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1994-06-29
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From: gemini7@phantom.com (NY)
Subject: NYC Lawyers' Oppose War On Drugs
Date: 27 Jun 1994 04:38:09 GMT
The June 1994 issue of "The Record," the official
publication of the Association of the Bar of the City of New
York, will include a recently released report by the Association's Special
Committee on Drugs and the Law. The report is entitled "A Wiser Course:
Ending Drug Prohibition" (the "Report"). In typewritten form,
the Report is 83 pages long and has 203 footnotes of sources
and authorities.
On June 15, 1994, the New York Law Journal (the daily newspaper
for lawyers in New York) printed on page one a news article
about the Report. Unfortunately, the rest of the "media"
(e.g., the New York Times, The Daily News, Newsday, ABC, CBS,
NBC, C-SPAN, TBS) have failed, at least so far, to take any
notice of this Report.
To get the word out about this Report, the Association
has given permission for the Report to be distributed on the
Internet. A full-length copy of the Report (about 96,388 bytes
but without the 203 footnotes) is posted here for your reading
enjoyment. The dissent is also reproduced at the end.
If anyone is interested in purchasing a hardcopy of "The
Record" issue containing the footnoted version of the Report,
please use the following information:
The Association of the Bar
of the City of New York
42 West 44th Street
New York, New York 10036
(212) 382-6600
If you agree with opinions expressed in the Report,
please tell the media, your state and federal representatives,
your friends, and your family about the Report. Let's get the
debate on the "War On Drugs" rolling!!!!
********************************************************************
A WISER COURSE: ENDING DRUG PROHIBITION
TABLE OF CONTENTS
I. INTRODUCTION
II. THE COSTS OF PROHIBITION
A. DISTORTION OF THE JUDICIAL SYSTEM
1. New York State
2. Other States
3. Federal Courts
4. The Judiciary is Impatient with the Present System
5. Efforts to Handle Court Congestion
B. THE PRISON STATE
C. EROSION OF THE RULE OF LAW AND CIVIL LIBERTIES
1. Perception of Ineffectiveness
2. Perception of a Self-Perpetuating System
3. Police Corruption
4. Poor Children are Victims of the "War on Drugs"
5. Selective Prosecution
6. Erosion of Constitutional Rights
7. Forfeiture's Heavy Hand
8. Erosion of Privacy Rights
D. PROHIBITION-INDUCED VIOLENCE
E. PROHIBITION'S FAILURE TO LIMIT DRUG USE
F. PROHIBITION THREATENS PUBLIC HEALTH
1. Spread of Disease
a. Sharing Needles
b. Trading Sex for Drugs
c. Neglect of Health
d. Avoidance of the Health-Care System
2. Lack of Information and Quality Control
a. Adulterated Drugs, Designer Drugs, and Drugs
of Unknown Potency
b. Lack of Knowledge About Safer Use
c. Using Alcohol and Tobacco Instead of
"Soft Drugs"
3. Injuries Due to Violence
4. Diversion of Resources from Treatment and
Prevention
5. The Sense of Treating Drugs as a Public
Health Problem
a. Treatment Works
b. Self-Help Groups
c. Therapeutic Communities
d. Other Inpatient Drug-Free Treatment
Programs
e. Outpatient Methadone Maintenance
Programs
f. Outpatient Drug-Free Therapy
6. Empirical Research on Effective Drug
Treatment
a. Studies Examining the Effects of
Treatment on Substance Abuse
b. Studies Examining the Effects of Drug
Treatment on the Consequences of
Drug Abuse
7. Education Works
a. Life Skills Training Program
b. Students Taught Awareness and
Resistance
c. Project Healthy Choices
d. Student Assistance Program
e. Smart Moves
f. Seattle Social Development Project
g. Programs for Children of Addicts
III. TOWARD A NEW DRUG POLICY
IV. CONCLUSION
**********************************************************************
A WISER COURSE: ENDING DRUG PROHIBITION
I. INTRODUCTION
In 1986, the Association of the Bar of the City of New
York, responding to a general perception that criminal and civil
sanctions against the manufacture, distribution, or possession of
drugs were not "solving," or even ameliorating, the problems
associated with drug use in our society, formed a Special
Committee on Drugs and the Law (the "Committee") to study our
current drug laws and to report its recommendations on the wisdom
of such laws.
The Committee has considered the complex legal, social,
medical, economic, and political issues raised by our nation's
current drug control policies. Despite billions of dollars spent
on law enforcement, criminal prosecution, and incarceration
during the past 80 years, the United States has made little or
no progress toward reducing drug use or solving its "drug
problem." On the contrary, illegal drug use remains a pervasive
and powerful influence in our cities and in the nation at large.
Beyond the continuing availability and consumption of
drugs, the unintended consequences of our current prohibition
policy are ubiquitous: our courts, both state and federal, are
jammed; our prison populations are burgeoning; urban and ghetto
children, as well as adults, are frequent victims of violent
"turf wars"; our civil liberties are being eroded, along with our
society's respect for the rule of law generally; our public
health is threatened; the enjoyment of urban life has declined;
and our nation's institutions, as well as those of our South and
Central American neighbors, are undermined by the immense wealth
accumulated illegally under the current prohibition policies.
The Committee has concluded, in some cases reluctantly, that the
costs of drug prohibition are simply too high and its benefits
too dubious.
