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DrugsandDrugPolicy
ThirdEdition
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DrugsandDrugPolicy
TheControlofConsciousness
Alteration ThirdEdition
ClaytonJ.Mosher
WashingtonStateUniversity
ScottM.Akins
OregonStateUniversity
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Title:Drugsanddrugpolicy:thecontrolofconsciousnessalteration/ClaytonJ. Mosher,WashingtonStateUniversity,ScottM.Akins,OregonStateUniversity.
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Preface ix Acknowledgmentsxix
CHAPTER1 • DrugControversiesandDemonization1 Demonizing(Illegal)Drugs:TheSocialConstructionofDrug “Epidemics” 2 Glue-Sniffing5 Marijuana6 CrackCocaine27 Ecstasy(MDMA)28 Methamphetamine33 Drug “Epidemics” ofthe2000sand2010s38 TheOpioidEpidemic43 Conclusion49 ReviewQuestions50 InternetExercises50
CHAPTER2 • TheoriesofDrugUse51 NatureTheories52 Genetic/BiologicalTheories53 DiseaseTheory58 PsychologicalTheories62 SociologicalTheories65 Conclusion82 ReviewQuestions84 InternetExercise84 WebResources84
CHAPTER3 • TheEffectsofDrugs,PartI:Stimulants, Depressants,andOpioids85 RisksThatDrugsPose86 Stimulants93 Depressants115 Opioids124 NonopioidAnalgesics137 ReviewQuestions138 InternetExercise138
CHAPTER4 • TheEffectsofDrugs,PartII: Hallucinogens,Dissociatives,Marijuana,and Antidepressants139 Hallucinogens/Psychedelics139 PCPandKetamine(TheDissociatives)152 Marijuana155 AntidepressantDrugs174 Conclusion177 ReviewQuestions178 InternetExercise179
CHAPTER5 • PatternsofIllegalDrugUse181 Self-ReportSurveys182 CorrelatesofIllegalDrugUse192 Conclusion219 ReviewQuestions220 InternetExercise220
CHAPTER6 • PatternsofLegalDrugUse221 Age221 Gender/Sex229 Race/Ethnicity235 SocialClass246 GeographyandRural/UrbanLocation249 Conclusion252 ReviewQuestions253 InternetExercise253
CHAPTER7 • DrugPreventionPrograms255 DrugEducationPrograms255 AntidrugAdvertisingCampaigns267 Zero-TolerancePolicies274 DrugTestingPolicies277 Conclusion293 ReviewQuestions295 InternetExercises295
CHAPTER8 • DrugTreatment297 PharmacologicalTreatmentApproaches299 OpioidAntagonists313 The12StepsofAlcoholicsAnonymous334 Conclusion340 ReviewQuestions341 InternetExercises341
CHAPTER9 • PoliciesRegulatingLegalDrugs,PartI: AlcoholandTobacco343 Tobacco343 Alcohol359
Conclusion383 ReviewQuestions386 InternetExercise386
CHAPTER10 • PoliciesRegulatingLegalDrugs, PartII:PrescriptionDrugsandDietary/Herbal Supplements387 RegulatingthePricesofPrescriptionDrugs388 AdvertisingofPharmaceuticalProducts390 TheRegulationandApprovalofPharmaceuticalProductsinthe UnitedStates393 Off-LabelUsesofDrugs400 ThePoliticalEconomyofthePharmaceuticalIndustry401 TheOpioidEpidemic407 Conclusion424 ReviewQuestions425 InternetandMediaExercises426
CHAPTER11 • PoliciesRegulatingIllegalDrugs427 TrendsinArrestsandIncarceration427 “SchoolZone” Policies440 PublicHousingEvictions443 DenialofWelfare445 DenialofStudentAid446 AssetForfeiture447 RecentChangesinStateDrugLaws450 MarijuanaLaws457 TheFederalGovernment’sResponsetotheOpioidCrisis472 ReviewQuestions481 InternetExercises481
CHAPTER12 • DrugPoliciesinOtherCountries483 AnOverviewofHarmReductionApproaches484 CountriesWithSevereDrugPolicies486 DrugPoliciesinWesternCountries491 GlobalDevelopments519 Conclusion522 ReviewQuestions523 InternetExercise523 Glossary525 References529 Index 641 AbouttheAuthors661
PREFACE
Thepursuitofconsciousnessalterationthroughtheuseofbothlegaland illegalpsychoactivesubstancesisapervasivefeatureofhumans;some scholarshaveevenarguedthatthepursuitofintoxicationisabasichumandrive (Siegel,1989)andthatabsolutesobrietyisnotanaturalorprimaryhumanstate (Davenport-Hines,2001).Infact,thereareonlyafewrecordedinstancesof societiesanywhereinhistorythathavelivedwithouttheuseofpsychoactive substances.Andwhilesubstanceuseandabusehavebeenaconcernof researchersandpolicymakersintheUnitedStatesandothercountriessinceat leasttheearly1900s,anumberofsignificantdevelopmentsinthelastfew decadessuggestthatthedynamicsofdruguseandpoliciestodealwithdruguse areatacriticaljuncture.
InconsideringissuesrelatedtodruguseanddrugpolicyintheUnited States,itisusefultobeginbynotingsomeratherstrangeparadoxes.Totakejust oneexample,itisestimatedthattensofmillionsofAmericansuseantidepressant drugs.Thesedrugsarewidelyadvertisedandmarketed,andtheindividualswho consumethemgenerallyexperiencenolegalpenaltiesfortheirconsumptionof thesesubstances.Atthesametime,morethan450,000individuals,themajority ofwhomaremembersofunderrepresentedgroups,languishinAmericanjails andprisonsforpossessionandtraffickinginconsciousness-alteringsubstances thattheUnitedStateshasdeemedtobeillegal(Sawyer&Wagner,2020).In fact,theincreasingstringencyofdruglawsoverthe1970sto(roughly)2010 periodwasoneoftheprimaryfactorsassociatedwithunprecedentedlevelsof incarcerationintheUnitedStatesoverthepast30years(Austin&Irwin,2012). AsSullum(2003a)comments, “Ifanunhappypersontakesheroin,heis committingacrime.IfhetakesProzac,heistreatinghisdepression” (p.284). Similarly,inquestioningthedistinctionbetweenlegalandillegaldrugsinthe UnitedStates,Pollan(1999)notes,
Youwouldbehard-pressedtoexplainthetaxonomyofchemicals underpinningthedrugwartoanextraterrestrial.Isit,forexample, addictivenessthatcausesthissocietytocondemnadrug?(No;nicotineis legal,andmillionsofAmericanshavebattledaddictionstoprescription drugs.)Sothen,ourinquisitivealienmightask,issafetythedecisive factor?(Notreally;over-the-counterandprescriptiondrugskillmore than45,000Americanseveryyearwhile,accordingtoTheNew EnglandJournalofMedicine, “Thereisnoriskofdeathfrom smokingmarijuana.”)Isitdrugsassociatedwithviolentbehavior thatyoursocietycondemns?(Ifso,alcoholwouldstillbeillegal.) Perhaps,then,itisthepromiseofpleasurethatputsadrugbeyond thepale?(Thatwouldonceagainruleoutalcohol,aswellasViagra.)
Itisalsoimportanttonotethatthetrafficindrugs bothlegaland illegal isbigbusiness.Itisestimatedthattheinternationalillicitdrugbusiness generateshundredsofbillionsofdollarsintradeannually,representingabout 8%ofallinternationaltrade aboutthesamepercentageastourismandtheoil industry(Davenport-Hines,2001).Atthesametime,consumerspendingon medicinesintheUnitedStateswasanestimated$450billionin2016(IQVIA, 2017).Inthiscontext,itisnotablethatwhiletheUSgovernmentenactspolicies anddevotesconsiderablemonetaryresourcestopunishingthosewhousemindalteringdrugsproducedincountriessuchasColombia,Mexico,and Afghanistan,ithasalsoenactedpoliciesthatservetoexpanddomesticand internationalmarketsformind-alteringsubstancesmanufacturedbycompanies suchasAnheuser-Busch,RJReynolds,andlargepharmaceuticalcompanies, amongothers.
TheUnitedStateshasachievedthisthroughthepromotionanddisseminationofDrugWarpropaganda,which,asBruceAlexander(1990)hasnoted, createsa “systematicreductioninpeople’sabilitytothinkintelligentlyabout drugs” (p.71).Partofourgoalinthisbookthen,istodeconstructthisdrugwar propaganda,toassistreadersinthinkingintelligentlyaboutdrugs,andtocriticallyassessourcurrentdrugpolicieswithrespecttobothlegalandillegaldrugs.
MisinformationandDistortion ANoteonSourcesUsed inThisBook
Indiscussingdrugs,theireffects,whousesthem,andpoliciesregulatingthem,it isobviouslyimportanttoreviewthescientificliterature;thisbookincludes extensivecoverageofresearchpublishedinmedical,scientific,social-scienti fic, andotheracademicjournals.However,unlikemostauthorswritingonthetopic ofdrugs,wealsodrawextensivelyfromprintandInternetmediadiscussionsof drugs.Weadoptthisstrategybecausewebelieve,basedonourteachingexperienceandparticipationinconferencesandpublicforumsontheseissues,that mostofthegeneralpublicderivetheir(oftenmis-)informationaboutdrugs,their effects,anddrugpoliciesfromthesesources.Whileaconsiderableproportionof thediscussionofdrugsinprintmediasources,is,infact,derivedfromscientific literature,reportersandjournalists,eitherthroughignoranceordesign,often misinterpretthescientificinformationinwaysthatmayservetomisleadthe generalpublic.Itisthusnecessarytoinclude,andcriticallyreview,media materialsondrugs.
