the supermarket model to the side. The more one speculates about the consequences of such a model, the more one realizes that all sorts of additional assumptions have to be made about the type of society that would favor such a model - and that these assumptions are even more speculative than anything we assume about the vulnerability of today's population to such a model. At the very least, the sets and settings that so powerfully shape the nature and consequences of drug use would inevitably defer dramatically from their contemporary formulations. Furthermore, as soon one engages in the process of trying to think through the consequences of such a model, one encounters the inevitable tendency to begin framing restrictions on the supermarket. Whether one analogizes to alcohol and tobacco or to the nineteenth-century model of widespread drug availability, one confronts with the tendency both in the United States and elsewhere t

o impose restrictions on the distribution of psychoactive drugs.

The right of access model

We thus return to question: How can the risks and harms of the free market model be reduced without undermining the many benefits that such a model offers? And how far can the free market model be stretched without giving up its essential feature? That essential feature, it must be stressed, is the legal availability of drugs in the absence of any requirements that the permission of governments-sanctioned gatekeeper be obtained beforehand. It is that feature that distinguishes the legal status of alcohol, tobacco, caffeine, and aspirin from that of marijuana, cocaine, morphine, and Valium - and that accounts for the generally greater and easier availability of the legal drugs compared to the illegal drugs. Legal drugs are almost always available over-the-counter; illegal drugs are not. Government-sanctioned medical authorities and pharmacists, and sometimes additional barriers as well, stand between the illegal drug and the person who wishes to obtain it.

It is important to recognize that legal availability does not always connote easy availability, and that the restrictive legal status of a drug does not always make it that difficult to obtain. Legal drugs may, for instance, be so expensive - either because of high costs or of production or high taxes - that they are for all intents and purposes unavailable to many potential customers. Distribution channels may be relatively undeveloped or otherwise circumscribed. And efforts by government to restrict severely the availability of a legal drug without depriving consumers entirely of the right to purchase it legally may prove successful. Powerful evidence in support of these propositions can be found in the alcohol control efforts in the United States, Australia, and much of Europe during the 1920s and 1930s. Whereas the former initially favored Prohibition, the latter opted instead for tough, but non-prohibitionist, regulatory regimes. The results were more substantial, and more lasting, declines in alc

ohol consumption and alcohol-related ills in Europe and Australia than in the United States (18).

Illegal drugs, by contrast, can occasionally prove to be highly available. Medical practitioners often write prescriptions for mild tranquilizers, sedatives, and other psychoactive drugs in response to their clients' plaints. They may do so because they believe that such drugs are a proper and effective way of medicating their clients, or because they believe that a client's satisfaction with a visit to her doctor depends in part upon the doctor's willingness to end the visit by writing a prescription. And even apart from such channels, illegal drugs can prove readily available wherever substantial markets generate high levels of supply - as was the case with marijuana in much of the country during the 1970s and 1980s. The same holds true of more localized markets, in particular the inner-city markets for cocaine since the mid-1980s as well as for other drugs that have attained high levels of popularity in particular neighborhoods or cities. In cases such as these, illegal drugs may prove more available

than many legal drugs, such as alcohol, for which the hours of sale are often restricted by government. In many highly restricted environments, moreover, such as prisons, jails, and mental institutions, illegal drugs are often more available than alcohol because their smaller bulk makes them easier to smuggle past guards and other barriers.

The foregoing analysis suggests that it is possible to construct legal drug control regimes in which certain drugs may be less available than is the case under prohibition regimes. When we stretch as far as possible from the free market extreme of the drug policy continuum, but seek at the same time to retain the basic feature of nongatekeeper accessibility, the model that emerges is one that might be called the "right of access" or "mail order" model. It is based on the notion that adults should be entitled not merely to the right to possess small amounts of any drug for personal consumption but also to the right to obtain any drug from a reliable, legally regulated source responsible (and liable) for the quality of its products. In identifying such a right, I must stress, I do not mean to suggest that it is on a par with the more privacy-based right of possession and/or consumption, but merely that it provides a useful parameter - both ethically and conceptually - for designing alternative drug control

policies. Unlike the supermarket model, the right of access model is one than can be superimposed on the current drug prohibition system.

If such a right of access were legally acknowledged by Congress or the Supreme Court - a prospect, I recognize, with scant political or jurisprudential potential in the foreseeable future - those desirous of minimizing the potential threat to public health might well advocate the notion of a mail order system. In order to ensure a right of access to all residents of the United States no matter where they might live, at least one mail order source would have to be available in the United States from which any adult could order a modest amount of any drug at a reasonable price reflecting production costs and taxes. Most states, cities, and other communities might well continue to prohibit the sale and public consumption of most drugs within their jurisdictions as they do now, but would be obliged to acknowledge the basic right of access by mail order as well as the basic right of possession and consumption. Some localities might also adopt, if they had not already done so, the various sorts of harm reducti

on policies that are advisable under any regime. One might also imagine many other local variations by different states and municipalities to accommodate the particular health, criminal justice, and moral concerns of each. But the option of ordering one's drugs by mail would allow any adult to opt out, in effect, of the local control system insofar as private consumption was concerned.