The Committee recognizes that calling for an end to
drug prohibition cannot be either the end of our inquiry or the
sum of our recommendations. There are several difficult
questions that remain to be answered: What forms of governmental
regulation, if any, are appropriate instead of prohibition? To
what degree, if any, should private distribution of drugs be
permitted? Is a regulatory regime similar to one now used to
control alcoholic beverages appropriate for some, if not all,
drugs? How should a new regulatory regime treat children,
adolescents, or pregnant women? What kinds of prevention and
treatment programs should there be and how should they be funded?
These and other issues demand both the urgent attention and
honest judgment of our Committee and, more broadly, our society.
The Committee believes the necessary inquiry cannot
begin in earnest so long as our nation remains committed to the
illusion that drug use can be prohibited at an acceptable cost.
Only by recognizing that this is no longer true can we fashion a
method of controlling drugs other than the current coercive drug
laws, which have been largely ineffective and which are sapping
the vitality of our cities, our legal system, and our society as
a whole. It is the Committee's hope that this report will
advance the discussion of this important issue.
II. THE COSTS OF PROHIBITION
A. DISTORTION OF THE JUDICIAL SYSTEM
At a time of ever-increasing competition for scarce
public funds, the volume of drug prosecutions and convictions
continues to increase, as does the strain on judicial budgets,
personnel, and facilities in the federal and state systems. The
added burdens on the judiciary due to drug prosecutions have
substantially diminished the courts' capacity to manage the civil
docket. Criminal cases take priority, with civil jury trials
relegated to the bottom of an increasing waiting list. Some
courts, for purely budgetary reasons, have been forced to suspend
all civil jury trials for periods of time.
1. New York State
The majority of drug cases are handled by state and
local courts. Consequently, it is instructive to review first
the impact of these increased caseloads and costs on New York
State.
In 1991, New York State spent a total of $8,641,418,000
for all judicial and legal services (including police protection,
$3,662,389,000; courts, $932,314,000; prosecution and legal
services, $461,790,000; and public defense, $197,194,000). It is
difficult to obtain specific dollar figures for the cost of drug
arrests and prosecutions in New York State, but by combining the
available data on caseloads and judicial costs it is possible to
make some rough estimates. In 1987, total arrests in New York
State were 481,676, whereas in 1991 the total was 506,710, an
increase of 5.2%. During the same period, felony drug arrests
rose from 42,655 (approximately 9% of total arrests) in 1987 to
54,184 in 1991 (11% of all arrests), a 27% increase. By
contrast, between 1987 and 1991, misdemeanor drug arrests dropped
from 53,621 to 36,489, a decrease of 32%.
In 1991 a tremendous volume of caseload
activity confronted the Judiciary's judges
and nonjudicial personnel. Nearly 79,000
felony indictments and superior court
informations were filed in Supreme and County
Courts throughout New York. That number
represents a 54% increase compared with 1985.
Most of the statewide increase was the result
of phenomenal caseload increases in New York
City. This year, the Supreme Court Criminal
Term in New York City received over 52,000
felony filings, an astonishing 70% increase
since 1985. The remarkable level in felony
filings is primarily caused by increases in
drug-related filings.
. . . Unquestionably, these caseload
increases are the product of the drug crisis
which, perhaps for the first time in our
State's history, threatens to test our
ability to administer justice on the local
level, not just in New York City, but
statewide.
The increasing number of drug prosecutions in New
York's courts has taken its toll on the judicial system. One New
York State Supreme Court Justice has summarized the impact of the
so-called "war on drugs" on New York's criminal justice system as
follows:
Our court calendars groan under the burden of
ever-increasing new drug cases. New York
City's Corrections Department estimates that
70 percent of its inmates are charged with
drug-related crimes. Yet these ever-growing
prosecutions and incarcerations are having
little or no impact on drug crimes. In 1980
only 11 percent of the total inmate
population was incarcerated for drug
offenses, yet by 1992 this figure rose to 44
percent. At a cost of $30,000 per year to
maintain each prisoner, our state spent over
$195 million in 1992 to confine drug
offenders alone. Last year the state's
Office of Court Administration requested an
additional $40 million just to cover the
expense of drug cases. Since the advent of
crack a decade ago, the city has hired 9,000
new police, 700 additional assistant district
attorneys, and has added 18,000 new cells on
Rikers Island. The total cost: $591 million
a year.
2. Other States
State court convictions for drug law violations have
increased dramatically nationwide since the mid-1980s. Between
1986 and 1988, there was a nearly 70% increase in the number of
persons convicted of felony drug trafficking or possession
charges (from 135,000 to 225,000). The number of persons
convicted who received state prison sentences rose from 49,900 to
92,500. In 1988, drug offenses accounted for approximately
one-third of all felony convictions in all state courts.
3. Federal Courts
The case loads and concomitant costs of managing drug
cases in federal courts also have increased substantially over
the past decade. In 1982, the budget for prosecution of all
federal drug cases in the United States was $78.9 million; in
1993, the budget was ten times as much -- $795.9 million.
In federal district courts in 1989, a total of 54,643
criminal cases were prosecuted; of those 16,834 (approximately
30%) were for drug offenses. In 1990, 19,271 defendants were
prosecuted for drug offenses; of those 3,083 were not convicted,
and 16,188 were convicted: 13,036 by guilty plea (81%), and
3,121 after trial (19%). Between July 1992 and June 1993,
50,366 defendants were convicted in the federal courts, and 27%
of these (18,576) were convicted of federal drug offenses.