WealsodrawonmaterialsfromorganizationssuchastheNationalOrganizationfortheReformofMarijuanaLaws(NORML),theMarijuanaPolicy Project(MPP),theDrugPoliceAlliance(DPA),andCommonSenseforDrug Policy(amongothers),allofwhichhavebeencriticalofUSdrugpoliciesand havecalledforreform.Weareawarethatsomewillviewtheseorganizationsas “advocacygroups” inthedrugpolicycontext,andwewouldtendtoagree. However,we findmanyoftheargumentsmadebytheseorganizationstobe compelling;aswillbedemonstrated,unlikeseveral “officialgovernment”
publicationsandcommentariesondrugsanddrugpoliciesfrombureaucracies suchasthefederalgovernment’sOfficeofNationalDrugControlPolicy (ONDCP),tosupporttheirargumentsfordruglawreform,theseso-called advocacygroupstypicallyrefertoactualscientificstudiesintheirpublications.In contrast,muchoftheinformationondrugspublishedbyofficialgovernment organizationsisblatantlymisleading,andinsomecases,simplyfalse.Itisthus importanttocriticallyreviewtheinformationdisseminatedbythesegovernment sourcesbecause,aswillbediscussed,thisinformationhashadadirectimpacton policiesregulatingbothlicitandillicitdrugs.
Overthelastfewdecades,muchofthemisinformationondrugshasbeen presentedby “drugczars” appointedbyUSpresidents.Forexample,incriticizingthemorerelaxedapproachtodrugsintheNetherlands,GeneralBarry McCaffrey(drugczarunderPresidentClinton)commented, “TheDutch experienceisnotsomethingwewanttomodel.It’sanunmitigateddisaster ” (as quotedinGray,2001).McCaffreyclaimedthatallyouthinAmsterdam’ s VondelParkwere “stonedzombies” andstatedthat “themurderratein HollandisdoublethatoftheUnitedStates. that’sdrugs” (asquotedin Reinarman,2002,p.127).Injustifyingthisclaim,thedrugczarnotedthatthere were17.58murdersper100,000populationintheNetherlands,comparedto 8.22per100,000intheUnitedStates.However,theDutchhomicideratecited byMcCaffreycombinedhomicidesandattemptedhomicidesinthesame category:theactualDutchhomicideratewas1.8per100,000orlessthanonequartertheUSrate(Reinarman,2002).Whenanoffi cialfromtheDutch embassyquestionedMcCaffrey’sdeputydrugczaraboutthesemisleading statistics,thedeputy’sresponsewas, “Let’ssaythat’sright.Whatyou’re leftwithisthatthey[theDutch]areamuchmoreviolentsocietyandmore inept[atmurder]andthat ’snotmuchtobragabout” (asquotedinReinarman, 2002,p.129).
Inanotherexampleofdistortionandmisinformationpropagatedbyfederal governmentofficials,JohnWalters,thedrugczarunderPresidentGeorgeW. Bush,pointedtodatafromtheMonitoringtheFutureStudy(astudythat measuresdruguseamongyoungpeopleintheUnitedStates)andclaimedthat “thissurveyconfirmsthatourdrugpreventioneffortsareworking” (asquotedin Cole,2005).ButasColepointsout,acomparisonofthe1991and2002 MonitoringtheFuturedataindicatedthatoverthisperiod,marijuanause increasedby30%for12th-gradestudents,128%for10th-gradestudents,and 188%for8th-gradestudents.ThesedatapromptedColetoask, “HowcanJohn Walterssaythisstudyshowsourdrugpreventioneffortsareworking?Couldthe drugwarriorspossiblybelyingtous?”
AmorerecentexampleisPresidentTrump ’spraiseofleadersincountries thathaveparticularlyseveredrugpolicies,aspectsofwhichthepresident apparentlythinkstheUnitedStatesshouldadopt.Inaphoneconversation withPhilippinesPresidentRodrigoDuterte(wheretensofthousandsofcitizenshavediedasaresultofDuterte’swarondrugs),PresidentTrump commented, “IjustwantedtocongratulateyoubecauseIheardoftheunbelievablejobonthedrugproblem.Manycountrieshaveadrugproblem,but
whatagreatjobyouaredoingandIjustwantedtocallandtellyouthat ” (as quotedinSanger&Haberman,2017).
Similarly,indefendinghiscampaignpromiseofbuildingawallonthe southernborderoftheUnitedStates,PresidentTrumphasrepeatedly(and incorrectly)claimedthatthemajorityofillicitdrugsenteringtheUnitedStates comethroughunprotectedportionsoftheUSborderwithMexico(asopposed toportsofentry)(Rosenberg,2019a).Thisjustificationignoresthefactthateven thefederalgovernment’sownDrugEnforcementAdministration(DEA)has concludedthatdrugtraf fickers(particularlythoseinvolvedintraf fickingharder drugssuchascocaine,methamphetamine,andheroin) “transportthebulkof theirgoodsovertheSouthwestborderthroughpointsofentry,usingpassenger vehiclesortractortrailers” (Lopez,2019c).Infact,theDEA’s2018National DrugThreatAssessmentreportestimatedthat90%ofheroin,88%ofcocaine, 87%ofmethamphetamine,80%offentanyl,and39%ofmarijuanaenteringthe UnitedStatesfromMexicoisseizedatportsofentryasopposedtobetween portsofentry(Leeetal.,2019b).
ThroughoutthisbookwewillcriticallyassessthecontentionsofgovernmentofficialsintheirsupportoftheUnitedStates’ continuingwarondrugs.
ContentOverview
InChapter1,weaddressthewidespreaduseofpsychoactivesubstancesacross timeandsocieties.Theubiquityofdruguseisparticularlyinterestinggiventhat theuseof all formsofdrugs bothlegalandillegal involvessomelevelofrisk. Thesubstantiallevelofharmposedbytheuseoflegaldrugscontrastswiththe typicalviewofsomedrugsas “good” andothersas “bad.” Accordingly,this chapterdemonstrateshowlegalandillegaldrugsaresimilaranddifferentand addressesthewaycertaindrugshavebeendemonizedinordertojustifytheir illegalstatus.
Avarietyofstrategieshavebeenemployedtoemphasizethedangersof (illegal)drugsoverthepastcentury.Commontacticsincludeclaimsthatillegal druguseisresponsibleforthemajorityofcrimethatoccursinsociety;that illegaldrugspossessuniquepowersthatencourageotherwisenormalpeopleto engageinbizarreandoftenviolentbehaviorswhileundertheinfluenceofthese drugs;thatminorities,immigrants,andforeignnationalsaretheprimaryusers andtraf fickersinillegaldrugs;andthatillegaldrugs(incontrasttolegaldrugs) poseauniquethreattothehealthofchildren.Finally,illegaldrugshavebeen demonizedthroughamisrepresentationofthescientificevidenceontheeffects ofthesedrugs,particularlybygovernmentagencies.
TheintentofChapter1isnottoignoreorminimizethesubstantialharm causedbytheuseofdrugsinsociety,butrathertoproperlyassessthethreat posedbytheuseofparticulardrugsandtodemonstratethatbothlegaland illegaldrugsposesignificantrisks.Sociallyconstructeddrugepidemicstendto exaggerateanddistortthenatureandmagnitudeofdrugproblems,making appropriateprevention,treatment,anddrugcontrolresponsesmoredifficult.
InChapter2,weaddressavarietyoftheoreticalexplanationsforsubstance useanddependency.Theoriesofsubstanceusearedesignedtoexplainwhydrug useandabuseoccursandwhyitvariesacrossdifferentcircumstancesandsocial conditions.Wesummarizenature,genetic/biological,psychological,andsociologicaltheoriesofsubstanceuseandexaminethescientificevidencewithrespect tothevalidityofthesetheories.
InChapters3and4,wediscussseveralcategoriesofdrugsbasedontheir physiological,psychological,andbehavioraleffects.Basedontheseeffects, psychoactivesubstances whichincludeherbalsupplements,over-the-counter medications,prescriptiondrugs,andotherlegalandillegalsubstances are groupedintothefollowingcategories:stimulants,depressants,opioids,hallucinogens,PCPandketamine(thedissociatives),marijuana,antidepressants,and aphrodisiacs.
Asnotedabove,theillegalstatusofcertaindrugsisoftenbasedonrhetoric thatillegalsubstancesaredistinctintermsoftheharmstheyposetosocietyand theuser.Toassessthepotentialofadrugtocauseharmtotheindividualand society,multipledimensionsofriskmustbeconsideredsimultaneously.In additiontotheirpsychoactiveeffects,drugscanbeassessedintermsoftheir abilitytogeneratephysicaldependence,psychologicaldependence,andboth short-andlong-termadversehealtheffectsinusers.Whensubstancesare evaluatedacrossallthesedimensionsofharm,itisclearthattherearefewdifferencesbetweenlegalandillegaldrugs.