The right of access notion offers us, I think, a more valuable, modest, and realistic alternative extreme than the supermarket model from which to stretch toward the optimal policy. As a model, it retains in skeletal form the essence of a legalization regime, which is the elimination of any sort of gatekeeper - policeman, doctor, pharmacist, etc. - between the seller and consumer of drugs with the power to deny the latter access. It thus strikes at the heart of much of what is wrong with drug prohibition, in particular the creation of violent and powerful black market entrepreneurs, the harms that result from unregulated production of psychoactive drugs, and the many infringements on individual freedoms. But it also provides a skeletal framework that can be filled out with many of the sorts of antidrug abuse measures that we associate with both harm reduction approaches to illicit drug control policy and public health approaches to alcohol and tobacco control. It has the advantage of resembling actual mod

els in other domains of public policy both today and in recent history, including the alcohol distribution system in Canada and Sweden during the early decades of this century as well as in pre- and post-Prohibition United States, and the modification of FDA policy in recent years to allow individuals to import by mail small amounts of drugs that are legally available outside the United States but that have yet to be approved by the FDA for the treatment of AIDS or cancer (19). Given the preference among critics of drug prohibition for a fairly high degree of "local option", it addresses the inevitable tensions among different state and local drug control policies, between those policies and federal policies, and even (albeit to a lesser extent) between domestic policies and international requirements. At the same time, it offers a paradigm for addressing and reconciling the tensions between individual rights and communitarian interests that lie at the heart of so many struggles over public policy in democr

atic societies.

This model is not, I must stress, a panacea, nor should it be misconstrued as a final proposal for an alternative drug control regime. It raises numerous questions such as how such a mail-order system would be established and maintained, who would run it and profit from it, who would oversee it, who would have access to its mailing lists and other information about consumers, how consumer privacy would be protected, how minors would be prevented from taking advantage of it, how new drugs would be made available, and so on. Most of these questions strike me as susceptible to fairly precise answers, in good part because there are so many analogies to a mail-order system. More difficult to assess are the same sorts of questions raised by the supermarket model and all other alternative models, in particular those that focus on assessing changes in psychoactive drug consumption - although I assume that they are easier to answer with respect to a mail-order model since such a system is more readily integrated w

ith the current prohibition model than is the case with the supermarket model.

One prominent difference between the right of access or mail-order model and the supermarket model is that the former fails to eliminate the black market. Just as some gun control laws rely on waiting periods between the time a person orders a firearm and the time he obtains possession, so a mail-order system imposes a sort of waiting period - presumably a minimum of one day. It is highly reasonable to assume that black markets would persist not only to supply minors - which is presently the case with most psychoactive substances, including alcohol and tobacco - but also to supply those who will not or cannot wait to obtain their drugs from the mail-order system, as well as those who want to obtain more at any one time than is allowed by law.

We typically assume than an important objective of legalizing drugs is to undercut the black markets and place them in the hands of either government or government-licensed and regulated distributors. This objective is tempered by the recognition that there are better and worse features of illicit markets, and that a preferable drug policy ideally would focus on eliminating the worst while tolerating the better features. It would, for instance, attempt to undermine the accumulation of power by organized criminals, reduce the violence that attends such markets and generally push large-scale production into the hands of regulated, tax paying, and collecting producers and distributors. But at the same time, it might well choose to ignore smaller scale illicit markets - what are often referred to less disparagingly as informal or unregulated markets - which are of value not just because they often prove more innovative and enterprising in designing and offering new products but also because they provide an im

portant source of income for many people who face substantial disadvantages in their efforts to penetrate and succeed in the more established legitimate markets. This holds true, for instance, of both rural producers of marijuana and inner-city entrepreneurs engaged in the low-level distribution of crack and other drugs. Two probable advantages of the right of access model are that it would effectively undercut efforts by organized criminals to create highly profitable national distribution systems, since any adult could purchase the drugs by mail. At the same time, it would not eliminate many illicit small scale, localized production and distribution systems that meet local demands for immediate availability, rapid delivery, and specialized products. Local authorities could choose, in effect, either to suppress such black markets vigorously or to manage them through conventional vice control methods. But the scale of such markets would probably bear a closer resemblance to illicit prostitution rings in

cities that sanction regulated prostitution than to contemporary illicit drug markets.

Transition issues

Few drug control regimes are static. Prohibitions, regulations, and decriminalizations tend to evolve as new drugs emerge, as drug use patterns shift, as other drug-related norms change, and as popular and elite perceptions of various drugs, drug consumers and drug problems shift. In contemplating alternatives to the current drug prohibition regime, we need to distinguish between transition phases, longer term consequences and equilibria, keeping in mind that there is no drug control regime that will suffice forever. The distinction is important with respect to issues of both drug consumption and black markets. It is safe to assume that illicit markets do not just shrivel up and die when confronted with competition from licit markets during the initial phase when licit producers and distributors are still gearing up, having the advantage of their previous investments in production and/or distribution as well as their expertise. The share of the market that is captured by legal producers and distributors

in the long-term, however, probably would depend more on price, availability, competition, the intensity of continued law enforcement

efforts to suppress the remaining black market, and changing tastes and fads among consumers. There are also important policy questions regarding the extent to which those involved in the illicit markets during prohibition should be allowed or encouraged to play a role in legal markets after prohibition.

Close examination of the aftermath of Prohibition in the United States, other postprohibitionist periods elsewhere, and other decriminalizations, such as of gambling, prostitution, pornography as well as of nonvice markets in countries experiencing significant deregulations (such as the former Soviet bloc countries) can provide important insights into how drug markets are likely to evolve (20). The impact of decriminalization on those involved in illicit drug dealing, as well as on those who would have become involved in drug dealing but for decriminalization, is especially important when we focus on African-American and Latino youth in the urban ghettos. Clearly the dramatic drop in the price of currently illicit drugs following decriminalization would greatly reduce one of the most powerful incentives for engaging in drug dealing and other criminal activities. According to a recent report by the Justice Department's Bureau of Justice Statistics, 13 percent of all convicted jail inmates, and 19 percent o

f those convicted of drug trafficking offenses, said they had committed their offense to obtain money to buy illicit drugs (21). Dramatic reductions in size and profitability of the illicit markets would also remove the powerful financial and social incentives that have lured so many urban youth into drug dealing activities even before they began to consume illicit drugs.