Expenses associated with appeals of federal drug cases
rose from $8.2 million in 1982 to $104.2 million budgeted in
1993. A significant portion of this increase resulted from
appeals filings in drug-related cases, which totalled 1,583 in
1981, 4,386 in 1989, and 5,658 in 1990 (a 29% increase from the
previous year alone and, overall, a 383% increase in ten
years). In 1991, there were 5,570 federal drug-related appeals
filed.
4. The Judiciary is Impatient with the Present System
Federal and state judges throughout the United States have
publicly expressed frustration with the present laws prohibiting
drugs, and some senior federal judges have even refused to sit on
drug cases. In the Southern District of New York and in the
Eastern District of New York, Judges Whitman Knapp, Robert
Sweet, and Jack Weinstein have spoken out publicly against the
present laws and their associated draconian penalties, and
Judges Knapp and Weinstein have refused, as is their right as
senior judges, to preside over drug trials and sentences.
State judges in New York have also protested the increasing time
on their calendars that drug cases take and the Second Offender
sentencing rule that compels them to give lengthy prison
sentences to second-time drug offenders. These judges seek a
solution to the "war on drugs" before the whole judicial system
breaks down under the strain.
5. Efforts to Handle Court Congestion
Because of the enormous increase in drug cases,
especially in large urban areas, several stop-gap solutions are
being pursued to balance limited court resources against the
burgeoning caseloads. In New York City and New Orleans, for
instance, special narcotics divisions have been established to
expedite processing of drug felonies. These experimental
programs are designed to hear cases just prior to grand jury
proceedings with the goal of inducing defendants to accept plea
bargains that are better than would be expected if the case
proceeded through the grand jury process. Also, special court
parts -- staffed by personnel with expertise in drug cases,
addiction, and community treatment centers -- have been
established in New York City to deal exclusively with drug
cases. Unfortunately, none of these short-term solutions will
correct the fundamental distortion of the priorities of the state
and federal judicial systems caused by the "war on drugs."
B. THE PRISON STATE
One of the most tangible, measurable effects of the
"war on drugs," has been the creation of a "prison state".
According to the Federal Bureau of Investigation's statistics,
one million arrests are made annually for violations of the
federal and state drug laws.
As a result of these massive numbers of arrests each
year, "the United States has a higher proportion of its
population incarcerated than any other country in the world for
which reliable statistics are available."
Incarceration in America is now at an all-time high.
>From 1925 through 1973, the American prison population fluctuated
between 90 and 120 people in prison per 100,000 of the
population; in 1973 the rate was 98 per 100,000, a ten-year low.
Between 1973 and 1980, however, there was a 40% increase, to 135
people in prison per 100,000; and by 1986, following the start of
the modern "war on drugs," the incarceration rate had jumped to
200 per 100,000. In 1993, the rate of Americans serving prison
time stood at 325 per 100,000. In 1993, the number of inmates
in federal and state prisons in New York increased by 4.6%, to
64,600.
On average, it costs $20,000 per year to maintain one
prisoner, $100,000 to build a single prison cell, and $20,000
per year to staff a prison cell.
More than one in forty American males between the ages
14 and 34 are locked up.
Between 1980 and 1990, the total prison population in
the United States increased by 133% to over 771,000 prisoners.
In 1993, the total prison population reached 949,000, nearly
three times as many as in 1980. During the 1980s, new
imprisonments on drug charges increased over 1,000%.
Drug offenders have accounted for an
increasing percentage of the population in
State and Federal correctional facilities.
Drug offenders constituted an estimated 22%
of the State prison population in 1991, up
from 6% of the population in 1979. In
Federal correctional facilities, drug
offenders accounted for 61% of the
population, up from 16% in 1970, 25% in 1980,
and 52% in 1990.
The vast majority of the prison population increase
during the 1980s, which doubled the number of persons under
custody for all charges, involved drug law violations. Due to
the great increase in drug-related incarcerations, the federal
and state prison systems are overwhelmed, as reported almost
daily in the newspapers. Prison overcrowding persists despite an
unprecedented boom in prison construction. For example, between
1983 and 1992, New York State built 29 prisons, increasing the
number of prisons in the state to 68 and the inmate capacity from
29,253 to 57,862.
No one wants overcrowding. It riles inmates,
strains prison guards, encourages the spread
of illness and generally makes prisons more
volatile places. In the past, when there was
money to spend, the solution to overcrowding
would have been clear -- create more space.
Not any more. With money scarce and a sense
that more prison beds have not resulted in
less crime, many lawmakers are being forced
to conclude they can no longer build their
way out of the problem.
According to the United States Department of Justice,
"drug offenders" are becoming a larger share of the prison
population for two reasons: first, the likelihood that a
conviction will result in incarceration is increasing; and
second, those convicted on drug charges are receiving longer
prison sentences.
Mandatory sentencing laws, such as the federal
sentencing guidelines, exacerbate the problem by forcing judges
to impose lengthy sentences for simple possession of small
amounts of drugs. These laws, first passed in the 1970s but
increasingly relied on as a weapon in the "drug war" in recent
years, have in large measure been responsible for today's severe
overcrowding. Mandatory minimum sentences require judges to
impose a statutorily-defined minimum period of incarceration
without the possibility of parole, with no consideration of the
specific facts of the crime or any mitigating circumstances.