Chapters5and6examinepatternsoflegalandillegaldruguseinsociety. Informationontheuseandabuseofillegaldrugsisderivedprimarilyfrom severallarge-scalesurveysandselectedcompilationsofcriminaljustice andhealthstatistics,aswellasobservationalstudiesandinterviewswithdrug usersandof fi cialsindrug-related fi elds.Thesedatahaveenabledresearchers todemonstratethatdruguseismorecommoninsomepopulationsthan others.
Thekeydemographicfactorsthatinfluencelegalandillegaldruguseare age,gender,race/ethnicity,socialclass,andurbanity.Druguseismorecommon inlateadolescenceandearlyadulthoodthanatanyotherpointinthelifecourse. Genderisanotherimportantpredictorofillegaldruguse.Malesaremorelikely thanfemalestouseillegaldrugsandalcohol,andthosewhoidentifyasnonbinary(withrespecttosexualorientation)areparticularlyatriskforsubstance abuseastheyaremorelikelytofacepersecution,criminalvictimization,and mentalhealthissues,allofwhicharestronglycorrelatedwithdrugandalcohol abuse.
Drugusealsovariesbyrace/ethnicity,butincontrasttowhatis commonlybelieved,whitepeopleareamongthemostlikelytousebothillegal andlegaldrugs.Wheredataallow,inChapters5and6weexaminethe divergentpatternsofdrugusethatexistwithincertainracial/ethnicsubgroups (e.g.,HispanicpeopleandAsians),illustratingthatdrugusevariesbothwithin aswellasacrossrace/ethnicity.Wealsonotethatracialdifferencesindruguse arelinkedtosocialclassandreviewtherelationshipbetweensocialclassand substanceuseandabuse.Finally,residencecharacteristics,suchaswhetherone
livesinanurbanareaasopposedtoasmalltownorruralarea,areimportant forunderstandingdruguse.
InChapter7weexamineissuesrelatedtodruguseprevention,which involvesawidevarietyofstrategiesintendedtolimittheuseandabuseof psychoactivedrugs.Whileresearchindicatesthatpreventionprogramsfocused onreducingdrugriskfactorsandenhancingdrugprotectivefactorscanbe effective,untilrecently,mostpreventionexpendituresandeffortswereprimarily investedinprogramsbasedonnarrowandmisguidedconceptionsofthereality ofdruguse.Amongtheseprogramsareselectdrugeducationprograms(e.g., D.A.R.E.),antidrugadvertisingcampaignsprimarilydirectedatyouth,zero tolerancedrugpoliciesinschools,anddrugtesting(asappliedinschoolsandthe workplace).
AlthoughseveraljurisdictionsintheUnitedStateshavediscontinuedthis program,D.A.R.E.wasthelargestschool-baseddrugeducationprograminthe countryfortwodecades.NearlyeveryscientificstudyofD.A.R.E.foundthe programtobeineffectiveinreducingdruguse.ThisislargelybecauseD.A.R.E. (similartomanyotherdrugeducationprograms)isbasedonanumberof problematicassumptionsaboutdruguse,includingthat(1)experimentationwith drugsisnotacommonaspectofyouthculture;(2)anydruguseiseither equivalentto,orwilleventuallyleadto,drug abuse;(3)marijuanaisthegateway toharddrugssuchasheroinandcocaine;and(4)exaggeratingtherisksassociatedwithdrugusewilldeteryoungpeoplefromexperimentingwithdrugs. WhiletheD.A.R.Eprogramhasundergonechangesinrecentyears,the fundamental “justsayno” todrugsmessageoftheprogramhaspersisted.But therearealsoindicationsthatmoreevidence-basedandrealisticdrugeducation programsareemergingintheUnitedStates.
Antidrugadvertisingcampaignsareanotherformofdrugpreventionefforts thathavebeenfoundtobeineffectiveatreducingdrugusebyyouth.These advertisingcampaignsoftenpresentfalseandsometimesridiculousinformation aboutillegaldruguse,andtheytypicallypaylittleattentiontothedangersof tobacco,alcohol,andprescriptiondruguse.Liketheineffectivenessof D.A.R.E.,theineffectivenessofthesecampaignsistiedtohowyoungpeople respondtothemessagespromoted.Thecampaignsmayhaveacounterproductiveeffectonyouthdrugusebecauseyoungpeopletendtorejectallantidrug messageswhentheyidentifysomeasbeingfalse,orbecausetheyencourage youngpeopletodesireandseekoutsomethingthatisforbidden(knownas “reactance”).
School-based “zerotolerance” policiestypicallyinvolvethesuspensionor expulsionofstudentswhoareinpossessionoforundertheinfluenceofdrugson schoolproperty.Advocatesofthesepoliciesbelievethattheyarebeneficial becausetheysendaclearmessagethatdrugusewillnotbetoleratedandthey supposedlykeepdrug-usingyouthawayfromtherestofthestudentbody.Part ofthisstrategyinvolvesdrugtestingstudentswhowanttoparticipateinathletics orotherextracurricularactivities.Thesepolicieshavelittlepreventativeeffecton druguseamongstudentswhoremaininschool,andtheymay,infact,encourage drugusebythoseyoungpeoplewhoaremostatrisk.
Drugtestingintheworkplaceisanotherwidelyimplementedprevention strategyintheUnitedStates.Wedonotdisputethatthereareoccupationsfor whichdrugtestingisappropriateintheinterestofpublicsafety,butworkplace drugtestingoutsidesuchcontextsiswidespreadandistypicallyjustifiedasbeing aneffectivedeterrenttodrugusethatwillincreaseworkerproductivityand companyprofits.However,scientificresearchdoesnotidentifyapreventive effectofdrugtestingforemployeedruguse,andthereislittleevidenceto suggestthattheseprogramsincreaseworkerproductivity.Inpart,thisisbecause thedrugthatismostlikelytobeidentifiedindrugtests(byfar)ismarijuana,due tothefactthatitremainsdetectableintheurineforweeksafteruse.Marijuanais farlesslikelytolimitproductivitythanisalcohol,andtheillegaldrugsthat wouldbemorelikelytonegativelyinfluenceworkerproductivity(e.g.,heroin, cocaine,amphetamines)becomeundetectableintheurinewithindaysandare thusrarelyidentifiedbydrugtests.Drugtestingmayalsolimitproductivity becauseitcreatesanegativeworkenvironmentthatalienatesworkersfromtheir employers.
Chapter8providesanoverviewofthe fivebroadcategoriesofdrugtreatmentcurrentlyavailableandreviewstheevidenceontheireffectiveness.Pharmacologicaldrugtreatmentinvolvestheuseofdrugsormedicationstotreat substanceabuse.Thisformoftreatmentcanbetemporary,longterm,orpermanentinnature.Temporaryformsofpharmacologicaltreatmentinvolveusing onedrugtorelievewithdrawalsymptomsorotherwisefacilitatethegoalof abstinenceorreduceduseofanotherdrug.Long-termorpermanentpharmacologicaltreatmentinvolvesuseofadruginthebeliefthatthenewdrugwill reduceoreliminatetheuseofamoreproblematicdrug(e.g.,methadone maintenanceforheroinaddicts).
Long-termresidentialdrugtreatmentprograms,themostnotablebeing therapeuticcommunities,involvetreatmentprovidedtopatientswholiveina treatmentfacilityforperiodsofupto2years.Thetherapeuticcommunitymodel typicallyviewsdrugabuseasonlyonesymptomofabroaderproblemthatafflicts theindividual.Becauseofthis,theresocializationoftheindividualisthoughtto benecessarytoachievepositiveposttreatmentoutcomes.
Compulsorydrugtreatmentinvolvestreatmentthatismandatedinsome waybythecriminaljusticesystem.Whilethespecificstrategiesarediverse,this caninvolvetreatmentinprisonorinthelargercommunity.Amongthemost popularformsofcompulsorytreatmentaredrugcourts,whichallowindividuals toparticipateindrugtreatmentinlieuofprison,withtheunderstandingthat sanctions(includingthepossibilityofincarceration)mayresultiftheindividual doesnotcomplywiththerequirementsofthetreatmentprogramasagreedupon incourt.
AlcoholicsAnonymous(AA),12-step,andrelated “peersupport” programs involvetreatmentinwhichindividualsidentifiedasalcoholicsoraddictsattend meetingsintheircommunitywithotherpeopleidentifiedasalcoholicsor addicts,enablingthemtodrawoneachotherforsupportandunderstandingin theirstrugglewithaddiction.AArepresentsbyfarthelargestdrugtreatment “program” intheworld.WhilethecentraltenetsoftheAAmodel including
thatalcoholicsareafflictedwithanincurablediseasecharacterizedbyalossof controloveralcoholandthattotalabstinenceistheonlyeffectivemeansof treatment arenotsupportedbyscientificresearch,thesegroupshavehelped manyindividualswiththeirproblemdrinking,largelybecauseofthepeer-supportnetworkandstructureprovidedbytheprogram.
Theneedfordrugtreatmentfrombothahumanitarianandeconomic standpointisclear.Studiesoftreatmentefficacy findthatmanyprogramsare usefulintermsofreducingdruguse,reducingcriminalactivity,andincreasing levelsofemployment.Assuch,treatmentisfarmorecost-effectiveand humanitarianthandealingwithdrugproblemsexclusivelythroughthecriminal justicesystem.