Further insights into this question can be derived both from analyzing the response of bootleggers to the repeal of Prohibition and from observing how illicit drug dealers adapt when illicit drug markets decline, as seems to be the case today (22). Illicit vice entrepreneurs seem to respond to decriminalization and shrinkage in illicit markets in any of four ways. Some succeed in making the transition to legal entrepreneurship in the same line of work. Some seek to remain in the business illegally, whether by supplying products and services in competition with the legal market or by employing criminal means to take advantage of the legal markets. For instance, following Prohibition, some bootleggers continued to market their products by forging liquor tax stamps, by strongarming bartenders into continuing to carry their moonshine and illegally imported liquors, and by muscling their way into the distribution of legal alcohol. Some also fought to retain their markets among those who had developed a taste

for corn whiskey before and during Prohibition. The third response of bootleggers and drug dealers is to abandon their pursuits and branch out instead into other criminal activities involving both vice opportunities and other sorts of crime. Indeed, one potential negative consequence of decriminalization is that many committed criminals would adapt to the loss of drug dealing revenues by switching their energies to crimes of theft, thereby negating to some extent the reductions in such crimes that would result from drug addicts no longer needing to raise substantial amounts of money to pay the inflated prices of illicit drugs. The fourth response - one that has been and would be attractive to many past, current, and potential drug dealers - is to forego criminal activities altogether. Relatively few criminal pursuits can compare in terms of paying so well, requiring so few skills, remaining fairly accessible to newcomers, and presenting attractive capitalist opportunities to poorly educated and integrated

inner-city youth. During Prohibition, tens if not hundreds of thousands of Americans with no particular interest in leading lives of crime were drawn into the business of illegally producing and distributing alcohol; following its repeal, many if not most of them abandoned their criminal pursuits altogether. There is every reason to believe that drug decriminalization would have the same impact on many involved in the drug dealing business who would not have been tempted into criminal pursuits but for the peculiar attractions of that business. The challenge of researchers, of course, is to estimate the relative proportions of current and potential drug dealers who would respond in any of these four ways. The even broader challenge is to determine the sorts of public policies that would maximize the proportion that forego criminal activities altogether.

The need to distinguish between transition phases and longer term consequences and equilibria also applies to the impact of decriminalization on potential and current illicit drug users. The initial liberalization of availability is likely to spark high levels of curiosity, stimulated both by the media and by the mere fact of legal access, and substantial experimentation with different drugs - but it is reasonable to assume that this would moderate over the long-term. At the same time, the initial reluctance of many Americans to try newly available drugs to which they are unaccustomed may fade over time. Those who have grown up under a prohibition system, moreover, and have thus been influenced to one degree or another by the many assumptions that prohibition conveys about drug use, are likely to experience a legal regime differently than succeeding generations for whom it will represent the norm.

Gatekeepers, norms, and information systems

There is also the question of how a liberalization of legal availability will affect both the doctor-patient relationship and the role of pharmacists. It would be useful to know, for example, what proportion of visits to doctors are motivated principally by the desire or need to obtain a prescription for a controlled substance. Between one-half and two-thirds of all consultations with doctors result in the writing of a prescription (23). A legal drug regime would negate the need for visits motivated solely by the need to obtain a prescription, with mixed results. Some people would suffer as a result of not being obliged to consult with a doctor, but many others who must now waste time and money on unnecessary doctor visits would surely benefit. The problem of undermedication, and particularly undertreatment of pain, would almost surely be less of a problem than it is now. But some people would surely be more likely to use inappropriate drugs and to develop unhealthy dependencies on drugs that are now ava

ilable only by nonrenewable prescription. Better insights into these issues can be gained by analyzing the available evidence about why people go to doctors as well as patterns of self-medication and doctor visitation in other times and places in which there have been fewer controls on the availability of drugs (24).

The role of doctors and pharmacists as gatekeepers for prescription drugs is of course part and parcel of a broader question about the basic need for creating and maintaining a distinction between over-the-counter and prescription drugs. This question has been addressed most sharply by economists, although the literature on the broader implications of the distinction remains quite limited (25). The notion of requiring prescriptions for drugs other than cocaine and opiates is, as Peter Temin wrote in his historical study of drug regulation in the United States, a relatively recent notion - one that was not consonant with the 1938 Federal Food, Drug, and Cosmetic Act but that emerged in spite of a legislative intent to the contrary (26).

Implicit in the notion was the belief that many Americans would not act rationally in their choice and use of drugs and thus needed to be shielded from their own irresponsibility by governmental controls. One result was a significant constriction in the provision of information about drugs to consumers. The supposition that a mandatory drug prescription system plays an essential role in protecting the health of consumers has yet be systematically tested. One study that employed a cross-national comparative perspective concluded that the prescription requirement did not yield a net benefit in health effects (27).

Another, by Peter Temin, suggested certain criteria that could be used to determine when a drug should be restricted or made available over-the-counter (28). These studies provide valuable insights, but they represent only a small step in the direction of determining the likely consequences of severely restricting or eliminating the mandatory prescription system.