Faced with mandatory sentences laws, there has been at
a growing movement at the state level to minimize their draconian
effects. In New York, for example, the courts had been
cooperating with prosecutors and defense attorneys to avoid the
harsh effects on second-time drug offenders. New York's
Governor, Mario Cuomo, in his 1994 budget message has asked the
Legislature to restore discretion to judges meting out second-
time drug felony sentences "to relieve overcrowding in state
prisons."
For all of the extra burden on the prison and judicial
systems and on the taxpayer caused by the "war on drugs,"
American society has little to show for it. "If such toughness
had much to do with crime, you'd think we'd have seen some
results by now. But . . . overall crime has decreased only 6%
since 1973; violent crimes are up 24%. The National Research
Council of the National Academy of Sciences recently concluded
that a tripling of time served by violent offenders since 1975
had `apparently very little' impact on violent crime."
With 61% of today's federal inmates incarcerated on
drug law convictions, judiciary and corrections overcrowding
and escalated costs would necessarily be reduced were the current
drug policy altered toward a less punitive, more humane approach
which removes the profit motive fueling the black market in
illegal drugs.
C. EROSION OF THE RULE OF LAW AND CIVIL LIBERTIES
One of the more insidious effects of the "war on drugs"
has been the gradual erosion of the rule of law and the public's
civil liberties. Several interrelated elements contribute to
this particularly destructive consequence of the current drug
laws.
1. Perception of Ineffectiveness
Politicians from the President of the United States to
mayors running in local elections are importuned by the people
for the assurance that increasing crime and the criminal element
be contained in our society. Our country, with the highest rate
of drug abuse of any industrial country in the world, also has
the largest budget in the world to enforce its laws prohibiting
drugs. Despite huge increases in the federal government's budget
for the "war on drugs," the so-called "drug problem" with all of
its ramifications, has not significantly abated. The public's
perception of its political leaders' ineffectiveness in
alleviating drug-related violence adds to the general atmosphere
of lawlessness and breeds cynicism and disrespect for the law.
Instead of progress since the first federal anti-drug
law was passed in 1914, nearly 80 years of drug prohibition
have yielded few inroads against the sale or use of drugs. This,
understandably, suggests to the public that the law itself is an
ineffectual tool for dealing with the issue.
2. Perception of a Self-Perpetuating System
The large sums of money appropriated for
law-enforcement create enormous, self-perpetuating bureaucratic
agencies, such as the United States Drug Enforcement Agency
("DEA"), which fight for independence and scarce public resources
while making little headway against the "drug problem." These
agencies have ample motivation to exaggerate or distort the
extent and danger of "drug abuse" so as to justify (and thereby
insure) their continued existence. Being inherently biased, they
have great potential to ignore the public's true welfare.
3. Police Corruption
The fact that drug prohibition breeds corruption has
been known for decades. Every day there are news stories of
law enforcement officers being arrested for their involvement
with drug dealers. The sums of money involved in the drug
business are too great and too inviting for the law enforcers not
to seek their share. Corrupt police behavior creates a further
disillusioned public. In addition, just as organized crime
became entrenched during Prohibition, the current prohibitionist
regime is currently subsidizing the mafia and other organized
crime groups because of the highly inflated prices on the black
market.
4. Poor Children are Victims of the "War on Drugs"
There is no reason to believe that recognized market
forces cease to apply where the drug business is concerned.
There is public recognition that youths and unemployed adults
often cannot just say "no" to drugs when saying "yes" as a dealer
or a dealer's helper is much more profitable than are the
alternatives. Children living in poor, urban neighborhoods are
particularly susceptible to being drawn into illegal drug-related
activities by visions of status and easy money. Laws against
drugs thus discourage many youths and adults from productive
legitimate employment that would benefit society.
5. Selective Prosecution
Criminal prosecutions for violations of the federal and
state drug laws appear to be disproportionately directed against
minorities. Understandably, there is widespread public concern
that the drug laws are selectively enforced with vigor against
the poor and disenfranchised, while rich and middle class drug
users are permitted to indulge without serious fear of legal
consequences.
6. Erosion of Constitutional Rights
The pursuit of a "drug-free" society has resulted in a
panoply of intrusions into the lives of United States citizens:
The Bill of Rights is in danger of becoming
meaningless in cases involving drugs.
Tenants charged with no crime are evicted
from homes where police believe drugs are
being sold. Public housing projects are
sealed for house-to-house inspections. The
Supreme Court has permitted warrantless
searches of automobiles, the use of anonymous
tips and drug-courier profiles as the basis
for police searches, and the seizure of
lawyers' fees in drug cases. Property on
which marijuana plants are found can be
forfeited even if the owner is charged with
no crime. Prosecutors have been allowed to
try the same person at the state and federal
levels for the same drug-related crime.
A few examples will illustrate the erosion in
individual civil liberties occasioned by the "war on drugs."
In 1991, the United States Supreme Court in Florida v. Bostick,
upheld the constitutionality of a police tactic of boarding long-
distance buses and asking permission to search passengers'
baggage, overruling the Florida Supreme Court's ruling that such
an encounter with the police is so inherently coercive that no
consent given for such a search could be truly voluntary. The
Florida v. Bostick decision was merely one of a number of rulings
since the early 1980s which authorized police stops and
questioning of airline, train, and bus passengers without the
level of suspicion generally required for Fourth Amendment search
and seizure purposes.