Chapters9and10addresstheregulationoflegaldrugs.Chapter9focuses ontheregulationoftobaccoandalcohol,whileChapter10examinespolicies regulatingprescriptiondrugsandherbalsupplements.Manyofthelegalsubstanceswhoseregulationwecoverinthesechaptersare,infact,moreharmful, bothintermsoftheireffectsonindividualusersandthelargersociety,than drugsthatarecurrentlycategorizedasillegalintheUnitedStates.
Theapparentgoalsofpoliciesdesignedtoregulatelegalandillegaldrugs arethesame:topreventdrugmisuseandabuseandminimizetheharmsto society.However,thenatureofregulationforlegalandillegaldrugsisfundamentallydifferent.Theregulationofillegaldrugsreliesheavilyonpunitive criminaljusticesystemresponses,whiletheregulationoflegaldrugsinvolves controllingaccesstothem,taxingthem,andinsomecases,dealingwiththe harmfulconsequencesassociatedwiththeuseofthesedrugs.
Anotherfundamentaldifferencebetweenpoliciesregulatingillegalandlegal drugsisthatthecompanieswhoproducelegaldrugshaveanadvantagein marketingandsellingtheirrespectiveproductsthatisnotenjoyedbythosewho sellillegalsubstances.Theprofitsassociatedwiththesaleoflegaldrugs, includingtobacco,alcohol,andprescriptiondrugs,aretremendous,andthe companiesmanufacturingtheseproductshavesubstantialpoliticalandeconomic power,whichtheyusetoinfluencelegislatorswhocreatepoliciestoregulate thesesubstances.Whilecurrentlawsallowcompaniestoselltheirlegaldrug products,itisalsoimportanttoconsiderhowtheyaredealtwithbygovernment authoritieswhentheyarefoundtobeinviolationofthe(alreadycomparatively weak)lawsdesignedtoregulatethem.
Thepronouncedlackofregulationforalcoholandtobaccoisparticularly notablewhenplacedinthecontextofthelevelsofharmassociatedwithuseof thesesubstances.Asoneindicationoftheirlevelofharm,intheUnitedStates, theannualnumberofdeathsattributabletotheuseoftobaccoandalcoholis roughly30timestheannualnumberofdeathsattributabletotheuseofallillicit drugscombined.Whilemodernalcoholandtobaccopolicieshavebeenenacted withthelaudablegoalofreducingalcohol-andtobacco-relatedharm,inpractice,someofthesepoliciesarerelativelyeffective,butsomearetotallyineffective andservetoexacerbateproblems.
Chapter9thusexaminesattemptstoregulatetheconsumptionoftobacco throughbansonpublicsmoking,restrictionsontheadvertisingandmarketingof
tobaccoproducts,andtaxesonthesaleoftheseproducts.Thechapteralso addressesagelimitsforthepurchaseandconsumptionofalcohol,alcohol interventionstargetedatcollegepopulations,andpoliciesdesignedtoreduce drunkdriving.
TheregulationofprescriptiondrugsisaddressedinChapter10.We recognizethatmillionsofpeoplebenefitfromtheproductsmanufacturedby pharmaceuticalcompanies,butnotethatthemotivationofthesecompaniesto increasetheirprofitsoftentakesprecedenceovermoregeneralpublichealth concerns.Severalunsafedrugshavebeenaggressivelymarketedbythesecompaniesandusedbyconsumers,resultinginsignificantnumbersofinjuriesand deaths.Perhapsmoredisturbingly,pharmaceuticalcompanieshaveusedtheir considerablepoliticalandmonetarypowertoinfluencetheFoodandDrug Administrationandtoshapelegislationregulatingtheirproducts.
Chapter10alsoaddressestheregulationofdietary/herbalsupplements we pointoutthatthesesubstancesareassociatedwithtensofthousandsofadverse healthoutcomesinusersinanygivenyear.Despitethisconsiderablelevelof harm,theregulationofdietary/herbalsupplementsisevenmorelaxthanthe regulationofpharmaceuticalproducts.
Chapter11presentsacriticalexaminationofcurrentpoliciesdealingwith illegaldrugsintheUnitedStates,focusingonissuesofeffectivenessinachieving theirstatedgoals,economicandsocialcosts,andunintendedconsequences resultingfromthesepolicies.SeveralWesterncountriestreatdruguseand dependencyprimarilyaspublichealthissues,buttheUnitedStateshasalong historyofaddressingdrugproblemsthroughthecriminaljusticesystem.Our reviewofUSpoliciessuggeststhatcriminaljusticeresponsestodrugusedolittle ornothingtoreducedruguseinthegeneralpopulation,whiletheysimultaneouslycreateanumberofsocialandeconomicproblems.Themostproblematicconsequencesofthesepoliciesarethattheysubstantiallyincreaseprison populationsandjusticesystemexpenditures,withadisproportionatelynegative impactonmembersofunderrepresentedgroupsandthelowersocialclasses.
While “warsondrugs” havebeenvirtuallycontinuousthroughoutthe20th centuryandintothe21stcenturyintheUnitedStates,themostrecentwaron drugs,whichbeganinthemid-1980s(althoughnowshowingsignsofabating somewhat),resultedinanintensificationofthecriminaljusticesystemresponse todruguse.Annualarrestsfordruguseincreasedsubstantiallyoverthe 1980–2010period,averagesentencesfordrugcrimeswereconsiderablylonger, andthenumberofpeopleincarceratedfordrugoffensesincreasedexponentially. Thesepolicieshavealsohadadisparateimpactonthelowerclassandmembers ofunderrepresentedgroups.DespitethefactthatAfricanAmericansand Hispanicpeopleuseillegaldrugslessfrequentlyorinapproximatelythesame proportionaswhitepeople,theconsequencesofdrugpoliciesfalldisproportionatelyonminoritiesintermsofarrests,prosecutions,incarcerations,anda hostofadditionalsocialandmonetarycosts.
WhiletheUS’ policiestowardillegaldrugswereapparentlyimplemented withthegoalofpreventingandreducingdruguseanddrug-relatedharm,after 30yearsandbillionsofdollarsincriminaljusticesystemandotherexpenditures,
itisclearthatthesepolicieshavefailedtoachievethesegoals,andtheyhavealso createdsubstantialancillaryharmsintheprocess.Althoughtherearesomesigns ofasofteningofdrugpolicies,particularlyatthelevelofindividualstates, fundamentalchangeseemsunlikelytooccur.
InChapter12,webeginwithadiscussionofharmreductiondrugpolicies, whichareincreasinglycommoninmanycountries(especiallyWesternindustrializednations).Weproceedtoadiscussionofpoliciesincountriesthat continuetorespondtosubstanceusethroughseverepenalties.Thechapterthen addressespoliciesinasampleofWesternindustrializednations,withaspecific focusondevelopmentsinharmreductionpoliciesinthosecountries,and cannabislawreforms.
Futuredrugpoliciesshouldconsidertheempiricalevidenceontheharms posedbyparticulardrugsandenactlawsthatdomoregoodthanharm.Theshift ofmostdevelopedcountries(andagrowingnumberofunderdevelopedcountries)toapproachesthatarebasedonharmminimization,andthelackofsubstantialincreasesindrugusefollowingsuchpolicychanges,suggeststhatthe UnitedStatesneedstoreconsideritsstrictcriminaljusticesystemapproachto regulatingcurrentlyillegaldrugs.
PrefacetotheThirdEdition
Thiseditionofthebookincludesmorethan2,000additionalreferences. However,weincludemuchofthematerialfromthe firsteditionandsecond editionsbecausewebelievethathistoricalcontextandperspectiveiscrucialin discussingdrugsanddrugpoliciesinthecurrentera.
Withrespecttonewandimportantissuesthathaveemergedsincethe publicationofthe2ndeditionofthebook(in2014),wedevoteconsiderable attentiontotheUSopioidcrisis(spreadthroughoutthebook,butparticularlyin Chapters1and11)emergingissueswithrespecttoyouthvaping(particularlyin Chapter7),andongoingdevelopmentswithcannabis(inChapter1,adiscussion of “redemonization” ofcannabis,particularlyassertionsthatcannabisconsumptionleadstomentalillnessandinvolvementinviolentbehavior;andin Chapters11and12,developmentsincannabispolicyinUSstatesandinother nations).
Newsocialissuesareexamined,suchasthedrugtestingofpeoplereceiving publicbenefits,employmenttestingformarijuanainthecontextofmedicaland recreationallegalization,racialandethnicdisparityintheenforcementofdrug laws,prohibitingemploymentofsmokersandpenalizingsmokers,andthe problemoffalsepositivedrugtests.Anumberofpolicy-relateddevelopments arealsocovered,includingdebatesaroundraisingtheminimumtobaccopurchaseage,regulationofthepriceofprescriptiondrugs,TheFairSentencingAct, anddrunkdrivingpolicies.
