by Arnold S. Trebach - Professor Department of Justice, Law and Society and President of The Drug Policy Foundation, Washington D.C.

CONFERENCE ON IMPORTANT PROBLEMS OF DEVIANT BEHAVIOR. Institute of Sociology and the Soviet Sociological Association Academy of Sciences

Moscow April 23-29 1990

ABSTRACT: The author, President of the Drug Policy Foundation, with this report delivered at the conference on drugs, held at the Academy of Sciences of Moscow from the 23rd to the 29th of April 1990, presents a vast analysis of the problems connected to the "war against drugs" promoted by Bush in the U.S.: the failure of prohibition on alcohol in the United States in the twenties represents an emblematic and exhaustive example on the uselessness and the danger of such provisions; prohibition has given rise to the illegal trade of drugs and the groups that take advantage of it. This is why the author believes that a reform of the policy on drugs in an antiprohibitionist direction is necessary: "not because the current policy is totally wrong, but because its excesses cause too many damages and too much injustice".

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This statement is aimed primarily at an American audience. I am sharing it with the international audience of this meeting in the Soviet Union so that the participants may understand the complexity of American drug policy through the eyes of the loyal opposition in the United States.

We are witnessing a continuing national tragedy. For seven decades, the United States has pursued a harmful drug policy. During the Reagan-Bush Era, that policy has been pushed to its most destructive extremes. After eight years of a multi-billion dollar drug war, our prisons are filled to record levels, violent drug traffickers pollute our cities, and drug abuse is rampant. Despite the most aggresive drug war campaign in history, so much cocaine has been imported since 1981 that the price has dropped to a fraction of its former level. While some of our children now find it more difficult to buy marijuana, many find it much easier to buy crack and cocaine.

Yet the Bush-Bennett National Drug Control Strategy, unveiled as required by law on Sept. 5, 1989, promises only to continue and expand this disaster. The congressional Democrats have criticized the $7.9 billion plan only to say that the final federal drug package passed into law will reach a record $10 billion. The states will spend many billions more. Four more years of the current drug war promise more illegal drugs on our streets, more crime, more Americans in prison, and more youth enticed into drug dealing and drug abuse.

There will soon come a time when we will all look back on the excesses of the current anti-drug campaigns with shame. They will join the roster of national embarrassments that include alcohol Prohibition in the Thirties, internment of Japanese-Americans in the Forties, McCarthyism in the Fifties, and the Viet Nam War in the Sixties and Seventies.

Now is the time, before any more damage is done, before our leaders further embarrass the American people in the eyes of the world and history, for the healing process to begin in the harsh anti-drug war. We Americans are at our worst when we get a moralistic, patriotic, crusading fire in our bellies and go roaring off wide-eyed after a convenient enemy. We are at our best when we sit down with those supposed enemies and work out compromises in the middle ground between the extremes. It is often forgotten that in the 1780s, after the victory of the revolution, the new American nation was on the verge of civil war. During a long hot summer, cooler heads prevailed at that secret convention in Philadelphia and produced the American constitution, which has been called a bundle of peaceful compromises. We should follow that example now as the drug civil war tears at the vitals of this democracy. In summary form, my proposals for reform are, first, that this nation recognize the futility of the very concept

of a war on drugs. Instead we should be fashioning peaceful methods - those not involving criminal law or the military - for curbing drug abuse while preserving constitutional freedoms. Second, we should medicalize the use of marijuana and heroin to ease the suffering of those millions of our citizens afflicted with such diseases as cancer, glaucoma, and multiple sclerosis. Third, we should experiment with various forms of decriminalization or legalization of currently outlawed recreational drugs during the remainder of this century. This could include experiments that involve state laws providing for full legalization of virtually all illegal drugs for adults. If the experiments work well, we can move on to more widespread use of legalization; if not, we should again invoke the full weight of the criminal law. Fourth, we should invest billions now in new treatment methods and invite the best brains in the nation to participate in attempts to help rather than harm our neighbors who are addicts and abus

ers.

The leaders of American government and society have played a major role in creating the underlying conditions for the illegal drug markets, for the crime and violence, and for the drug abuses that harm our citizens. They act as if they had no responsibility for these horrors, always preferring to place the blame elsewhere - on the Sixties generations, on foreign dictators, or even on terrorists. Yet, a significant share of the blame for these conditions lies at the feet of draconian drug laws and enforcement policies. The destructive impact of these policies is now just beginning to be understood by most ordinary Americans and by the citizens of other countries, who are starting to reconsider their slavish imitations of the American drug war. As I travel about the United States and other countries, I find that revuslsion appears more and more on the faces of my audiences as I recite the basic facts about the Reagan-Bush-Bennett holy war.