I should stress that these issues are at least as important with respect to the urban ghettos as they are in thinking about middle-class drug usage. Much illicit drug abuse in urban ghettos can fairly be described as a form of self-medication for depression and other pschological pain among people who tend not to seek out psychiatrists and other doctors for such ills. The drugs they use to hide and forget their pains - alcohol, illegal heroin and cocaine, and other "street drugs" - are often more dangerous but no more effective than those prescribed to middle-class patients by their doctors. At the same time, urban ghettos are full of people who might well benefit from access to the same sorts of antidepressants and other drugs that middle-class Americans obtain from their doctors but who fail to obtain them both because they eschew the illicit markets and because financial and cultural limitations preclude visits to doctors. Here it is worth pointing out the patent absurdity of the claim that drug legal

ization would devastate inner-city populations. Both legal and illegal drugs are already so widely available in inner cities that virtually any resident can obtain them far more quickly than in suburban neighborhoods. But a liberalization of drug availability would make more easily available drugs that are safer than those now sold in urban liquor stores, crack houses, and street markets. At the same time, it would substantially reduce the negative consequences of prohibition - all of which are felt most severely in the urban ghettos.

More broadly, there is good reason to think that a regime of legal availability would substantially, even radically, transform the ways in which Americans relate to psychoactive drugs. One might well imagine that pharmacological experts, certified perhaps by either government or professional agencies, would play an increasingly important role not so much as gatekeepers but as educators and consultants on the preferred uses of drugs for medicinal, psychotherapeutic, recreational, and other purposes. But even more importantly, nonlegal norms would undoubtedly emerge in the absence of current prohibitionist norms to shape the way people relate to drugs, the ways in which they use them, and the cautions they exercise. Here again, there is the question of determining which people are likely to prefer the least potent and least risky drugs and which are more likely to opt for the most potent, quickest acting, and so on. There is also the possibility that a world of widespread drug availability might be more li

kely to generate self-protective norms against all forms of drug taking. And it is fair to assume that far more people would assume greater responsibility for their relationship to drugs than is currently the case, since the gatekeeper role of doctors effectively transforms consumers into far more passive actors.

This in turn leads to the question of how information about psychoactive drugs could be better distributed to a population so that it is readily available and intelligible to typical consumers. The challenges here are fourfold. The first is to design an effective means of distinguishing among categories of drugs so that those who purchase either by mail or at retail outlets are properly informed of the risks and appropriate uses. This task could be performed by either a Food and Drug Administration (FDA) or a nongovernmental agency such as Consumer Reports, or both. The second is to design an information system separate from the distribution systems whereby consumers can obtain necessary information on their own at little or no cost.

This might involve information distribution systems accessible by telephone or other easily accessed computer hookups. Current efforts by the FDA, and by consumer organizations such as those promoted by Ralph Nader, to ensure that consumers are provided with both more accurate and more accessible information may well provide something of a model in thinking about issues such as these. The third challenge is to create honest drug education programs that tell children the truth about drugs without stimulating premature desires to try them (29). And the fourth is to design public health campaigns that effectively discourage drug misuse without resorting to lies, scare tactics, and the demonization of people who use drugs. The public service advertisements directed at discouraging tobacco consumption and drunken driving provide far better models in this respect than the "Fried Egg" ads, caricatures, and untruths promoted by the Partnership for a Drug-Free Ameria (30).

Most of what people know about drugs they have never used comes from the commercial media. It has repeatedly played a central role in transforming local fads and fashions into national and even international phenomena (31). We can safely assume that it will play a crucial role in the distribution of information and the shaping of public perceptions about drugs, particularly those that are relatively unfamiliar to most Americans. One need only imagine what impact the news magazines' cover stories in late 1989 and early 1990 on the new antidepressant, Prozac, would have had if Prozac were available over-the-counter or by mail; indeed, it would be interesting to know what impact those stories actually did have on potential consumers (32). How many people, for instance, visited doctors thereafter with the intention of obtaining prescriptions for Prozac, how many succeeded, and - even more difficult to say - how many benefited or suffered as a consequence? Conversely, how many people who might benefit from Pr

ozac have not tried it yet solely because they are unaccustomed to visiting a doctor to obtain assistance in alleviating depression? Certainly there is good reason to fear the media's impact on drug consumption preferences under a legal regime given its historic and persistent incapacity to provide accurate and balanced information about psychoactive drugs (33). On the other hand, the media occasionally has demonstrated its capacity to shape preferences in healthier and otherwise better directions. It is certainly a loose cannon insofar as our efforts to evaluate the future direction of drug use are concerned. But there is good reason to devote at least some effort to considering how the media has shaped drug consumption patterns in the past.

The issue of advertising is a difficult one. In 1986, the Supreme Court rules in Posadas de Puerto Rico Associates vs. Tourism Company of Puerto Rico that strict restrictions on advertising casino gambling were constitutionally permissible (34). There seems to be little question that comparable restrictions on advertising psychoactive drugs would also be regarded as legal (35). The difficult issues thus involve balancing the costs and benefits of both specific types of advertising as well as the advertising of psychoactive products generally. There is good reason to fear, and curtail, the mass promotion of psychoactive drugs that present the sorts of harm associated with alcohol and cigarettes (36) There are also substantial incentives to avoid a revival of medical quackery and the mass marketing of patent medicines that once tricked millions of Americans into buying products that did them little good and occasionally much harm. On the other hand, advertising can play a valuable role in informing people

of new and beneficial products, in luring consumers to switch from more dangerous to less dangerous drugs, and in promoting competition that saves consumers money (37).

This is true of both psychoactive and non-psychoactive drugs as well as those used for both recreational and more traditional therapeutic purposes. The solution to the advertising dilemma - to the extent we are willing to put aside First Amendment concerns - may well lie in a combination of restrictions on the promotion of more harmful products with vigorous educational campaigns to discourage their consumption.