The search for tell-tale evidence of drug use has even
descended to the level of compelling federal employees to give
urine samples for analysis, without regard to whether such a
privacy intrusion is related to job performance. The public --
led by the government -- appears to be willing to jump on the
bandwagon "to restrict civil liberties, and even accept
warrantless searches of homes and cars, in order to reduce the
use of illicit drugs."
7. Forfeiture's Heavy Hand
Forfeiture has become one of the most publicized and
controversial weapons in the government's anti-drug arsenal.
Any assumption, however, that the law would be deployed only
against "drug kingpins" and major players has proved unwarranted
as small time dealers and marginal users are more often targeted:
Under Zero Tolerance, which targets casual
drug users, the government has seized
thousands of cars, boats, and homes because
occupants or guests allegedly carried drugs.
In 1990, seizures exceeded $527 million, and
they are expected to exceed $700 million in
1991. The U.S. Marshalls Services now has a
$1.4 billion inventory of seized assets
including more than 30,000 homes, cars,
businesses and other property.
In the fiscal year 1993, "the DEA made 14,430 domestic
seizures of nondrug property, valued at approximately $669
million." Moreover, forfeitures have become a popular way to
generate additional revenue.
The in rem nature of a civil forfeiture proceeding,
replete with its many procedural pitfalls, rests on the legal
fiction that the property itself is guilty of wrongdoing. The
uneven burdens of proof assigned the parties reveals the
imbalance in the system. To prevail, the government need only
have reasonable grounds to believe the property is subject to
forfeiture. It falls to the claimant to prove by a
preponderance of the evidence the negative proposition that the
property was "innocent."
As a result of the over-zealous application of the
forfeiture statutes, the judiciary has attempted to curb some of
the more visible excesses. For instance, absent exigent
circumstances, pre-hearing seizures of homes, where the tenants
were either evicted outright or were permitted to stay at the
sufferance of the United States Marshall, are no longer
tolerated. And the forfeiture of real property is now
expressly subject to the limitations of Eighth Amendment
proportionality analysis.
A claimant's ability to defend against a forfeiture has
long been compromised by the maze of rules allowing for the
freezing of assets, which alone often discourages private counsel
from taking on a case. Too often, the failure to secure
experienced counsel results in the loss of the property.
Finally, with news accounts of law enforcement
personnel driving around in expensive cars seized during drug
operations, reports of police helicopters with sophisticated
detection equipment hovering over homes, and the intrusive
subpoenaing of records from bona fide businesses (such as those
offering hydroponic gardening equipment), it is clear that
forfeiture laws require an overhaul.
8. Erosion of Privacy Rights
Although the Ninth Amendment guarantees that "[t]he
enumeration in the Constitution of rights shall not be construed
to deny or disparage others retained by the people," our
society has struggled to find a balance between individual
liberty and privacy and governmental intrusion. Although the
United States Supreme Court has recognized certain activities as
being beyond the reach of most state or federal governmental
intrusion (e.g., birth control, abortion during the first
trimester, and the possession of adult pornography in the
home), drug use has never been found to be within the "right of
privacy" that the Court has forged.
Because the law, as it stands today, does not recognize
the right to use drugs, the "war on drugs" has become "in effect,
if not in intention, a war on drug users." Year after year,
state and federal laws that prohibit the possession of drugs,
demonize and criminalize the users of drugs, estimated to be at
least 20 million in the United States alone. Yet, "[d]rugs
have been used to alter consciousness in most societies
throughout history, and different drugs have been considered
acceptable at different times and places." As Lester Grinspoon
and James B. Bakalar have stated:
Of all the Prohibition era mistakes we are
now repeating, the most serious is trying to
free society of drugs by the use of force.
There is no reason to believe that the
inclination to ingest substances that alter
consciousness can be eradicated. A drug-free
society is an impossible and probably an
undesirable dream. . . . Our present drug
policies are immoral because they require a
war of annihilation against a wrongly chosen
enemy. We will never be able to regulate the
use of consciousness-altering drugs
effectively until our ends are changed along
with the means that serve them.
Ending drug prohibition would enable the Court and our
society to recognize the right of individuals to alter their
consciousness (the most private of matters), so long as they do
not harm the persons or property of others.
D. PROHIBITION-INDUCED VIOLENCE
In New York and elsewhere in the United States, wild
shootouts in urban areas are frequently publicized. These
reports reveal that innocent bystanders in these areas are often
caught in the cross-fire. It is, however, far from clear that
the use of or need for prohibited drugs causes this sort of
violent crime. Rather, the available evidence tends to support
the conclusion that it is the prohibitionist laws against drugs
that cause the violent crimes that people generally deplore.
So-called "drug-related crime" is often related only
indirectly to the drugs themselves, resulting instead from the
illegal black market in drugs that is, in turn, spawned by laws
prohibiting the legal sale of drugs. For example, the Los
Angeles police have long known that the lucrative black market in
cocaine has provided the incentive (as well as the financing) for
the bloody gang turf wars in that city. Similarly, it is
estimated that 40% of the homicides in a study of 414 homicides
in New York City precincts were indirectly attributable to black
market trafficking in drugs. Further supporting the fact that
it is drug prohibition rather than drug use which is causing the
alarming "drug-related" violence saturating our culture is the
historical precedent of alcohol Prohibition which was accompanied
by the same type of violence.