Revulsion greets my recitation, for example, of official federal data showing how the United States is leading the democracies to become prison states.

Between the beginning of January 1981 (the month Mr. Reagan assumed office) and the end of June 1989, the U.S. prison population expanded a record 104 percent, from 329,821 to 673,565. These figures cover only inmates serving long sentences, those of at least a year or more. The rate of increase during the first six months of 1989 was a shocking 14.3%. If that rate continues, the American prison population will be 2.8 million at the beginning of the next century. If the Bush-Bennett policy continues in related areas, it is reasonable to project that there could be another 2.8. million Americans institutionalized in jails, juvenile facilities, so-called bootcamps for first offenders and casual users, and psychiatric institutions for the recalcitrant cases. A significant percentage of the 5.6 million inmates of the new American gulag will have been imprisoned as a result of the drug war.

DRUG REFORMERS WANT THE SAME OBJECTIVES AS DRUG WAR SUPPORTERS

Most drug policy reformers and most drug war supporters want similar goals. Certainly, we law reformers want to see our children grow up drug free in a healthy, democratic and safe society. We want all Americans to be able to walk the streets without worrying about harm from violent criminals. We want the freedom and privacy of all Americans to be preserved and protected by the government. We want the twin scourges of AIDS and drug abuse to be controlled and its victims treated effectively and compassionately by medical authorities and society. We want uncorrupted police institutions capable of providing the intelligent assistance that a democratic people expect of their law enforcement agencies.

We oppose the drug war because it does not bring us these important goals which are vital to a free society with an expanding economy. Indeed, the drug war creates conditions that prevent proper controls on drug abuse, on crime, on corruption, and on invasions of privacy.

Drug war hysteria creates and Orwellian mind-set in which perverse Big Brother tactics are made to appear as patriotic measures to save the soul of America. My upbringing and my old-fashioned New England schooling would lead me to believe it is undignified, un-American, and downright perverse for government officials to order female Navy personnel to disrobe and then to observe them eye-to-eye sitting on toilets urinating. Yet, the country is told by its leaders that such perversions - and a thousand permutations - are not perversions or in violation of American traditions at all.

Many of us old-fashioned Americans no longer believe our leaders in the White House or here on Capitol Hill when they tell us they see light at the end of the drug-war tunnel - and that if only we stay the course of the war, if we have the courage to gut it out and commit more troops and treasure, violate just a few more insignificant rights, we can achieve victory. We have heard that line not too long ago in regard to another emotional conflict. And as in Viet Nam, the cause was noble and shared by most decent citizens. Then we fought communism, now drug abuse.

By 1968, however, massive numbers of Americans who opposed communism became opponents of the Viet Nam war as well because they came to believe that it was an ineffective way to save our people from communists. Now, 20 years later, a similar popular revulsion is developing. It is smaller than that against the Asian war but it is large enough and powerful enough to be heard throughout the land, in all major newspapers and on all national media networks, and in the halls of legislatures around the world. We at the Drug Policy Foundation now receive so many requests for information that we find it difficult to respond within a reasonable time. During the past year or so, I have personally testified before major drug policy hearings of the U.S. House of Representatives in Washington, the Bundestag in Bonn, and the New York State Senate in Manhattan.

As was the case during Viet Nam, proponents of continuing the war paint the peace movement as being in league with the enemy or even sponsored by them. However, the Viet Nam peace movement came to span such a wide spectrum of respectable political opinion that this gambit was eventually dismissed as a desperate joke. Today, however, fear of being seen as soft on drugs continues to be a vibrant political reality.

The staid "New York Times" moved to headline a major story on Sept.11 1988, "Tougher Than Thou". Commenting on a series of harsh drug-war measures passed by overwhelming majorities that week, the "Times" observed that when it comes to illegal drugs, most members of the House of Representatives "want no enemies to the right of them". The same might have been said at the time of the two major presidential candidates, Messrs. Bush and Dukakis. It could be repeated today as the Bush-Bennett plan is being pushed through Congress with overwhelming support. No enemies to the right.

Yet, the movement for drug reform continues in the face of this new form of McCarthyism. We reformers oppose drug abuse. Therefore, we oppose the drug war. We propose fundamental changes in the American drug policy.

This volume contains many proposals for change which show the great depth and diversity of thought in the reform movement. My personal proposals follow.

BUNDLE OF COMPROMISES

1. Experiment with full legalization in some states. My perception of what is a reasonable compromise in the drug has changed in recent months. For years, I have denied that charge. Now, I plead guilty, but with mitigating circumstances.