ACKNOWLEDGMENTS
WewouldliketoacknowledgethecontributionsofChadSmith,Franci Benson,LaurieDrapela,andJanetWestendorf,whoreadandcommented onearlierversionsofchaptersofthe firsteditionofthebookandmadesuggestionsfortheinclusionofadditionalmaterials.Wewouldalsoliketothank KristinCutler,whomadesuggestionsforthethirdeditionofthebook,aswellas thereviewerswhosecommentshelpedshapethethirdedition:
Althoughsomeofthesereviewersdidnotagreewithsomeofwhatwewrote inthesecondeditionofthebook,theirsuggestionsservedtoimprovethis manuscript.ThesereviewersincludeDavidAllenoftheUniversityofNew Orleans;TammyAndersonoftheUniversityofDelaware;DonBarrett, CaliforniaStateUniversity,SanMarcos;DeborahBaskin,CaliforniaState University,LosAngeles;JosephBebo,UniversityofMassachusetts,Boston; MichelleBrown,OhioUniversity;JenniferButters,CenterforAddictionand MentalHealth,Toronto;GiniDeibert,TexasStateUniversity,SanMarcos; PeterFenton,KennesawStateUniversity;ShellyWatkinsFichtenkort,Modesto JuniorCollege;AnneHatcher,MetropolitanStateCollege,Denver;James Hawdon,VirginiaPolytechnicandStateUniversity;JerryHimmelstein, AmherstCollege;DarrellIrwin,UniversityofNorthCarolinaatWilmington; BarbaraKail,FordhamUniversityGraduateSchoolofSocialSciences;Sheila Katz,SonomaStateUniversity;RobertO.Keel,UniversityofMissouri,St. Louis;DavidN.Khey,UniversityofFlorida;TinaLivingston,St.CloudState University;ScottMaggard,OldDominionUniversity;CarlMaida,California StateUniversity,Northridge;MathaiVairamonMathew,TexasSouthern University;SylviaMignon,UniversityofMassachusetts,Boston;LeahMoore, UniversityofCentralFlorida;KellyMosel-Talavera,TexasStateUniversity, SanMarcos;BryanPayne,OldDominionUniversity;AaronPeeks,Universityof Nebraska,Lincoln;AdamRafalovich,TexasTechUniversity;GregoryRosenboom,UniversityofNebraska,Lincoln;RonnieSwartz,HumboldStateUniversity;BobbySykes,UniversityofNewMexico;KenSzymkowiak,Chaminade UniversityofHonolulu;AlexThomas,SUNYOneonta;andLisaAnneZilney, MontclairStateUniversity.
Wearealsoindebtedtoseveralscholarswhoseworkhasshapedour approachtothinkingaboutdrugsanddrugpolicies:BruceAlexander,NeilBoyd, EdwardBrecher,EthanNadelmann,andAndrewWeil,tonamejustafew. Finally,wewouldliketothankthestaffatSAGEPublications,including SarahWilson,CandiceHarman,andPreethiAgnesThomas.Weareparticularlyindebtedtotheeditorofthe firstandsecondeditionsofthisbook,Jerry Westby,whosepatienceandsenseofhumor(andtoleranceofourattemptsat
humor)throughoutthevariousstagesofpreparationofthismanuscripthave beeninvaluable.Wealsoappreciatethepatienceandsuggestionsoftheeditorof thethirdeditionof DrugsandDrugPolicy,JessicaMiller.
Publisher’sAcknowledgments
SAGEthanksthefollowingreviewersfortheircontributionstothisedition.
JohnBoman,BowlingGreenStateUniversity
VickiLindsay,TroyUniversity
SelenaM.Respass,MiamiDadeCollege
ManuelF.Zamora,AngeloStateUniversity
Drugsappealtousbecausetheydeliveravarietyofmoodsandstatesnotimmediately availablefromoursurroundingrealities.Thesemaytakeincompleterelaxation, ecstatichappiness,thenegationofsuffering,radicallytransformedperceptions,orjust asenseofbeingalertandfullofpotentialenergy.(Walton,2002)
DruguseisubiquitousinAmericansocietyandthroughouttheworld.The USSubstanceAbuseandMentalHealthServicesAdministration’s(SAMHSA) NationalSurveyonDrugUseandHealthestimatedthatin2017(themostrecent yearforwhichdataareavailable),30.5millionAmericansaged12yearsorolder, or11.2%ofthepopulationinthatagegroup,usedanillegaldrugduringthe monthpriortothesurvey(SAMHSA,2018c).Thesamesurveyindicatedthat 140.6millionpeopleaged12yearsorolderwerecurrent(pastmonth)usersof alcohol,while48.7millionwerecurrentcigarettesmokers.Theuseofprescription drugsisalsowidespread in2016,anestimated55%oftheUSpopulationtookat leastoneprescriptionmedicine,andthosewhouseaprescriptiondrugtakean averageoffour(Preidt,2017).In2016,morethan4.5billionprescriptionswere filledatretailpharmaciesintheUnitedStates(this figuredoesnotincludemail, Internet,andothertypesofprescriptionpurchases)(Preidt,2017),andspending onmedicinesreached$450billioninthesameyear(IQVIA,2017).
Thewidespreaduseofdrugs,bothlegaland illegal,isbynomeansrestrictedtotheUnited States.TheUnitedNationsOfficeonDrugsand Crime(UNODC,2018)estimatesthatapproximately275millionpeople(roughly5.6%ofthe world’spopulationaged15–64years)used illegaldrugsatleastoncein2016,andtheretail valueoftheworldtradeinillicitdrugsisestimated tobebetween$426billionand$652billion (USdollars)(Tharoor,2017).Globally,anestimated192millionpeopleusedcannabisin2016, 34millionusedamphetamines/prescription stimulants,34millionusedopioids,18million usedcocaine,andmorethan8millioninjected drugs(UNODC,2018).Datasuchasthesehave ledsomecommentatorsondrugusetoassertthat intoxicationisnotunnaturalordeviant;instead, absolutesobrietyisnotanaturalorprimary humanstate.AsAndrewWeil(1986)suggests, “Theubiquityofdruguseissostrikingthatit mustrepresentabasichumanappetite” (p.17).
Elephants,likemanyofus,enjoya goodmaltedbeveragewhenthey cangetit.Atleasttwiceinthepast tenyears,herdsinIndiahave stumbleduponbarrelsofricebeer, drainedthemwiththeirtrunks,and goneondrunkenrampages…. Howlermonkeys,too,haveataste forthingsfermented.InPanama, they’vebeenseenconsuming overripepalmfruitattherateof tenstiffdrinksintwentyminutes. Even flieshaveanoseforalcohol. Theyhomeinonitsscenttolay theireggsinripeningfruit, ensuringtheirlarvaeapleasant buzz.Fruitflybrains,muchlike ours,arewiredforinebriation (Bilger,2009).
Whiledrugs boththosethatarecurrentlyillegalintheUnitedStatesandthose thatarelegal provideanumberofbenefitstothosewhousethem,alldrugsarealso associatedwithcertainharms.Forexample,globally,itisestimatedthatnearly 6milliondeathsperyear,includingmorethan480,000intheUnitedStates,are relatedtotobacco(CentersforDiseaseControl,2017),that88,000peoplediefrom alcohol-relatedcausesannuallyintheUnitedStates(NationalInstituteonAlcoholism andAlcoholAbuse,2017),andin2017,thereweremorethan17,000deathsrelatedto prescriptionopioids(NationalInstitute onDrugAbuse,2019).Itisimportanttonote thatallofthedrugsmentionedabovearecurrentlylegalintheUnitedStates,and althoughaswediscussbelow,therehavebeen recentincreases,thenumberofdeaths relatedtocurrentlyillegaldrugsintheUnitedStatespalesincomparisontothedeaths associatedwithlegaldrugs.Ifweconsiderdeathsassociatedwithdrugstobeatleast oneacceptablemeasureoftheirharmfulness,wemayquestionwhyalcohol,tobacco, andmanypharmaceuticaldrugsarelegalsubstances,whiledrugssuchascocaine, ecstasy,heroin, methamphetamine,andmarijuana(whichhasneverbeenshownto causeanoverdosedeath,althoughasofthiswriting,itisillegalin39USstatesandthe overwhelmingmajorityofcountriesintheworld)arecurrentlyillegal.
Wemayalsoquestionwhythemostnoteworthyresponsetothealleged illegal drugproblemintheUnitedStateshasbeentheincarcerationofmassivenumbersof people.Whilethe28countriesoftheEuropeanUnion(withacollectivepopulation ofabout200millionmorethantheUnitedStates)incarceratedatotalof574,469 peoplein2015,intheUnitedStates,approximately435,000peoplewereincarceratedforthecommissionofdrugoffensesalone(Wagner&Sawyer,2018).
Theseparadoxesrequireustoconsiderthedistinctionbetweenlegaland illegaldrugs,and,moredirectly,toexaminehowcertaindrugshavebeen demonizedinordertojustifytheirillegalstatus.
DEMONIZING(ILLEGAL)DRUGS:THESOCIAL CONSTRUCTIONOFDRUG “ EPIDEMICS ”
Thedatapresentedaboveindicatethattheuseof psychoactivesubstances bothlegalandillegal iswidespreadthroughouttheUnitedStates andtherestoftheworld.Itappearsthatpeopleneedtoingestanincreasingly diversearrayofsubstancesinordertoaltertheirconsciousness.Butthisneed forpsychoactivesubstancesextendsto otherconstituencies,includinggovernmentandcriminaljusticesystemof fi cialsandthepopularmedia.As O ’ Grady(2010)notes, “ Thedrugwarriorindustry,whichincludesboththe privatesectorandamassivegovernmentbureaucracydevotedto ‘ enforcement ’ hasanenormouseconomicincentivetokeepthewarraging. ” Government of fi cialsneeddrugsinordertocreateheroesandvillainsand,inmanycases,to divertattentionfrompoliciesthathaveledtodruguseinthe fi rstplace. Criminaljusticesystemof fi cialsneedpsychoactivesubstancesinordertojustify increasesin fi nancialandotherresourcesdevot edtotheirorganizations,and thepopularmedianeeddrugsinordertocreatemoralpanicsandsellnewspapersandadvertisingtime.