There is no reason to believe that black markets would
not disappear with the ending of drug prohibition. Common sense
indicates that without the immense profits guaranteed by the
necessarily restricted nature of the outlets, there would be
little advantage to maintaining such black markets. The
current patterns of drug-sale related turf violence would be
substantially, if not wholly, undermined.
E. PROHIBITION'S FAILURE TO LIMIT DRUG USE
Proponents of the "war on drugs" often eagerly declare
that the draconian prohibitionist laws of the state and federal
government are causing a decline in drug use. The evidence,
however, tends to show that "the number of heavy drug users in
the United States is undiminished." In addition, recent
surveys show an increasing number of high school students using
marijuana and lysergic acid diethylamide ("LSD"). Even
proponents of the "war on drugs" candidly admit that "drug abuse
cannot be entirely eliminated." Some experts have estimated
that the government has spent close to $500 billion dollars over
the past 20 years to enforce the prohibitionist laws against
drugs, while during the same period use levels rose and the
number of arrests and the amounts of drugs seized increased
unabated annually. 750,000 people were incarcerated for
violating the prohibitionist drug laws during a twenty-year
period, costing an average of $25 billion annually and $61
billion for 1991 alone.
Although the vast majority of Americans polled stated
that they would not take now-prohibited drugs if they were
legalized, many people voice the concern that use would
escalate sharply upon legalization. Implicit in the idea that
use of drugs would rise upon legalization is the assumption that
the current prohibitionist laws discourage many people from using
them. The available evidence tends to show that Americans can
and do voluntarily control their use of drugs.
The recent decline in middle class use of drugs as
well as recent declines in alcohol and tobacco consumption have
been attributed by many experts to factors (such as education,
health and fitness awareness, and social pressures) other than
the prohibitionist laws against drugs. Experts have recognized
these other factors as the basis for the current levels of use of
drugs (including alcohol and tobacco) rather than the existence
of prohibitionist laws.
Indeed some observers have cited the prohibitionist
laws against drugs as a significant factor leading to increased
use and greater numbers of addicts than we would otherwise have:
[T]he growth of addiction over the last four
decades in the US had little to do with price
reductions or, for that matter, with the
growth of real income. The crucial factor in
the spread of the drug habit has been the
unrelenting pressure exerted by legions of
street pushers in the continuing endeavor to
widen the circle of the customers. In other
words, the crucial factor in spreading the
drug habit has been the super profits made
possible only by governments' illegalization
of the trade."
It is impossible to prove the levels of post-
legalization use of now-prohibited drugs, but reasonable
extrapolations may be made by referring to similar experiences in
this country and abroad.
Prohibition of alcohol in the United States earlier in
this century is a basis for comparison, albeit an imperfect one.
A review of alcohol consumption patterns during and after
Prohibition shows that during most of the Prohibition era per
capita alcohol consumption actually increased. After
"Prohibition's repeal in 1933, consumption remained fairly stable
until after the Second World War when, without any change in
public policy, it began increasing." The prohibitionist laws,
therefore, seem to have little impact on an individual's decision
whether to use drugs.
Another useful example is the experience of the ten
states that decriminalized the possession of small amounts of
marijuana for personal consumption in the 1970s. There was no
increase in the level of marijuana use in those states. Indeed
marijuana consumption declined in those states just as it did in
states that retained criminal sanctions against marijuana.
In 1976, the Dutch decriminalized marijuana
consumption, although possession and small sales technically
remained illegal. The level of use actually declined after
decriminalization. Indeed marijuana use in the Netherlands is
substantially lower than in countries waging a "war on drugs,"
including the United States and, at least until recently,
Germany. Among Dutch youths aged 17-18, only 17.7% used
marijuana at least once in their lifetimes, as opposed to 43.7%
of Americans. Only 4.6% of the Dutch had used marijuana at least
once in the past month, as opposed to 16.7% of the Americans.
While indicating clearly that prohibitionist laws do not prevent
the use of drugs, these statistics also tend to show that
legalizing now-prohibited drugs, at least marijuana, does not
inevitably cause an increase in use.
Under an exception to the British prohibitionist
system, doctors may provide prohibited drugs to addicts. Dr.
John Marks of Liverpool commenced such a program in 1982, and, to
his astonishment, he noted that the number of new addicts
decreased in Liverpool while in a nearby town operating under
prohibition the rate of new addicts was twelve-fold higher.
Dr. Marks attributed the decline in the number of new addicts to
the fact that addicts received their needed drugs from his
program for pennies, thus there was no longer any need for
addicts to bring in new customers to raise enough money to
support their habits.
Others addressing the issue of whether the levels of
use of now prohibited drugs would escalate to overwhelming
proportions after legalization (as many prohibitionists have
predicted) have likened possible patterns of illegal drug use to
patterns of alcohol use, with which we have a solid familiarity.
They point out that Western cultures have handled alcohol
consumption with tolerable skill for centuries and point out
that most of the American population that drinks occasionally, or
even every day, exercises moderation.
Indeed the available data indicate that the vast
majority of the American population that uses now-prohibited
drugs does so with moderation. According to United States
government statistics, more than 75 million persons in the United
States household population have used prohibited drugs. The
National Institute on Drug Abuse estimates that close to 40
million Americans continue to consume these substances. Yet,
only a comparatively minuscule number of deaths due to drug
overdoses, 4,242, occurred in 1991 according to medical examiner
data compiled by the Drug Abuse Warning Network.