Conclusion

Predicting human behaviour remains, and shall always remain, an imprecise art. Social science can provide modest insights into the consequences of incremental changes in regulatory structures on human behaviour. But when we try to envision the consequences of more far reaching changes in such structures, our confidence in social science insights falters. The variables are too numerous, the changes in individual and societal consciousness too unpredictable, and the tools too paltry to pretend that we can really know the future. Here history offers a more powerful guide - with its potential to shed light on both the accretion of incremental changes and the suddenness of revolutionary change. But even its lessons are limited by unanswerable questions regarding the potential of the future to evolve in unprecedented ways. Ultimately our predictions are bounded by theories of human behaviour, and particularly of human and societal vulnerability and resilience, that have more to do with our visceral fears and

confidences than any objective readings of the evidence.

When we switch from predicting the future to trying to plan it, our preferences are determined not only by our calculations of their consequences but also by our choices among competing ethical values. Such choices may be made implicitly, as when we accept without question conventional ethical values, or explicitly. They establish the parameters beyond which policy options will not be considered. They influence our calculations of the costs and benefits of various options. And they guide us in deciding who should benefit and who may be harmed by choosing one option over another. There are no objective standards by which to choose among ethical values. One can only appeal to conscience, principle, and empathy.

The challenges of evaluating radical alternatives to our current drug prohibition system are formidable. But so are the challenges of predicting the consequences of persisting with our current policies. In 1960, few Americans had ever heard of LSD, and the notion that sixty million Americans would smoke marijuana during the next three decades would have seemed bizarre to most Americans. In 1970, few Americans gave much thought to cocaine, and most would not have believed that twenty-five million Americans would try it during the next two decades. By the late 1970s, many Americans believed that marijuana would be sold legally within a few years. In 1980, no one had ever heard of "crack" cocaine; the notion of an AIDS epidemic among injecting drug users seemed inconceivable; and the prospect of a quarter-million Americans in jail or prison by 1990 for violating drug prohibition laws seemed preposterous. Clearly, retention of our drug prohibition system provides no guarantees about future patterns of drug

use or the scale of future drug problems. Legalization may present a wider array of possibilities, but its uncertainties are not dramatically greater than those of persisting with prohibition.

There are powerful reasons for taking seriously the alternatives to drug prohibition. The first is simply that drug prohibition has proven relatively ineffective, increasingly costly, and highly counterproductive in all sorts of ways that many Americans are only beginning to appreciate. Nowhere is this more true than in the urban ghettos, where the war on drugs has failed to reduce the availability of illicit drugs or the incidence of drug abuse and offers no prospect of doing so in the future. At the same time, these neighborhoods and their residents have suffered the negative consequences of drug prohibition more severely than any others. Not unlike Chicago under Al Capone, they must live with the violence and corruption generated by prohibition, the diversion of law enforcement resources, the distortion of economic and social incentives for their youth, the overdoses that result from unregulated drugs, the AIDS that spreads more rapidly because clean syringes are not legally or readily available, and

the incarceration of unprecedented numbers of young men and women. Those who contend that legalization would mean writing off impoverished inner-city neighborhoods ignore the remarkable extent to which drug prohibition has both failed and devastated the urban ghettos. Drug legalization offers no panacea, particularly if it is not accompanied by more fundamental changes in the norms and leadership of urban societies. But there is no question that it can alleviate many urban ills at relatively little risk.

Second, there are good reasons to believe that a nonprohibitionist regime would not result in dramatic increases in drug abuse. Public opinion polls reveal that few Americans believe they would use drugs that are now illicit if they were legally available. Important implications, moreover, can be derived from the observation that we already live in a society in which all sorts of psychoactive substances are cheaply and readily available to both adults and children. Legalization would make more drugs more available than they are today, but it would not present a situation dramatically different from that which currently exists. The same sorts of norms and interests that prevent most Americans from misusing drugs today would persist. And even many of those who do misuse illicit drugs would be no worse off, and in many ways better off, under an alternative regime. Some Americans would suffer from the abolition of drug prohibition, but all the evidence suggests that their numbers would be modest. We posse

ss, in short, substantial evidence of a fundamental societal resilience in the face of widespread drug availability.

Third, there are also good reasons to anticipate positive shifts in drug consumption patterns if we move in the direction of non-prohibitionist controls. The current drug control regime favors certain legal and illegal drugs over others that may well present fewer dangers to both consumers and society generally. Under a legalization regime, alcohol and tobacco would no longer be artificially favored by their legal status. Crack cocaine would no longer benefit from the perverse dynamics of the illicit market. And traffickers and consumers would no longer be obliged to favor more compact and potent drugs over bulkier but more benign substances simply because the former were less detectable. Both illicit drug abusers and responsible consumers, particularly among the poor, would have better access to drugs that are safer than those that are most available now. Drug legalization might thus result in more consumption of a wider array of substances than is currently the case but with dramatically fewer negati

ve consequences.

Fourth, those who take seriously such values as tolerance, privacy, individual freedom, and individual responsibility have little choice but to seek out alternatives to the current system. These values are fundamentally at odds with a prohibition regime that criminalizes the possession of small amounts of any drug for personal consumption. They are seriously threatened, moreover, by a war on drugs that promotes notions of zero tolerance toward drug users, that pursues its objective of a drug-free society with few restraints, that encourages neighbors and family members to inform on one another, and that incarcerates hundreds of thousands of Americans for engaging in vice activities that were entirely legal less than a century ago.

In proposing a mail-order distribution system based on a right of access, I have tried to offer a model that strikes at the heart of what is most problematic about drug prohibition. I realize that such a model is easily mocked by those with little interest in thinking seriously about alternatives to drug prohibition. My intended audience are the progressive prohibitionists and legalizers of all stripes interested in developing the discourse about alternatives to drug prohibition. I believe the model offers an effective means of eliminating or reducing the worst consequences of drug prohibition. It represents the best compromise I can envision between individual rights and communitarian interests. It provides for both a skeletal framework at the federal level and substantial flexibility for local option at the state and local level. It allows for substantial latitude in implementing public health measures and campaigns designed to reduce drug abuse. And it offers a system which can be fairly easily sup

erimposed on the current prohibition system.

