It's Time for Realism (Page 2)

By now, it should be clear that America's drug problem is home-grown, and that any effort to combat it must be centered here. In particular, we must confront the real source of our problem--the demand for drugs. On this point, many liberals subscribe to the "root causes" school. This holds that the problem of drug abuse in America reflects deeper ills in our society, such as poverty, unemployment, racial discrimination and urban neglect. To combat abuse, we must first address these underlying causes--through policies to promote full employment, increase the minimum wage, provide universal health insurance, end housing segregation and create opportunities for disadvantaged youths.

In focusing attention on the link between poverty and drug abuse, the root-causes school provides a valuable service. Studies indicate that drug addiction in the United States is disproportionately concentrated among the unemployed and undereducated. And certainly most liberals would endorse measures to improve their lot. This, however, takes us far beyond the realm of drug policy. To maintain that we must end poverty and discrimination in order to combat drug abuse seems a prescription for paralysis. The key is to find a strategy that is humane, affordable and sellable--to find a strategy, in short, that could actually work.

Certainly such a standard would seem to rule out the third main school of left/liberal drug reform--legalization. On the surface, drug legalization has undeniable appeal. If drugs were legalized, the vast criminal networks that distribute them, and that generate so much violence, would disappear. Prison space would be reserved for the truly dangerous, black motorists would no longer be stopped routinely on the New Jersey Turnpike, relations with countries like Mexico and Colombia would improve and Americans would no longer be hounded for the substances they decide to consume--a matter of personal choice.

Yet legalizing drugs would entail some serious risks, the most obvious being an increase in abuse. While legalizers tend to cite drug prohibition as the source of all evil when it comes to drugs, drugs themselves can cause extensive harm. Heroin, cocaine, crack and methamphetamine are highly toxic substances, and those addicted to them engage in all kinds of destructive behavior, from preying on family members to assaulting strangers to abusing children. In all, there are an estimated 4 million hard-core drug users in the United States. Though making up only 20 percent of all drug users nationwide (the rest being occasional users), this group accounts for two-thirds to three-quarters of all the drugs consumed here. They also account for most of the crime, medical emergencies and other harmful consequences associated with drugs. If drugs were legalized, the number of chronic users could well increase.

History is full of cautionary examples. In the early seventies, for instance, doctors routinely began prescribing Valium (a minor tranquilizer) for everyday cases of anxiety. As the number of prescriptions increased, so did the incidence of abuse; by the late seventies Valium was sending more people to hospital emergency rooms than any other drug, heroin and cocaine included. As physicians became aware of Valium's dangers, they began writing fewer prescriptions for it, and the number of emergency cases began dropping as well. Clearly, making drugs easier to get can increase the extent to which they are abused, and one can only imagine what would happen if such potent intoxicants as heroin and crack suddenly became available by prescription or were sold openly. Under the regimes favored by some libertarians and free-marketeers, legalized drugs would be sold commercially and marketed aggressively, with potentially disastrous results for addicts and kids.

From a political standpoint, the liabilities of legalization are no less obvious. According to opinion polls, most Americans strongly oppose legalizing drugs. While the unpopularity of an idea should not automatically disqualify it, legalization seems a long-term loser. Indeed, the fact that legalization has so often been presented as the sole alternative to the drug war has hindered the movement for reform.

By now, the risks of legalization have become so evident that even onetime supporters no longer advocate it. Instead, they have embraced a variant of legalization called harm reduction. Not always easy to define, harm reduction generally holds that the primary goal of drug policy should not be to eliminate drug use but rather to reduce the harm that drugs cause. Those who can be persuaded to stop using drugs should be; those who can't should be encouraged to use their drugs more safely. To that end, harm reductionists favor expanding the availability of methadone, setting up needle-exchange programs, opening safe-injection rooms for heroin users and establishing heroin-maintenance programs that provide addicts with a daily dose of the drug.

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