This is a recent change of heart brought on by the realization, really an epiphany, that full legalization of drugs would create order out of chaos, not vice versa as the drug war advocates believe. Tim, a caller to the Seattle radio talk show in which I was participating long distance, put it best recently: "Prohibition is deregulation". In other words, the real effect of the criminal drug laws is exactly the opposite of the intended result. Anarchy now rules the distribution and sale of drugs. No government authority checks into the backgrounds and ages of sellers. No agency sets the rules on the conditions of sale or the age of buyers. No distributor fills in a tax return form and sends in a tax check to a government office or even one dollar of the 100 to 200 billion dollars in sales that take place each year in the American illegal drug market - or in the rich illegal drug markets that pervert and undermine the very foundations of the other democratic nations.

Prohibition has created a jungle. When turf and territory are invaded, the only law that controls is the law of the jungle, the tooth and the claw. Or, in America now, the Uzi and the Maz-10.

Such thoughts led me to testify in support of the Galiber Bill on June 16, 1989. This proposed law, S.1918, Senate of the State of New York, "would legalize drugs for adults and also would provide for regulation by a Controlled Substances Authority". The position of the sponsor, Senator Joseph L. Galiber of the Bronx, is that currently illegal drugs should be controlled and sold like alcohol. The CSA would grant licenses to qualified sellers and set conditions for sale. Initially, only doctors and pharmacists could apply for sales licences. No prescriptions would be necessary but purchasers would have to prove that they were over 21 years of age. Places of sale could not be near schools or religious establishments. Sales to minors or near schools would be criminal acts.

I have made a number of criticisms and suggestions for improvement regarding the Galiber Bill. The same is true of other such legalization bills that have been drafted in recent years, some of which appear in this volume or in related publications of the Drug Policy Foundation. Indeed, the only debate worth having is one that deals with the practicalities of reforms that assume prohibition is dead, those that deal with practical alternatives to the war on drugs.

These bills and reform plans propose to replace the law of the jungle with the rule of civilized law. Even though a part of my own mind and emotions recoil at the very thought of the legal sale of heroin and crack, the idea that the rule of law might soon prevail makes a lot of sense to me.

Accordingly, I now see experiments with state legalization laws as part of the middle ground between extremes. Such bills will allow for the gradual implementation of their provisions. For example, they might provide that at first marijuana and hashish would be made available to adults. If that worked, coca leaves and oral methadone. Then powdered cocaine and injectable methadone. And so on.

I realize that it is unlikely that even one such bill will pass a state legislature in the near future. Accordingly, other less far-reaching compromises must also be considered.

2. TOLERANCE, COMPASSION, AND HELP FOR USERS AND ABUSERS

We must develop means of opposing the destructive ideology that lies at the heart of the drug war. One of the worst examples is that which treats users and abusers of illegal drugs as the enemy. Mrs. Reagan, when she was First Lady, labelled casual users of drugs as "accomplices to murder". Drug Czar William Bennett has made casual users of illegal drugs the principal targets in his drug war strategy. He has proposed that severe penalties be imposed on those who are found to be "using or possessing even small amounts of drugs".

Few people, even in America, seem to understand the full scope of penalties that now exist or will soon be enacted. Casual users or those found possessing tiny amounts of drugs, such as a few marijuana cigarettes, could lose their cars and homes, be fired from their jobs, have their driver's licenses suspended for one to five years, and be prohibited from obtaining student loans and grants. Such casual users might also be imprisoned for months in boot camps or hospitalized against their will through civil commitment procedures in psychiatric institutions. Under some drug-free workplace regulations, employees may lose their jobs if they refuse to take a urine test when ordered. When a supervisor claims to see an appearance of impairment, employees may also be fired if the test shows signs of any drugs including alcohol.

We should use every strategy at our command to oppose such policies, starting with opposition to appointments of extremists to official leadership positions in the drug arena. In addition, we should encourage tolerance and compassion for users and abusers - at the same time that we try to educate them to the dangers of drugs. When the government mounts attacks on users or suspected users, we should encourage legal action to prevent these attacks from invading rights.

3. NATIONAL LEADERSHIP AND FUNDS FOR TREATMENT.

We should constantly point out to the public that users and abusers are members of our family (a kindly phrase I learned from Dutch officials) and that we want to help, not punish, them. We should encourage leading police organizations and thinkers to join with reformers to mutually support a vast increase in treatment facilities for legal and illegal drug abuse.