Asaresultoftheseneeds,throughoutthe20thcenturyandintothe21st century,governmentandcriminaljusticesystemofficialsintheUnitedStates, frequentlyassistedbythepopularmedia,haveengagedinaconcertedcampaignto demonize certain drugsinordertojustifytheirprohibition.Anumberoftactics havebeenusedinthisendeavor.Onestrategyusedinemphasizingthedangersof
(illegal)drugsistoclaim,oftenwithoutany soundempiricaldata,thattheuseofthese substancesisresponsibleforasignificant proportionofthecrimethatoccursinsociety. Forexample,whenPresidentNixonwas attemptingtojustifyhisadministration’swar ondrugsintheearly1970s,whichhereferred toastheUnitedStates’“secondcivilwar,” he claimedthatheroinuserswereresponsiblefor $2billioninpropertycrimeannually.This wasaratherstrangecalculation,giventhatthe totalamountofpropertycrimein1971 amountedtoonly$1.3billion(DavenportHines,2001).
Asecondfrequentlyusedstrategyisto attributeuniquepowersto(illegal)drugsthat allegedlyinduceuserstocommitbizarreacts (includingsexuallydeviantacts)whileunder theirinfluence.Sullum(2003a)referstothis tendencyas “voodoopharmacology”—theidea that(illegal)drugsareincrediblypowerful substancesthatcantakecontrolofpeople’ s behavior,turningtheminto “chemicalzombies.” ZimringandHawkins(1992)emphasizea similarthemeintheirdiscussionofthemetaphysicalnotionoftheuniquepsychoactivedrug thatleadstoasituationwherebyeachnew substanceidentifiedasbeingproblematicis viewedaschemically,physiologically,andpsychologicallybothnovelandunique.
Governmentofficials,themedia, andotherauthoritieshavefound thatdrugaddiction,abuse,and evenusecanbeblamedbyalmost anyoneforlong-standingproblems andtheworseningofalmost anything.Theft,robbery,rape, malingering,fraud,corruption, physicalviolence,shoplifting, juveniledelinquency,sloth, sloppiness,sexualpromiscuity,low productivity,andall-around irresponsibility—nearlyanysocial problemcanbesaidtobemade worsebydrugs(Levine,2001).
Thenewsmediacanalwaysbe reliedupontocomeupwith somebodywhohadasix-day sessiononthestuffandendedup bykillingandeatingthe neighbor’sdog,laterclaimingthat theyremembernothingofwhat hadhappened,andanother devastatingcrimewave.Thelast arisesbecauseeachnew substancehastobedescribedas beingmorerapaciously, instantaneouslyaddictivethan anythingelsepreviouslyheardof (Walton,2002,p.171).
Illegaldrugshavealsobeendemonized overthepast100yearsbyclaimsthatthey areconsumedprimarilybymembersof underrepresentedgroupsandthatthesubstancesaredistributedprimarilybyevil foreigntraffickers.AsMusto(1999)suggests, “Theprojectionofblameonforeignnations fordomesticevilsharmonizedwiththeascriptionofdrugusetoethnicminorities. Boththeexternalcauseandtheinternallocuscouldbedismissedasun-American” (p.298).Adefinitiveexampleoftheattributionofdrugproblemstoforeigners appearedintheUSDrugEnforcementAdministration’s(2018b) NationalDrug ThreatAssessment:
MexicoremainstheprimarysourceofheroinavailableintheUnitedStates Illicit fentanylandothersyntheticopioids,primarilyfromChinaandMexico,arenowthe mostlethalcategoryofopioidsusedintheUnitedStates Cocaineavailability anduseintheUnitedStateshavereboundedinlargepartduetothesignificant increasesincocainecultivationandproductioninColombia Methamphetamine remainsprevalentandwidelyavailable,andmostofthemethamphetamineavailable intheUSisbeingproducedinMexico ... Chinaremainstheprimarysource forsyntheticcannabinoidsandsyntheticcathinonesthataretraffickedintothe UnitedStates.
AswediscussinmoredetailinChapter11,PresidentTrumphasalsoblamed theUnitedStates’ opioidcrisisonMexicoandfalselyclaimedthatthemajority ofdrugsenteringtheUnitedStatescomethroughunprotectedportsofentryon thesouthernborder(Rosenberg,2019a).Trumphasmarshaledtheseclaims toful fi lloneofhismajorcampaignpromises tobuildawallonthesouthern border.
Governmentandcriminaljusticesystemof ficialsandmediasourceshavealso demonizeddrugsthroughassertionsthattheiruseresultsindeathandreferencesto thethreattheysupposedlyposetochildren.Finally,government,criminaljustice systemofficials,andmediasourceshavedemonizeddrugsthroughthemisrepresentation,distortion,or,insomecases,suppressionofscienti ficstudiesonthe effectsofthesedrugs.
Inordertoprefaceourdiscussioninlaterchaptersontheeffectsofand policiestodealwithbothlegalandillegaldrugs,thischapteraddressesthe demonizationofdrugsandthesocialconstructionofdrugepidemicsintheUnited Statesoverthelast100years.Itisimportanttostateattheoutsetthatincritically examiningtheseissues,wearenotsuggestingthatdrug “epidemics” areconstructed withoutanyfoundationwhatsoever;obviously,atleastsomeuseofthesubstancein questionhastooccurinorderforaparticulardrugtobeacandidatefor “epidemic” status.Butinthiscontext,itisimportanttoconsiderthemeaningoftheterm epidemic.Inthe1300s,thebubonicplagueclaimedthelivesof25millionpeople, one-thirdoftheworld’spopulation(“PastPandemics,” 2005);theIrishfamineof 1846–1850resultedinthedeathofasmanyas1millionpeopleoutofapopulation of8million(Bloy,n.d.);in1918–1919,astrainofH1N1 fl ukilledalmost100 millionpeople 5%oftheworld’spopulation(Yong,2018);andsincethe beginningoftheHIV/AIDSepidemicinthe1980s,approximately35million peoplehavediedofthedisease,andanestimated36.7millionpeopleworldwide wereHIV-positiveasof2016(WorldHealthOrganization,2018a).Mostofus couldagreethattheseareexamplesofepidemics.However,tousetheterm epidemic inthecontextofstatisticsthat1.6%ofAmericansreporteverusingheroinintheir lifetime,2.8%reporteverusing crackcocaine,6.0%reporteverusingecstasy,and 4.7%reporteverusingmethamphetamine(Statista,2018)isalarmistand misleading.Thisisnotsimplyamatterofsemantics,butratheritpointstothe misapplicationofscientificterminology,which,inthecontextofdruguseandwith respecttoitsimplicationsforpolicies,isinappropriate.
Inaddressingthedemonizationofdrugsandthesocialconstructionofdrug epidemicsinthischapter,wearealsonotsuggestingthatthesubstancesinquestion areharmless aswillbediscussedinChapters3and4,nodrugsare.However,as willbeseen,governmentandmediaaccountshavecreatedmythsaboutcertain substancesthroughtheexaggerationofharmsassociatedwiththem;itisnecessary todeconstructthesemyths.
Wewillprovideseveralexamplesofthesocialconstructionofdrugepidemics, focusingondifferentsubstancesoverdifferenthistoricalperiods,includingcrack cocaineinthe1980s,ecstasyinthe1990sto2000s,methamphetamineinthe1990s to2000s,aswellas “Spice/K2” and “bathsalts/bathsalts/flakka” inthe2000sto 2010s.Wedevoteconsiderablymoreattentiontomarijuana,which,despiteits legalizationinseveralstates,continuestodominatetheUnitedStates’ drugwarin termsofnumberofarrestsandlargercriminaljusticesystemactivity.Weconclude thechapterwithadiscussionofthecurrentopioidepidemicintheUnitedStates, which,incontrasttotheotherexamplescovered,trulydoesqualifyasanepidemic thisepidemicconstitutesaprimeexampleofthemaxim “Ifyougobackfar enough,nearlyeveryillicitdrugmarketcantraceitsrootstothepharmaceutical
industry” (Frydl,2017).Inordertosetthestageforthediscussionofconstructed drugepidemics,webeginwithadiscussionofthe “glue-sniffingepidemic” that emergedintheUnitedStatesinthelate1950sandearly1960s.Theprinciples outlinedbyBrecher(1972)inhisdiscussionofthisparticularepidemicarestrikinglysimilartothosethathavebeenappliedinconstructingdrugepidemicsin bothearlierandlatertimeperiodsandalsoforothersubstances.