The model does not, to be sure, represent a panacea. It raises as many questions as it answers. Like any other model, it has its vulnerabilities and it is susceptible to abuse by those determined to take advantage of it. Its potential effectiveness depends, moreover, on the extent to which it is filled out with sensible and humane drug control policies at state and local levels of government. But it does compare favorably, I believe, with both the American prohibition system and the supermarket model preferred by extreme libertarians. It presents greater risks than the conventional, prohibition-bound harm reduction model one finds in parts of Europe and Australia, but it also offers far more potential to transform drug consumption patterns in both the urban ghettos and the population at large in safer directions.

Intellectual ruminations about supermarket models, mail-order distribution systems, and a right of access to psychoactive drugs seem far removed from current political debates over drug control policy in the United States. There are, nonetheless, good reasons to develop the intellectual capital associated with the analysis of alternative drug control regimes. First, scholars are obliged to pursue their intellectual inquiries unencumbered by the blinders imposed by current prejudices and political realities. To limit the questions that one asks and the answers that one ventures to those sanctioned by officialdom is to forsake our moral and intellectual obligations to both our profession and our society. Future generations are ill served if today's scholars uniformly submit to the intellectual conservatism that so dominates social science and public policy analysis. Second, many of the assumptions that underlie both the current war on drugs and the prohibition system itself have not been systematically ex

amined for a long time. Even those who desire no substantial revisions in drug control policies can benefit from such an appraisal. Third, no one knows what the future will bring. New drugs and new ways of altering one's state of consciousness will surely emerge. The challenges of regulating psychoactive drugs are certain to increase. And the pharmacological Calvinism that dominates contemporary American public opinion and policy analysis can only persist for so long.

Cost-benefit analysis can, and should, play an important role in the debate over the future of drug control policy, if only because it provides us with the closest thing to an objective framework of analysis for clarifying our objectives and assessing our options. Ultimately, however, the debate over drug policy is really a debate over competing moral visions of society. I see no merit, and much evil, in calls for zero tolerance and a drug-free society. I also see nothing immoral, I must admit, about the consumption of psychoactive drugs by those who do no harm to others and who fulfill the obligations they have assumed to others. The challenge, from my perspective, is one of designing and promoting a drug control policy that combines a healthy respect for individual freedom and responsibility with a strong sense of compassion. These values do not trump all others all of the time. But it is important that they be not forgotten or pushed to the side whenever the fearful specter of DRUGS is uttered.

ACKNOWLEDGMENTS

I am grateful to the members of the Princeton Working Group on the Future of Drug Use and Alternatives to Drug Prohibition for their participation in the project, and to the Smart Family Foundation for its financial support of the working group. I am also indebted to the Ford Foundation and the Robert C. Linnell Foundation for their research support. I am grateful for comments on previous drafts of this paper from Michael Aldrich, Virginia Berridge, John Dilulio, Ernest Drucker, David Hawks, Sylvia Law, Stanton Peele, Craig Reinarman, Sasha Shulgin, Kenneth Warner, and Alex Wodak.

--------------

Extract from article published in Daedalus, Summer 1992, volume

(1) See N. S. Kline, The Future of Drugs and Drugs of the Future, Journal of Social Issues 27 (3), 1971: 73-87;

Wayne O. Evans and N. S. Kline, eds., Psychotropic Drugs in the Year 2000, Springfield, Ill.: Charles C; Thomas, 1971; A. Shulgin and A. Shulgin, PIHKAL: A Chemical Love Story, Transform Press, Berkeley Calif., 1991;

R. K. Siegel, Intoxication: Life in Pursuit of Artificial Paradise, E. P. Dutton, New York, 1989, p. 298-317;

and H. B. Clark, Altering Behaviour: The Ethics of Controlled Experience, SAGE Publications, Newbury, Calif. 1987.

A particularly bleak and pessimistic perspective is provided in Morton A. Kaplan, 2042: A Choice of Futures - A Nightmare, The World I, January 1992, p. 108-115.

(2) Note that the "needle park" experiment in Zurich, Switzerland, from 1990 to 1992 shared little in common with the sort of "supermarket" model developed here. Production and distribution of drugs remained illegal, the place of sale was strictly limited to one small park, and the entire scheme was developed within a fairly strict prohibitionist context. Much the same is true of the "open air" illicit drug markets in many urban ghettos. See A. S. Trebach, Lessons from Needle Park, in The Washington Post, 17 March 1992.

(3) See D. T. Courtwright, Dark Paradise: Opiate Addiction in America before 1940, Harvard University Press, Cambridge , Mass., 1982; and see E. A.Nadelmann, Historical Perspectives on Drug Prohibition and its Alternatives, American Heritage (forthcoming).

(4) See, for instance, M. R. Aldrich, Legalize the Lesser to Minimize the Greater: Modern Applications of Ancient Wisdom, Journal of Drug Issues 20, 1990, p. 543-53.

(5) Controlled consumption of heroin is examined in Zinberg, Drug, Set and Setting.

Controlled consumption of cocaine is examined in D. Waldorf, C. Reinarman, and S. Murphy, Cocaine Changes: the Experience of Using and Quitting, Philadelphia: Temple University Press, 1991, and in Peter Cohen, Cocaine Use in Amsterdam in Non Deviant Subcultures, Instituut voor Sociale Geografie, Universiteit van Amsterdam, Amsterdam, 1989.