Treatment is the one area in which positive drug legislation is possibile during the current session of Congress. There are many hopeful treatment provisions being put forward, but none, to my knowledge, goes far enough. I think it might be politically acceptable to recommend that the federal government take a leadership role in demanding experiments with new treatment models supervised by ADAMHA and NIDA and fueled by a vast infusion of funds, perhaps working up to three billion dollars per year by the early Ninties. The Reagan administration has cut treatment funds and put the pittance remaining into state block grants. Many congressmen across the political spectrum oppose this penurious approach.

These experiments should allow for a wide array of models, including drug-free, drug-maintenance, and needle exchange features. They should emphasize not just charitable treatment but also those paid for in whole or in part by the patients. Thus, all economic classes would benefit and all clases might support this legislation.

Treatment on demand for every drug abuser in need - that would be a great compromise victory in the best spirit of America. We can accomplish that wonderful goal by the early Nineties.

Treatment on demand should replace the war on drugs. To lead this dominant effort we need a new kind of drug czar, e competent health professional who is respected across the political and ideological spectrum. If Mr. Bush were serious about dealing with drugs, we would retire Mr. Bennett and bring back the former Surgeon General, the best appointment President Reagan ever made. Dr. C. Everett Koop, a conservative actually loved by liberals, should be given the funds and the mandate to turn America's best minds to the task of helping rather than destroying the addicts and users among us.

The same approach should be taken by every nation seriously concerned with coping realistically with their drug problems.

4. AIDS TREATMENT: A SPECIAL PRIORITY.

AIDS is a greater threat to our survival than all of the drugs combined. The major engine for the transmission of AIDS is the heterosexual injecting addict. Every nation should stand solidly behind any proposal that promises to provide better treatment for AIDS sufferers and that might curb the spread of the disease. Properly designed drug maintenance (even those providing for medical heroin and other feared drugs) and needle-exchange programs should be advocated as essential elements in all AIDS-control strategies and bills. While it is sad to say, the AIDS threat makes for a much more compelling argument for decent treatment of addicts than a simple appeal to human compassion.

5. ADOPT "HARM REDUCTION" AS A UNIFYING THEME.

A combination of moral and medical philosophy lies at the core of national strategies for dealing with drugs. The best unifying strategy theme may well be that known as harm reduction, a concept that seems to have its most visible roots in Amsterdam, Holland and in Liverpool, England. However, it has hidden roots in many countries over decades of emotional experience in dealing with addicts.

Indeed, one of the most ignored aspects of the American experience has been the use of narcotic drugs in the maintenance clinics in the United States. Between 1919 and 1923 there were at least 40 maintenance clinics in the United States. Clinic doctors dispensed a number of powerful injectable drugs, including morphine and heroin, to thousands of addicts. While often criticized by American experts, on the whole those early clinics were very helpful to many addicts. They were closed as a result of irrational actions by police and leaders of the medical profession.

The modern era of American narcotic maintenance commenced in January 1964 when Dr. Vincent Dole and Dr. Marie Nyswander commenced a series of experiments in New York City with methadone, a drug developed, as was heroin, for the relief of pain by German experts. Methadone maintenance is the most successful innovation in American drug control in modern history. While it cured no person of addiction, it helped tens of thousands of addicts lead legal, useful lives. For some, this led eventually to abstinence. The drug, in oral form only, is still available through specially licensed doctors and clinics as one treatment option. I know personally of some addicts now living productive lives who receive regular prescriptions of methadone from private clinics. Unfortuantely, there is great ambivalence about methadone maintenance among the leadership of American drug control. Yet, the modality continues to function, legally and quietly behind the scenes.

The leadership of the United Kingdom talk loudly about fighting shoulder-to-shoulder with their American friends in the war on drugs while quietly pouring out millions of pounds into humane experiments that run counter to much of the harsh American ideology. Some of the most ambitious of these experiments have taken place in the Liverpool-Mersey region. Health and education experts, working with the enthusiastic cooperation of the police, have developed a series of related projects that are as effective as any in the world.

These experiments conceptualize control and treatment programs as a series of safety nets. The most important safety net is abstinence. The best result of an intervention program would be to help an addict get off drugs entirely. However, these English experts know that the zealous and sole pursuit of abstinence could and does result in harm to many addicts. And, as one Liverpudlian observed to me, "It is very difficult to rehabilitate a dead addict". As a result, they have developed other safety nets or program components: the dispensation od regular maintenance prescriptions of oral and injectable drugs, including heroin in a few cases; free needle exchange and instruction in the proper use of needles; detoxification and abstinence counseling; free condoms and advice on safe sex; general health care; and mental health counseling.