GLUE-SNIFFING
Glue-sniffing,whilelikelyengagedin(perhapsinadvertently)byasignificant proportionofyoungpeople,wasvirtuallyunheardofintheUnitedStatesbefore 1959.Themedia firstmentionedthisissueinthatyearafterchildrenwerearrested inTucson,Arizona,andPueblo,Colorado,forglue-sniffing(Brecher,1972).The phenomenonthenapparentlysurfacedinDenver,whereajuvenilecourtjudgesaid heviewedglue-sniffingas “thenumberoneprobleminthemetropolitanarea” (p.324).Atleastpartiallyasaresultofconsiderablemediaattentiontothepractice, 130youthwerearrestedforglue-sniffinginDenverovera2-yearperiod,andin October1961,the NewYorkTimes publishedanarticledescribingasimilar problemwithglue-sniffinginNewYorkCity.Within5months,policeinNew Yorkhadarrested778individualsforglue-sniffi ng.
Similartothepatternwewillseeforother substancesaddressedinthischapter, mediasourcesbegantorecountbizarreactsandbehaviorsthatwereallegedlycaused byglueinhalation.Ina1962 Newsweek article,forexample,itwasnotedthat “a12year-oldboy,discoveredsniffingairplanegluebyhisfather,snatchedupaknifeand threatenedtokillhim.” ThesamearticlequotedaMiamipoliceofficerwhoasserted, “It’scommonforboyswhosniffgluetobecomebelligerent.Theyarewillingtotake onpolicementwicetheirsize” (ascitedinBrecher,1972,p.329).Federalgovernment officialsalsobegantoweighinontheproblem, emphasizinganotherconsistentthemeusedto demonizedrugs:theideathatglue-sniffingled toinvolvementinsexual(andhomosexual) activities(seebox).
Brecher(1972)furthernotesthatan additionalstrategyinconstructingthegluesniffingepidemicwastoreportondeaths allegedlycausedbytheactivity;anumberof popularmagazinesandnewspaperscontained reportsthatninedeathshadbeencausedby glue-sniffing.However,whenthesedeaths weresubjecttofurtherinvestigation,itturned outthatatleastsix(andpossiblyseven)of themweretheresultofasphyxiationcaused bytheglue-sniffer’sheadbeingcoveredbyan airtightplasticbag.Anotherofthedeaths attributedtoglue-sniffinginvolvedayoung personwhowassufferingfromotherailments andhadsniffedgasolinefumes,butnotglue. Attributingtheninthdeathtoglue-sniffing wasalsoproblematicbecausetheindividual inquestionhadnotevenbeensniffingglue beforehisdeath.
AnFBIBulletin(1965)onthetopicof glue-sniffingnoted, “Glue-sniffers havedescribedhowanumberof children,boysandgirls,meetin unoccupiedhouseswheretheywill sniffgluetogetherandlaterhave sexualrelations,bothhomosexual andheterosexual….Recently,while conversingwithdeputyprobation officers,Ihavebeeninformedthat severalepisodesofhomosexual relationshaveoccurredbetween adultsandchildrenunderthe influenceofglue.Someofthese sexualpervertsareencouragingthe childrentosniffgluewiththe intentionsofhavinghomosexual relationswiththem” (ascitedin Brecher,1972,p.330).
Brecher(1972)concludesthatthisglue-sniffing “epidemic” wasconstructed bythemediaandgovernment,andthatthedistortionswithrespecttothedangers associatedwithglue-sniffingmayhaveinadvertentlycontributedtoanincreasein druguseamongyouth.
Itseemshighlylikely,inretrospect,thattheexaggeratedwarningsagainstglue sniffingwereamongthefactorsdesensitizingsomeyoungpeopletodrugwarningsin general.Mostteenagersknewofothersintheirownneighborhoodswhohadsniffed gluerepeatedly,andwhodidnotdropdeadorgotothehospitalwithbraindamage, kidneydamage,orliverdamage.(p.332)
Arelated “epidemic” associatedwiththeuseofsolventsemergedin2001. Referringtoallegedincreasesintheuseofsolventsbyyoungpeople,Dr.JoEllen DyeroftheCaliforniaPoisonControlSystemcommented, “Iwouldsaywe’reat epidemicproportions.Thisisthenewmajordrugofabuseoutthere” (asquotedin Pena,2001).Evidenceforthisparticularepidemicwasthatthereweresixdeaths nationwideassociatedwithsolventuseoveraone-and-a-half-yearperiod.
MARIJUANA
Asdiscussedabove,oneoftheprominentstrategiesusedtojustifyprohibitionofa particularsubstanceistoemphasizeawiderangeofnegativeeffectsassociatedwith itsuse.Althoughmostwouldagreethatmarijuanaisthemostbenignofdrugsthat arecurrentlyillegalinmoststatesandcountries,anexaminationofthehistoryof itsportrayalbygovernmentofficialsandinmediasourcesrevealsanumberof recurrentthemesthatservedtodemonizethesubstanceandrationalizeitsprohibition.Atvariouspointsinhistory,marijuanahasbeenportrayedasasubstance thatisprimarilyusedbymembersofunderrepresentedgroups,asasubstancethat causesviolenceand “aberrant” sexualbehaviors,asasubstancethatcauses amotivationalsyndrome,andasasubstancethatisa “gateway” totheuseofharderdrugs.
ThePortrayalofMarijuana:1800sto1960
Marijuanahasalong,rich,andfascinatinghistory,bothintheUnitedStatesand globally.Hempwasusedforshipbuildingaround470BC,andthecannabisplantwas cultivatedforitspsychoactivepropertiesthroughoutAsiaandtheFarEastasearlyas the1stcenturyBC(Davenport-Hines,2001).Althoughtheexactdatewhenthe substancewasintroducedtoWesternEuropeisnotknown,anarcheologicalinvestigationattwoBronzeAge(roughly6,000–2,500BC)sitesuncoveredtheremainsof marijuanaseedsandpipesthatwereapparentlymadespecificallyforsmokingthe substance(Walton,2002).InBritain,alawpassedinthe1500srequiredthatfarmers setasidepartoftheirlandforthecultivationofhemp(Walton,2002) thePilgrims broughtcannabiswiththemtoNewEnglandin1632,andin1639,tomeettheneed forhempinEngland,colonistsinVirginiawererequiredbylawtocultivateand harvestacertainnumberofcannabisplantseachyear;thosewhodidnotcomplywith thelawcouldbesubjecttoimprisonment(Ventura,2016).HempfarmingandprocessingoftheplantplayedasignificantroleinAmericanhistory itiswellknownthat PresidentGeorgeWashingtongrewhempforseedand fiber,asdidThomasJefferson (Lee,2012).ThereisalsosomeevidencetosuggestthatPresidentWashington personallyconsumedhemppreparationsformedicalpurposes.Belville(2014)notes thatotherearlyUSpresidentswhoarebelievedtohaveconsumedcannabisfor
medicinaland/orrecreationalpurposes includeJamesMadison,JamesMonroe, AndrewJackson,ZacharyTaylor,andFranklinPierce.
Medicinaluseofcannabisinthe1800salsooccurredinother countries QueenVictoriauseditforrelieffrommenstrualcramps,anddiscussionsofthesubstancebegantoappearinthescientificandmedicalliteratureinthe 1800s.Bytheendofthecentury,morethan100articlesonhemp/cannabishad beenpublished,withmanyofthecommentatorsofferingimportantinsights regardingitsbenefitsandeffects(Mosher&Akins,2019).
Earlyreportsontheeffectsofmarijuanaindicatedthatitwasarelatively benignsubstance,especiallywhencomparedwithalcohol.Forexample,the1893 IndianHempDrugsCommission,whichhadbeenappointedbytheBritishgovernmenttoexaminecannabisuseinIndia,concluded, “Onthewhole,theweightof theevidenceistotheeffectthatthemoderateuseofhempdrugsproducesno injuriouseffectsonthemind .Thetemptationtoexcessisnotasgreataswith alcohol” (IndianHempDrugsCommission,1893,pp.264,286).
Similarly,inanarticlepublishedinthe JournalofMentalScience,Walsh(1894) wrote,
Itwouldseemthatthemoderateuseofhempdrugsmaybebeneficialundercertain conditions;atanyratesuchmoderateusecannotbeharmful... .[T]hereisnot,inmy opinion,anyspecificpropertyinhempdrugswhichincitestoviolenceorcrime.(p.27)
Aneditorialinthesamejournalnoted, “Apparentlyitismuchlessliablethan alcoholtoinducementocommitviolentactions” (“Editorial,” 1894,p.107).
Despitealackofscientificevidenceidentifyinganysignificantdeleterious effectsofmarijuana,whentheUSfederalgovernmentdecidedtocreatemarijuana legislationinthe1930s,theFederalBureauofNarcotics(FBN)initiatedavigorous antimarijuanapropagandacampaign.TheBureauanditsdirector,Harry Anslinger,providedmediasourceswith “information” ontheeffectsofmarijuana thatwaswidelyreportedandservedtodemonizethesubstance.Mosher’s(1985) contentanalysisofarticlesaddressingthetopicofmarijuanapublishedinpopular magazinesandnewspapersidentifiedanumberofthemesthatwereemphasizedin ordertojustifylegislationbanningmarijuana.From1900to1934(justpriortothe passageoftheMarijuanaTaxActin1937),mostarticlesonthetopicassertedthat theprimaryusersofmarijuanaweremembersofunderrepresentedgroups in particular,Mexicans.Forexample,onecommentatorfromSacramento,California, noted, “Marijuana,perhapsnowthemostinsidiousofnarcotics,isadirectbyproductofMexicanimmigration... .Mexicanpeddlershavebeencaughtdistributingsamplemarijuanacigarettestoschoolchildren” (ascitedinMusto,1999, p.220).Thepurportedeffectsofthedrugrangedfrom “temporaryelation” (“Facts andFancies,” 1936,p.7)to “themostviolentofallsexualstimulants ... reason dethroningandcausingitsuserstoenterintocriminallife” (Simon,1921,p.14).