Once the distinction between use of prohibited drugs
and abuse is acknowledged, the available statistics show that the
vast majority of Americans who use drugs do not abuse them.
Based on our experience with American states' and foreign
decriminalization of marijuana, it appears that decriminalization
does not lead to greater levels of use nor to abuse. Likewise
there is evidence to support the proposition that the
decriminalization of the so-called "hard drugs" does not lead to
increased rates of addiction. Perhaps most importantly, data
analysis strongly indicates that social factors wholly apart from
the criminalization of drugs account in the greatest measure for
reduced rates of use. Based on the evidence, it would not be
unfair to say that the predicted, post-legalization explosion in
the use of drugs has been greatly overstated and that use in
continued moderation would be the much more likely result.
European countries, such as the Netherlands, have benefitted from
an approach to drugs that focuses on "harm reduction" rather than
draconian measures to enforce prohibition.
F. PROHIBITION THREATENS PUBLIC HEALTH
1. Spread of Disease
a. Sharing Needles
Because the possession of hypodermic needles is
generally illegal, users of injectable drugs routinely share
needles and syringes with one another, often in "shooting
galleries" where dozens of addicts may line up to use a single
needle rented out by the dealers and not sterilized between uses.
This sharing of needles has become a major source of transmission
of blood-borne diseases such as acquired immune deficiency
syndrome ("AIDS") and hepatitis. According to a recent
national review, "more than 33% of new AIDS cases occur among
injecting drug users or people having sexual contact with
them." In New York State, the majority of new AIDS cases since
1988 have been reported among users of injectable drugs and their
sexual partners. Both the Centers for Disease Control and the
New York State Department of Health have estimated that more than
75% of pediatric AIDS cases are children whose mothers either
injected drugs or were the sexual partners of persons who
injected drugs. The data suggest, at the very least, that
sterile hypodermic needles should be readily and freely available
to drug users. So long as drug use remains unlawful, however,
free needle distribution is not likely to attract a substantial
portion of the user population. In response, some courts have
circumscribed laws dealing with the unlawful possession of
hypodermic needles by applying defenses of medical necessity.
b. Trading Sex for Drugs
Because illicit drugs are expensive, many addicts turn
to prostitution to make money to support their habits, or
exchange sexual services directly for drugs. Prostitute drug
addicts often do not protect themselves from contracting sexually
transmitted diseases carried by their customers, and they pass
such diseases on to other customers, their lovers, and their
children. The crack epidemic, in particular, has been blamed
for the recently noted resurgence of syphilis and other sexually
transmitted diseases. Dr. Robert Rolfs of the Centers for
Disease Control placed the blame squarely on cocaine and its high
cost:
People -- especially women -- have high-risk
sex and practice prostitution to support
their habits. And it is occurring in a
relatively poor population where people have
a lot of things that prevent their access to
treatment. Therefore, they stay infected
longer and are more likely to pass their
infections on to others.
Fewer addicts would be forced to resort to prostitution if the
current prohibitions against drugs were lifted.
c. Neglect of Health
Because of addicts' preoccupation with obtaining and
using drugs, and the debilitating effects of some of the drugs
themselves, many addicts are in very poor health. Malnutrition
is a frequent problem and, in turn, contributes to many others.
Addicts' poor health makes them especially susceptible to
diseases ranging from scurvy and shingles to tuberculosis and the
flu. Addicts are also more likely to contract communicable
diseases and therefore more likely to spread them. The
interrelated urban problems of homelessness and illegal drug
abuse have contributed to the development of multi-drug-resistant
strains of diseases such as tuberculosis, which was once thought
to be on the verge of eradication. These more virulent
diseases know few geographical limitations and pose risks to the
general population.
d. Avoidance of the Health-Care System
Individuals who use illegal drugs often put off
addressing their health problems for fear of prosecution or other
adverse consequences (e.g., rebuffs by doctors, loss of job).
This reluctance to seek medical care is compounded by the fact
that many drug addicts have no private physicians and rely
instead on public hospitals or clinics for any care they might
get.
Prohibition, therefore, has perverse results on health;
drug abusers tend to enter the health-care system only if and
when their need for care is acute, which is also when care is
most costly to deliver. If, for example, a woman avoids
pre-natal care, she may give birth to a baby with low birth
weight and other medical difficulties. If a drug abuser puts off
seeking treatment for illnesses and injuries, he or she may end
up in the emergency room and the intensive care ward.
Mothers and pregnant women face the additional and
justifiable fear that any detectable drug use may be reported as
a possible indication of child abuse or neglect. In many large
city hospitals, the urine of newborn babies is tested for
prohibited drugs, and mothers whose babies test positive for
pre-natal exposure are reported to the child abuse authorities.
Until recently, in New York City, such babies were routinely kept
from their mothers pending investigations that often lasted many
months, interfering with normal bonding and necessarily adversely
affecting the infant's development and relationship with the
parent. Moreover, these women have, in some jurisdictions, been
prosecuted for pre-partum distribution of prohibited drugs.
In addition to the obvious costs to the individuals who
become infected with catastrophic illnesses directly through drug
use, and the high costs to the health care system of treating
them, prohibition contributes to the spread of such diseases
throughout society, particularly to the sexual partners and
children of infected drug users. Left untreated, users and
addicts are more likely to give birth to unhealthy children, to
abuse or neglect their children after they are born, or to have
their children placed in foster care.