While the Mersey region has many problems of crime and addiction, these harm reduction efforts seem to have had a good impact. The police continues to support them because of humanitarian concerns and also because they have become convinced that these programs reduce crime. Health authorities are pleased that addicts seem healthier, with some coming off drugs entirely while others are taking better care of themselves even though they are still on drugs. Of stunning significance to the world, moreover, is the fact that AIDS is virtually unknown among addicts who have presented themselves for treatment to Liverpool clinics. Recent tests of approximately 3,000 injecting addicts showed few positive for AIDS or the HIV virus. In the entire Mersey Health region, comprising 2.5 million people, authorities are aware of only five addicts with AIDS and HIV positive.

6. MEDICINE FOR SUFFERERS OF MORE TRADITIONAL DISEASES.

Making feared drugs, such as heroin and marijuana, available as medicines for our sick people would seem to be a centrist proposal on which all sensible people would agree. Because of irrational fears of encouraging recreational use by our youth and others, even this most compassionate of proposed legislation may fail in Congress within the near future. If so, then Congress could pass legislation upholding most of the existing control scheme but demanding that the Food and Administration and the Drug Enforcement Administration, working together, see to it that heroin and marijuana were made available through doctors to those afflicted with cancer, glaucoma, multiple sclerosis, and other diseases who might be helped by these drugs. This availability could be part of a massive series of experiments in the control of pain and anxiety among our millions of sick people. An element in those experiments could be the more aggressive use of existing analgesics with less interference from the police.

Experimental use of any prohibited drug is allowed in medicine now, but federal officials set up impossible conditions for these experiments. Many innocent patients have died in agonoy from cancer or gone blind from glaucoma while waiting in vain for experimental protocols to be approved by DEA or FDA.

Powerful support for fundamental revisions in our attitudes and policies toward marijuana was contained in a historic decision on Sep. 6, 1988 by Francis L. Young, the chief administrative law judge of the Drug Enforcement Administration. For the first time in history, to my knowledge, there has been a full review of the evidence about marijuana in medicine before an impartial judicial tribunal. The federal government and reform organizations, including the Drug Policy Foundation, presented documents and expert witnesses on all sides of the issue over a period of many months. There was vigorous cross examination and the submission of extensive briefs. After presiding over this exhaustive inquiry, the DEA official recommended that marijuana be rescheduled so that it could be used by doctors in medicine.

In reaching that decision, Judge Young reviewed the massive body of evidence and came to conclusions that, while focused on the issue of medical use, destroy many of the fundamental ideas at the base of the drug war. Examples:

- "There is no record in the extensive medical literature describing a proven, documented cannabis-induced fatality."

- "...the record on marijuana encompasses 5,000 years of human experience...Yet, despite this long history of use and the extraordinarily high number of social smokers, there are no credibile medical reports to suggest that consuming marijuana has caused a single death".

- "In strict medical terms marijuana is far safer than many foods we commonly consume".

- "The evidence in this record clearly shows that marijuana has been accepted as capable of relieving the distress of great numbers of very ill people, and doing so with safety under medical supervision. It would be unreasonable, arbitrary and capricious for DEA to continue to stand between those sufferers and the benefits of this substance in light of the evidence..." .

- "There are those who, in all sincerity, argue that the transfer of marijuana to Schedule II will "send a signal" that marijuana is "OK" generally for recreational use. This argument is specious".

The top officials of the Drug Enforcement Administration seem stunned by Judge Young's rational decision. If they refuse to endorse it, Congress could pass legislation to implement it and simply place marijuana in Schedule II of the Federal Controlled Substances Act. It will also be necessary to force compassionate action from Food and Drug Administration so that the drug may be prescribed by American doctors when they deem it medically advisable. If Congress does not act, then what signal does that send about the level of humanity of this great nation as it enters its third century?

7. EXPERIMENTS WITH DECRIMINALIZATION OR LIMITED LEGALIZATION

Full legalization, as I have said, should be considered one option for experimentation in some states. Other options could include variations on that theme.

Working with police and prosecution leaders, Congress should encourage carefully researched experiments in decriminalization or de facto legalization of possession and small sales of all drugs. This is a major part of the Dutch approach and is controlled by an extensive set of written guidelines prepared by the prosecutors and police with the support of the judges. In essence, all drugs remain illegal; but peaceful users and small sellers are left alone; blatant sellers and those who are violent or connected with organized crime are arrested. The results here could be a reversal of the swamping of the criminal justice system, jails and prisons with drug offenders, a reduction in street violence and police corruption, and greater overall efficiency for the police and the criminal justice system.