Anarticlepublishedinthe St.LouisDispatch in1934,titled “DrugMenaceat theUniversityofKansas HowaNumberofStudentsBecameAddictsofthe StrangelyIntoxicatingWeed,” noted,
Thephysicalattackuponthebodyisrapidanddevastating.Intheinitialstagesthe skinturnsapeculiaryellowcolor,thelipsbecomediscolored,dried,andcracked.Soon themouthisaffected,thegumsareinflamedandsoftened.Thentheteethare loosenedandeventually,ifthehabitispersistedin,theyfallout.Likeallotherdrugs, marijuanaalsohasaseriouseffectonthemoralcharacteroftheindividual, destroyinghiswillpowerandreducinghisstamina.(ascitedinJ.Gray,2001,p.24)
Between1935and1939,anumberofarticlessuggestedthatcannabisposeda specificthreattoyoungpeople;forexample,a ScientificAmerican articlereferredtothe substanceasthe “assassinofyouth” (“MarijuanaMenaces,” 1936,p.150).Other articlesemphasizedthattheuseofmarijuanaledtoviolentcrime,sexualimmorality, andavarietyofadversepsychologicaleffects.Forexample,anarticleappearinginthe popularmagazine SurveyGraphic reported, “VictorLacata,whileundertheinfluence ofmarijuana,murderedhismother,father,sister,andtwobrotherswithanaxe.” The samearticlerecountedthecaseof “LewisHarris,26,arrestedfortherapeofanineyear-oldgirlwhileundertheinfluenceofmarijuana” (“Danger,” 1938,p.221).Ata meetingoftheAmericanPsychiatricAssociationin1934,Dr.WalterBromberg similarlyemphasizedmarijuana’seffectoninvolvementinsexualactivity,albeitwitha differentfocus:Marijuana “releasesinhibitionsandrestraintsimposedbysocietyand allowsindividualstoactouttheirdrives openly[and]actsasasexualstimulant [particularlyto]overthomosexuals” (asquotedinMusto,1999,p.220).Withrespect totheadversepsychologicaleffectsallegedlyassociatedwithmarijuana,anarticlein ScientificAmerican listed,amongothers, “theweakeningofpowertodirectthoughts, emotionaldisturbances” and “irresistibleimpulseswhichmayresultinsuicide” (“MarijuanaMoreDangerous,” 1938,p.293).
Inadditiontoantimarijuanapropagandaappearinginpopularmagazinesand newspapers,therewereanumberofmoviesproducedinthe1930sand1940sthat furtherservedtodemonizethesubstance. ReeferMadness (originallytitled TellYour Children,1935),producedlargelyincollaborationwiththeFBN,wasthebest knownofthesemovies.The filmdepictedmarijuanaasa “demonweed” thatwas capableofalteringthepersonalitiesofyoungpeoplewho,aftersmokingthedrug, wentinsane,immersedthemselvesin “evil” jazzmusic,andcommittedsuicideor wentonmurdersprees(Talvi,2003b).Perhapslesswellknownareotherantimarijuana filmsproducedinthisera,including WeedWithRootsinHell (1936), The Devil’sHarvest (1942),and SheShouldaSaidNo (WildWeed)(1948)(Schlosser, 2003).
Inthe1940s,researchconductedundertheauspicesofNewYorkMayor LaGuardia’sCommissionrefutedsomeoftheearlierreportsofmarijuana’ s allegedlynegativeeffects.AllentuckandBowman(1942)studied77marijuana usersandconcluded, “Whileexertingnopermanentdeleteriouseffects,marijuana givesrisetopleasurablesensations,calmness,andrelaxationandincreasesthe appetite” (p.249).Theseauthorsalsosuggestedthatthesubstancehadvaluable therapeuticapplications.
Inresponsetothisandanother1942publicationonthetopicofmarijuanathat hadstated “unqualifiedlythattheuseofmarijuanadoesnotleadtophysical,mental,or moraldegenerationandthatnopermanentdeleteriouseffectsfromitscontinuoususe wereobserved” (ascitedinDavenport-Hines,2001,p.278),theheadoftheFBN, HarryAnslinger(1943),wroteaneditorialinthe JournaloftheAmericanMedical Association statingthat “unsavorypersons” whowereengagedinthemarijuanatrade would “makeuseofthestatementinpushingtheirdangeroustraffic ” (p.212).The editorialalsostatedthataboyhadreadanaccountoftheLaGuardiaCommission reportandthatthishadledhimtoinitiatetheuseofmarijuana.
Inadditiontoattemptingtodiscreditthe fi ndingsofscientificstudiesindicatingthatmarijuanawasnotasdangerousasubstanceashadpreviouslybeen reported,theFBNandthepopularmediabegantoemphasizenewthemesinorder tojustifyprohibitionofthesubstance.Themostprominentandenduringofthese themeswasthenotionthatmarijuanawasastepping-stoneor gatewaydrug.This themewasillustratedinanarticleinthe NewYorker,whichnoted, “Mostdrug
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Ptosis, hysterical, 238 in tabes dorsalis, 830
Puberty, influence on causation of catalepsy, 318 of migraine, 407 , 411 influence on cerebral anæmia,
Puerperal insanity, 173 tetanus, 562
Pulmonary consumption, relation to mental diseases, 119 , 142
Pulsation of carotids, weakness of, in progressive unilateral facial atrophy, 696
Pulse, state of, in acute alcoholism, 587 , 588 , 593 in acute simple meningitis, 717 , 718 in acute spinal meningitis, 750 in catalepsy, 321 in cerebral anæmia, 784
in cerebral hemorrhage and apoplexy, 938 in chorea, 449 in concussion of the brain, 909 in epilepsy,
480 in hæmatoma of the dura mater, 708 in hysteria,
252 in migraine,
, 411 , 412 in tetanus, 551 in the chloral habit, 662 in the opium habit, 654 , 657 , 659 in thermic fever,
391 in tubercular meningitis, 726-728 and respiration in delirium tremens, 629
Pupils, dilatation of, in migraine, cause of, 411 hysterical dilatation of, 248 in acute simple meningitis, 717 in cerebral anæmia, 775
in chronic hydrocephalus, 741 in concussion of the brain, 909 in diseases of the cervical sympathetic, 1264 in disseminated sclerosis, 879 in epileptic fit, 480 in general paralysis of the insane, 195 in tabes dorsalis,
, 830 in tubercular meningitis,
loss of reflex of, in nervous diseases,
Pus, characters of, in abscess of the brain,
Pyramidal tract, derangements of, in amyotrophic lateral sclerosis,
Pyromania, 147
Quinia, use of, in acute simple meningitis, 721 in alcoholism, 642 , 643 , 645 , 646 in chronic lead-poisoning, 691 in intermittent neuralgia of supraorbital, 1233
in labio-glosso-laryngeal paralysis, 1175 in migraine, 414 in neuralgia, 1224 in paralysis agitans, 438 in sciatica, 1236 in spinal meningeal hemorrhage, 756 in thermic fever, 398
Race, influence on causation of chorea,
of hysteria,
of hystero-epilepsy,
of thermic fever,
Railway sickness,
Rectum, hysterical disorders of,
Reflex causes of epilepsy, 472 of neuralgia, 1220
irritability, changes in, in catalepsy, 321 irritation as a cause of catalepsy, 318
of chorea,
444 movements, abnormal, in nervous diseases,
50 of patellar tendon in nervous diseases,
52 paralyses in spinal anæmia, 806 paralysis in neuritis, 1193
Reflexes, active, in spinal hyperæmia, 802
exaggerated, in spinal syphilis, 1026
in acute spinal myelitis, 818 in amyotrophic lateral spinal sclerosis, 868 in chorea, 448 in combined forms of sclerosis, 870 in diffuse sclerosis, 888 in disseminated sclerosis, 875
, 877 in hemiplegia, 962 in spastic spinal paralysis, 862 in tabes dorsalis, 835 in tumors of the brain, 1041 of the spinal cord, 1092 , 1094
tendinous in epilepsy, 481
vaso-motor, 1248
Religious feeling, extreme, as a cause of ecstasy, 34
Remissions in general paralysis of the insane, 194 in tubercular meningitis, 727
Respiration, artificial, in cerebral hemorrhage, 976
in acute spinal meningitis,
750 in anæmia of the brain,
777 in catalepsy,
321 in cerebral hemorrhage and apoplexy, 935 in concussion of the brain, 909 in labio-glosso-laryngeal paralysis, 1171 in the chloral habit,
in thermic fever,
in tubercular meningitis,
in tumors of the brain, 1044
Rest, value of, in apoplexy, 975 in concussion of the brain,
in hyperæmia of the spine,
804 in melancholia, 160 in myelitis, acute, 823 in neuritis, 1194 in symmetrical gangrene, 1261 in writers' cramp, 533