(6) See Stanton Peele, Diseasing of America: Addiction Treatment Out of Control, Lexington Books, Lexington, Mass, 1989, who further observes that most drug abusers eventually quit or curtail their destructive behaviour without resort to conventional treatment programs. Also see C. E. Faupel, Shooting Dope: Career Patterns of Hard-Core Heroin Users, University of Florida Press, Gainesville, 1991.

(7) US Department of Justice, Bureau of Justice Statistics, Sourcebook of Criminal Justice Statistics - 1990, U.S. Government Printing Office, Washington D.C., 1991, p. 347; and US National Institute on Drug Abuse, National Household Survey on Drug Abuse: Highlights 1988, Department of Health and Human Services, Alcohol, Drug Abuse and Mental Health Administration, Washington D.C., 1990, p.8.

(8) The Gallup Poll Monthly, Nos. 288 and 303, reprinted in Sourcebook of Criminal Justice Statistics - 1990, p.347.

(9) Ibid

(10) National Household Survey on Drug Abuse: Highlights 1988, p. 44.

(11) Ibid., 8, p. 45-50.

(12) Ibid., p. 17-22.

(13) In a nationwide poll commissioned by Richard Dennis and the Drug Policy Foundation, 4 percent of the 1401 respondents said that they would be "very likely" to try marijuana if it were legal, 6 percent said they would be "somewhat likely", 8 percent said " not very likely," and 81 percent said "not at all likely." Asked the same question about the legalization of cocaine, 2 percent said they would be "very likely" or "somewhat likely", ' percent said "not very likely", and 93 percent said "not at all likely". Similarly, in the annual survey of American high school students conducted by the Monotoring the Future Project at the University of Michigan, 73 percent of respondents said they would not use marijuana even if it were legal, 11 percent said they would use it about as often as they do now, or less, 7 percent said they might try it, and only 3 percent said they would use it more often than at present. See L. D. Johnston, P. O'Malley, and J. G. Bachman, Drug Use Among American High School Seniors,

College Students and Young Adults, 1975-1990 , National Institute on Drug Abuse, Rockville,Md., 1991, p. 141-42.

(14) See Richard H, Blum & Associates, Society and Drugs, San Jossey-Bass, San Francisco, 1969, p. 25-44.

(15) See National Research Council, National Academy of Sciences, Evaluating AIDS Prevention Programs, National Academy Press, Washington D.C., 1988; and the report by the National Commission on AIDS, The Twin Epidemics if Substance Abuse and HIV, Washington D.C., 1991.

(16) See T. Szasz, Ceremonial Chemistry: The Ritual Persecution of Drugs, Addicts, and Pushers, Anchor Books, 1975.

(17) See S. Peele, The Meaning of Addiction: Compulsive Experience and Its Interpretation, Lexington Books, Lexinton, Mass., 1985; and J. Booth Davies, The Myth of Addiction, Harwood Academic Publishers, Philadelphia, Pa., 1992.

(18) The Australian policy is analyzed in R. Room, The Dialectic of Drinking in Australian Life: From the Rum Corps to the Wine Column, Australian Drug and Alcohol Review 7, 1988, p. 413-37. The British policy is assessed in A. Shadwell, Drink in 1914-1922: A Lesson in Control, Longmans, Green & Co., London, 1923. The impact of Prohibition on alcohol consumption and alcohol-related ills in the United States is assessed in J. P. Morgan, Prohibition is Perverse Policy: What Was True in 1933 Is True Now, in Krauss and Lazear, eds., Searching for Alternatives,

p. 405-23; Mark Thornton, The Economics of Prohibition, University of Utah Press, Salt Lake City, 1992; and J. A. Miron and J. Zweibel, Alcohol Consumption during Prohibition, in American Economic Review 81 (2), 1991, p.242-47. More generally, see E. A. Nadelmann, Response to letters, in Science 246, 1989, p. 1102-1103; and H. G. Levine and C. Reinarman, From Prohibition to Regulation: Lessons from Alcohol Policy for Drug Policy, in Milbank Quarterly 69 (3), 1991, p.461-94.

(19) Early twentieth-century models of alcohol control, many of which allowed adults to import alcoholic beverages into "dry" locales, are analyzed in R. B. Fosdick and A. L. Scott, Towards Liquor Control, Harper & Brothers, New York, 1933; L. V. Harrison and E. Laine, After Repeal: A Study of Liquor Control Administration, Harper & Brothers, New York, 1936 ; and R. E. Hose, Prohibition or Control? Canada's Experience with the Liquor Problem, 1921-1927, Longmans, Green & Co., New York, 1928. The modification in F.D.A. policy is discussed in James H; Johnson, How to Buy Almosy any Drug Legally without a Prescription, Avon Books, New York, 1990.

(20) See, for instance, D. Dixon, From Prohibition to Regulation: Bookmaking, Anti-Gambling, and the Law, Clarendon Press, Oxford, 1991.

(21) US Department of Justice, Bureau of Justice Statistics, Drugs and Jail Inmates, August 1991 p.1/9.

(22) See M. H Haller, Bootleggers as Businessmen: From City Slums to City Builders, in Law, Alcohol and Order: Perspectives on National Prohibition, Greenwood Press, David E. Kyvig ed., Westport, Conn., 1985, p. 139-57.

(23) See D.M. Warburton, Internal Pollution, in Journal of Biosocial Science 10, 1978, p.309-19; and Ruth Cooperstock, Current Trends in Prescribed Psychotropic Drug Use, in Research Advances in Alcohol and Drug Problems 3, 1976, p. 297-316.