Carefully guided experiments might also take place with other models of limited legalization. The Alaskan approach might be more acceptable in some areas than the Dutch; namely, allow legalization, not decriminalization, of growth and possession of marijuana for personal use in the privacy of the home. No other drugs would be affected by this change based upon a state supreme court decision. We might also consider variations of the new law being proposed by the Oregon Marijuana Initiative: upon the payment of $50 annual tax, adults would be given a certificate by the county which would allow them to grow and posses a small amount of marijuana for personal use. Again, all other drugs would remain fully criminal under this model.

Experiments also should be considered that would explore the industrial and commercial uses of the marijuana plant. Hemp has vast commercial potential as a fiber for rope and clothing, among other uses. It is possible that experiments will produce strains of marijuana that have a high fiber value and a low intoxication potential. In the current martial climate, research on such developments is not possible.

8. REMEMBER THE LEGAL DRUGS.

We must continue to support enlightened action that places greater legal and cultural controls on alcohol, tobacco, and caffeine. Positive steps are taking place in this arena - perhaps more in the United States than any other country - and we drug policy reformers support them. We must also emphasize that the greatest need for treatment remains in providing affordable help for legal drug abusers.

9. CREATE RELIABLE INTERNATIONAL DATA CENTERS.

In the course of writing this statement, I have cited comparative data on crime, violence and drug abuse. Yet, I have serious reservations as to just how reliable those statistics are. Existing international bodies, including agencies of the United Nations, have not proven equal to the task of producing usable comparative data. It is time that the western democracies combined to create a nonpolitical scholarly center or centers that produced reliable, objective studies on the basic comparative facts about crime and drugs in each country.

HOW MUCH DO YOU GIVE AN ADDICT?

As I have made clear, I am a strong advocate of drug maintenance as one among many optional treatments that should be available to addicts. In addition, I support the provision of injectable marcotic drugs and clean needles by doctors. Thus, I will deal briefly with questions about addict maintenance which trouble many good people.

For many years, I researched questions that, as it happened, were raised by Congressman Charles Rangel, Chairman of the House of Representatives Select Committe on Narcotics Abuse and Control, in a popular magazine articile just before the congressional hearings on legislation in September 1988. In the article, Mr. Rangel wrote: "And how much will you give an addict? A maintenance dose? They don't want to be maintained. They need to get high." Both the questions and the statements are misleading and reveal the basic misunderstandings at the highest levels of power that prevent rational consideration of new drug policies, ones that might work.

Some addicts need to get high. Some do not. Some do not want drugs at all but simply need a strong, sympathetic hand and close supervision while being detoxified. On the same day that the misleading article appeared, I had the joy of attending the wedding of a recovering heroin addict. He claims I saved his life because when he came to me one day in London in 1983 (where we were both visiting) and told me he was in trouble with heroin, I asked him what he wanted to do. He replied that he was totally out of control and that he needed to be "locked up." I immediately made arrangements and took him by the hand, as it were, and deposited him at a good psychiatric hospital. While in the locked ward, he was detoxified.

Had I suggested heroin to him, I would have been irresponsible. It is unfair, therefore, to paint all heroin addicts with the same criminal, irresponsible brush. They are no more alike than cigarette addicts or alcoholics - or congressmen or members of congress or university professors. When heroin addicts harm other people, I believe that they should be treated as criminals and punished. When heroin addicts reach a point in their lives that finds them seeking to come in from the criminal streets, society should treat them with compassion and care. That care should be inexpensive and readily available, virtually on demand, time and time again, since relapse is part of the process of cure.

The care should cover the full range of possibilities: locked psychiatric wards, drug-free detoxification, religious counseling, group therapy, out-patient psychiatric therapy, drug maintenance, and clean needles, among others. We must include drugs and needles because we do not now have, and never will have, a method for pushing all addicts off drugs immediately, even when the addict desperately wants to be rid of them. Maintenance is not a surrender but recognition of realities. It is an essential part of harm reduction in many cases. Properly operated maintenance programs do not kill addicts - because none of the opiates are toxic in proper dosages - and allow many addicts to live fairly normal lives. When an addict is "ready " to come off drugs, experienced doctors tell me that it is fairly easy to gradually accomplish that feat. But not before the patient, rather than the doctor or the police is ready. Compassionate maintenance programs keep many addicts functioning, working, and paying taxes for

years until that great day when they are ready to quit. For too many, that day never comes, but society and the patient are still better off because drug maintenance was available.

It is extremely difficult for doctors to determine the proper dosage of narcotics for any condition, including cancer pain. This is not a new issue for medicine. It is no surprise, therefore, that it is difficult to determine the proper dosage during maintenance and also to determine when an addict is actually ready to be properly weaned from powerful narcotic drugs. These questions should become some of the most important elements in the new wave of treatment experiments that democratic governments should launch under the leadership of health experts. The questions should be dealt with by doctors in consultation with their addict-patients, nurses, and other doctors - not by legislators and criminologists.

One of the great mistakes of American drug policy has been that politicians and police made it their business to tell the doctors how to prescribe drugs. Any nation that wishes to make progress must pull the government and the criminal law back from addiction treatment and let the healers debate issues of health policy.

British doctors have openly debated maintenance issues for decades. In 1924, their Minister of Health put some of the central question to a group of leading doctors: "to consider and advise as to the circumstances, if any, in which the supply of morphine and heroin...to persons suffering from addiction to those drugs may be regarded as medicaaly advisable." In 1926, the Rolleston Committe issued its historic report which described two types of patients for whom long term maintenance on these powerful narcotics was considered proper and helpful. First, "those in whom a complete withdrawal of morphine or heroin produces serious symptoms which cannot be treated satisfactorily under the ordinary conditions of private practice." Second, "those who are capable of leading a fairly normal and useful life so long as they take a certain quantity, usually small, of their drug of addiction, but not otherwise".

In other words, the Rolleston Committee saw the prescription of powerful narcotic drugs not as a means of destroying normal life or of killing a worthless addict off, but rather of making it possible for an addict to survive and to lead a fairly normal life outside a hospital. This medical advice is both compassionate and ageless. It is the original intellectual basis for modern harm reduction.

Applied today, it would mean that doctors would never provide drugs to patients not addicted and they would never provide such a high dosage to addict-patients that they become stuporous and unable to work or be good family members. By implication, then, good maintenance programs should involve a social contract: we in society will see to it that you receive your drugs of addiction and clean needles legally through doctors; you, the addict-patient, must in return see to it that you function as a good citizen, employee, and family member.

Does this mean that we would allow addicts on maintenance to work as pilots on airplanes and captains on nuclear submarines? Of course not. At the same time, we must realize that the greatest chemical threats to our air pilots and sea captains are found in alcohol abuse, a problem that the current war on drugs almost totally ignores. Even if all drugs were legal, alcohol would still be a greater threat to transportation safety than all of the currently illegal drugs combined.

USE AND ABUSE: WILL THEY RISE DESTRUCTIVELY?

We all should be concerned about the possibility of a great rise in use and abuse should the criminal drug laws be relaxed. I certainly worry about that, as should all sensible reformers. If I believed that law reform would bring a destructive explosion of use, I would rethink my position. However, my review of the evidence leads me to more comforting conclusions.

Some of my greatest comfort is found in a review of the historical record on the reports of impartial study commissions and authorities over the years. Many of them have recommended a relaxation of harsh criminal prohibition laws and experimentation with various compromise provisions allowing for greater freedom in the use of some drugs. Thus, we reformers have a good deal of scholarly history on our side.

This is particularly true of the record of marijuana reports. There have been at least seven major studies by impartial bodies of experts over the years in various countries. One of the most notable was "The Indian Hemp Drugs Commission Report" (1894) which was undertaken by British and Indian experts, who secured testimony from 1,193 witnesses from throughout the Indian subcontinent. In addition, there has been the "Panama Canal Zone Military Investigations" (1916-29); "The LaGuardia Committee Report" (1939-44) on conditions in New York City; "The Baroness Wooten Report" (1968) on the United Kingdom; "The Interim Report of the Canadian Government's Le Dain Commission (1970); the National Commission on Marihuana and Drug Abuse, "Drug Use in America: Problem in Perspective" (1973); and the National Resaerch Council of the National Academy of Sciences, "An Analysis of Marijuana Policy" (1982).

The congruence in basic findings of these studies spanning nearly a century is truly remarkable. None found marijuana to be harmless. All found marijuana to present some dangers to some people but concluded that the actual level of harm was consistently exaggerated and that control measures were frequently too harsh. Several of the studies stated flatly that rigid criminal prohibition laws were harmful.

The last two reports were issued by Americans and happen to be the only two major national studies performed by impartial groups of experts in our history. The report of the National Commission on Marihuana and Drug Abuse was mandated by Congress during the Nixon war on drugs and was carried out by a generally conservative commission appointed by the Republican president. After a massive series of studies of the entire illicit drug situation in the United States, the first recommendations of the commission were, to the dismay of President Nixon and many supporters of harsh drug laws, as follows:

"1. Possession of marihuana for personal use would no longer be an offense, but marihuana in public would remain contraband subject to summary seizure and forfeiture".