(24) Some of these issued are considered in J. P. Morgan and D. V. Kagan, Society and Medication: Conflicting Signals for Prescribers and Patients, Lexington Books, Lexington Mass., 1983.

(25) But also see C. N. Mitchell, Deregulating Mandatory Medical Prescription, in American Journal of Law and Medicine 12 (2), 1986, p. 207-39.

(26) See P. Temin, Taking Your Medicine: Drug Regulation in the United States, Harvard University Press, Cambridge, Mass., 1980 and P. Temin, The Origin of Compulsory Drug Prescriptions, in Journal of Law and Economics 22, April 1979, p. 91-105.

(27) See S. Peltzman, The Health Effects of Mandatory Prescriptions, in Journal of Law and Economics 30, October 1987,

p. 207-38, and S. Peltzman, By Prescription Only...or Occasionally?, in AEI Journal on Government and Society (3/4), 1987, p. 23-28.

(28) P. Temin, Costs and Benefits in Switching Drugs from Rx to OTC, in Journal of Health Economics 2, 1983, p. 187-205.

(29) See the excellent drug education text by A. Weil and W. Rosen, Chocolate to Morphine: Understanding Mind-Active Drugs, Houghton Mifflin, Boston, 1983. Also see D. F. Duncan, Drug Abuse Prevention in Post-Legalization America: What Could It Be Like?, in The Journal of Primary Prevention 12 (4), p. 317-22. Clements, J. Cohen, and J. Kay, Takinf Drugs Seriously: A Manual of Harm Reduction Education on Drugs, Healthwise, Liverpool, 1990; D. F. Duncan and R. S. Gold, Drugs and the Whole Person, Mac Millan, New York, 1985; and R. C. Engs, Responsible Drug and Alcohol Use, Mac Millan, New York, 1979.

(30) The efficacy of antismoking campaigns is discussed in K. E. Warner, The Effects of the Anti-Smoking Campaign On Cigarette Consumption, in American Journal of Public Health 67, 1977,

p. 645-50, and, by the same author, Effects of the Anti-Smoking Campaign: An Update, in American Journal Of Public Health 79, 1989, p. 144-51. Also see M. Raw, P. White, and A. McNeill, Clearing the Air: A Guide for Action on Tobacco, British Medical Association, London, 1990. The Partnership's advertisements are evaluated favorably in the Committee on the Value of Advertising, What We've Learned About Advertising from The Media-Advertising Partnership for A Drug-Free America, American Association of Advertising Agencies, New York, 1990. More critical analysis is provided in R. Blow, How to Decode the Hidden Agenda of the Partnership's Madison Avenue Propagandists, in Washington City Paper 11 (49), 6-12 December 1991, p. 29-35; C. Cotts, Hard Sell in the Drug War, The Nation 254 (9), 9 March 1992, p. 300-302; and L. Zimmer, The Partnership for a Drug-Free America and the Politics of Fear, paper delivered to the Fifth International Conference on Drug Policy Reform, Washington D.C., 15 November 1991.

(31) See: How to Launch a Nationwide Drug Menace, in E. M. Brecher and the Editors of Consumer Reports, Licit and Illicit Drugs, Little, Brown and Co., Boston, 1972.

(32) See The Promise of Prozac, in Newsweek, 26 March 1990; F. Schumer, Bye-Bye, Blues: A New Wonder Drug for Depression, New York, 18 December 1989; and the more balanced Beating Depression, in U.S. News and World Report, 5 March 1990.

(33) See F. Earle Barcus and S. M. Jankowski, Drugs and the Mass Media, in Annals of the American Academy of Political and Social Science 417, 1975, p. 86-100; P. T. MacDonald and R. Estep, "Prime Time Drug Depictions, Contemporary Drug Problems 12, 1985, p. 419-37; W. Braden, LSD and the Press, in B. Aaronson and H. Osmond, eds., S Psychedelics, Doubleday, New York, 1970; J. Young, Drugs and the Mass Media, in Drugs and Society 1 November 1971, p.14-18; and C. Reinarman and H. G. Levine, Crack in Context: Politics and Media in the Making of a Drug Scare, in Contemporary Drug Problems 16, 1989, p. 535-77.

(34) 478 U.S. 328, 92 L. Ed. 266, 106 S. Ct. 2968 (1986).

(35) See S. A. Law, Addiction, Autonomy and Advertising, in Iowa Law Review 54, 1992; and P. Hirsch, Advertising and the First Amendment, in Trebach and Zeese, eds. New Frontiers in Drug Policy, p. 404-407.

(36) See J. B. Tye, K. E. Warner, and S. A. Glantz, Tobacco Advertising and Consumption: Evidence of a Causal Relationship, in Journal of Public Health Policy 8, 1987, p. 492-508. The debate over tobacco advertising is aired in Advertising in Tobacco Products: Hearings before the Subcommittee on Health and the Environment of the Committee on Energy and Commerce, House of Representatives, 99th Cong., 2nd Sess., 1986, (Serial NO; 99-167). The debate over alcohol advertising is aired in Alcohol Advertising: Hearing before the subcommittee on Children, Family, Drugs and Alcoholism of the Committee on Labor and Human Resources, United States Senate, 99th Cong., 1st Sess. , 1985 (S.Hrg. 99-16), and Beer and Wine Advertising: Impact of Electronic Media: Hearing before the Subcommittee on Telecommunications, Consumer Protection, and Finance of the Committee on Energy and Commerce, House of Representatives ,99th Cong., 1st Sess., 1985 (Serial No. 99-16).

(37) See A. Masson and P. H. Rubin, Plugs for Drugs, in Regulation, September/October 1986, p. 37-53, which argues for fewer restrictions on prescription drug advertising.