"2. Casual distribution of small amounts of marihuana for no remuneration, or insignificant remuneration not involving profit, would no longer be an offense".

These proposals for moderate compromises have been treated with disdain by the American Congress and ignored by drug abuse experts around the world - but not by the prestigious National Academy of Sciences, a quasi-governmental body, in the latest comprehensive American report in 1982. The Academy reiterated its support for the recommendations of the Nixon commission a decade earlier but then went dramatically further. It recommended that carefully prepared and researched experiments be considered that would involve removal of federal criminal penalties for cultivation and distribution of marijuana. Under this thoughtful plan, states would be encouraged to devise methods of control as they now do with alcohol.

Thus, some states might have systems that provided for regulated sale and taxation of legal marijuana. This is consistent with the first compromise proposal that I made.

In making these recommendations the National Academy of Sciences carefully reviewed all of the available evidence on the relationship between the proposed changes in the criminal law and the possibility of an increase in use and abuse. Some of the most important evidence was found in the 11 American states that decriminalized possession during the Seventies. The Academy saw that these relaxed criminal laws had no significant impact on use but that the new laws had helped curb massive criminal justice expenditures and injustices to many people. The council projected the estimate that even the more far-reaching legal distribution and sale were not likely to produce significant changes in use - if governments, opinion leaders, and families employed sensible, non-criminal control methods.

The National Academy of Sciences placed great emphasis on building up public education and informal social controls, which often have a greater impact on personal behavior than the criminal law. The NAS also had these comforting thoughts for those who would expect to see disaster for our young in a change so radical as to allow regulated marijuana sales such as with alcohol: "...there is reason to believe that widespread uncontrolled use would not occur under regulation. Indeed, regulation might facilitate patterns of controlled use by diminishing the "forbidden fruit" aspect of the drug and perhaps increasing the likelihood that an adolescent would be introduced to the drug through families and friends, who practice moderate use, rather than through their heaviest-using, most drug-involved peers."

ALLEGED HEALTH SUCCESS OF ALCOHOL PROHIBITION

However, whenever such arguments are made, even by authorities as respected as the NAS, someone (recently, Drug Czar Bennett) always points out the alleged lesson of alcohol prohibition. The standard argument goes that while alcohol Prohibition was an overall failure in America, especially because of the crime and corruption it engendered, it was a resounding success in terms of public health. Support is found in such statistics as those on alcohol consumption: during the period 1916-19, per capita consumption of absolute alcohol for the drinking age population in the United States was 1.96 gallons; during Prohibition, it dropped by more than half to 0.90; after Repeal, during 1936-41, it went up again to 1.54. By 1986, it had reached 2.58.

This argument about the health-success of alcohol Prohibition during the Twenties ignores a number of salient facts, starting with the observation that the low figures during the Twenties are suspect because at that time people hid their use. Moreover, the highest periods of known mass alcohol consumption were during our earliest years as a nation when popular culture and private predilection made us a nation of hard drinkers. The high point was 1830 when Americans consumed 7.10 gallons of absolute alcohol per capita! By 1871-80, it had dropped to 1.72. All of these changes took place within an atmosphere of legality. Culture is often more powerful than the law.

Today, Americans are benefiting from a health culture. As a result, per capita tobacco use has been dropping dramatically recently. The percentage of smokers in the general population dropped from 41.7 percent in 1965 to 32.6 percent in 1983. And all the time, tobacco was fully legal.

On the other side of the coin, during the past twenty years we have had periodic explosions in use and abuse of, successively, marijuana, heroin, cocaine, PCP, and crack. In regard to most of these drugs, explosions in use were followed by periodic downswings. And all the time, each had been illegal. Culture and mass popular tastes again were more powerful than the law.

If, then, we implement reforms in laws or enforcement practices, we must also continue and enlarge programs of school and parental involvement in drug control. Teachers and parents have more impact on curbing drug abuse than police and jailers. Similar positive thoughts apply to ministers and treaters, especially if we invest in the recommended new array of treatment facilities.

Were the current system working so as to curb drug abuse and AIDS, I would hesitate to recommend changes. It is not working. On balance, the possibility of an overall gain in control of crime and of drug abuse from all types of drugs and alcohol outweighs the risk of an explosion in abuse of illegal drugs.

CONCLUSION

Drug policy is more akin to religion than science. The truths about it lie more in the heart than in the head. Yet, the head helps to count the gains and losses from alternate practical theologies. My argument is that drug policy reform is needed not so much because current policy is totally wrong but that its excesses cause a great deal of harm and injustice. As the extent of harm becomes obvious and painful to the masses, more politicians will be willing to take the risk in voting for the radical new experiments.