2. Lack of Information and Quality Control
a. Adulterated Drugs, Designer Drugs, and Drugs
of Unknown Potency
Because drugs are manufactured and distributed in
secret, it is impossible for users to guard against adulteration
or to determine the purity and potency of the drugs they use.
The problem is compounded by drug growers, manufacturers, and
distributors who, to minimize the risks of apprehension, develop
and purvey the drug varieties that pack the most intoxicating
effect into the smallest package. According to an experienced
New York City researcher,
The fact that cocaine, heroin and
related drugs are illegal encourages the use
of injection. Severe statutory restrictions
greatly increase the cost of illicit
substances to nonmedical users. Injecting
provides a way to economize. Injectable
forms of opiates and coca are much more
concentrated than traditional forms, such as
opium or coca tea. Injection provides an
intense and economical effect by maximizing
the amount of drug that reaches the brain.
People who sniff or smoke drugs say that if
they inject they need only one third of the
amount of the drug to maintain a habit.
Because the injection forms of illicit
drugs are concentrated, they are [also]
relatively easier to ship.
It has been demonstrated that, as law enforcement and
criminal penalties intensify, dealers also find other ways to
economize by inventing new drugs -- so-called "designer drugs" --
that are not yet prohibited. This places the ill-informed
consumers of such drugs at greater risk of overdose and other
health problems. Illnesses and deaths have resulted from (1) the
introduction of dangerous substances into drugs that could
otherwise have been used with greater safety, (2) inadvertent
overdoses due to variations in potency, and (3) the development
of "designer drugs" intended to give the effect of familiar
intoxicants with new chemical compositions that put them beyond
the reach of current laws. Just as the prohibition against
alcohol led to sales of poisonous wood alcohol and the
prohibition against abortion led to coat-hanger abortions, the
prohibition against drug manufacture, sale, and possession
results in unnecessary deaths due to adulteration, variable
purity, and "designer drugs." This contrasts sharply with the
government's current regulation of alcoholic beverages, which
ensures that the beverages are pure and that buyers know how
strong they are and what some of their health effects may be.
Experts have noted that heightened efforts to enforce drug laws
and amend them to encompass new formulations or ban precursor
substances may only push dealers to take greater risks, selling
ever more potentially dangerous substances.
b. Lack of Knowledge About Safer Use
Because many drugs are outlawed, individuals
considering drug use rarely have access to accurate information
about the effects of drugs. While a cautious user may err on the
side of avoiding certain activities while under the use of
drugs, he or she may have no way of knowing, beyond trial and
error, the possible adverse health consequences of certain
combinations of drugs and his or her individual tolerance for
particular substances. Because of its penchant for exaggeration
and cartoonish treatment of the issues, most current education
about drugs is not taken seriously by young people. As a result,
it is far less effective than other health education (e.g., about
nutrition, fitness, and smoking cigarettes).
c. Using Alcohol and Tobacco Instead of "Soft Drugs"
Alcohol and tobacco are completely legal yet do much
more harm, statistically speaking, than illegal drug use. It
is also generally recognized that alcohol, at least when used to
excess, can cause aggressive, anti-social behavior. The
current prohibitionist laws against marijuana, generally
considered an "a-motivational" drug, and other so-called "soft
drugs" have the effect of influencing some people to choose
alcohol over these "soft drugs." Peter Reuter, an economist at
the Rand Corporation, concludes that "If marijuana is a
substitute for alcohol . . . , alcohol is, by definition, a
substitute for marijuana. Thus tough marijuana enforcement must
increase drinking." Similarly, Frank Chaloupka, an economist
at the University of Illinois, found through statistical analysis
"that states without criminal sanctions against marijuana
possession suffered fewer auto fatalities." Finally, Karen
Model, a Ph.D. candidate at Harvard, found that "states
decriminalizing marijuana reported lower overall rates of drug-
and alcohol-related emergencies." To the extent that users are
choosing alcohol rather than marijuana or other "soft drugs," the
overall public health effects are probably worse than they would
be otherwise.
3. Injuries Due to Violence
The high prices commanded by prohibited drugs create
competition among groups and individuals willing to break the law
to supply drugs to consumers. Their competition often becomes
violent and has contributed to the build-up of arms and the
pervasiveness of violence in many areas. Gunshot wounds and
other traumas due to the illegal drug business have become
commonplace in big-city hospital emergency rooms. Not only
traffickers, but also law enforcement officers and innocent
bystanders are often the victims. Mayor Rudolph Giuliani
recently noted:
The victims of the[] gun battles [of
street-level drug dealers] are innocent
bystanders -- and often young children. Last
year alone, about 500 New York City children
were shot; of these, 89 were innocent
bystanders hit by crossfire.
The cost of prohibiting drugs must be measured in terms of lost
lives and expensive medical care and include the hidden costs of
lost productivity and the psychological damage to individuals and
entire communities living in fear, helpless and hopeless.
With the possible exceptions of cocaine and PCP, drugs
themselves do not generally cause violent behavior. It is,
instead, turf wars for the control of black markets and the drug
users' need for money to purchase such substances that leads to
violence. Indeed, marijuana and heroin have been shown to
render their users disinclined to violence or incapable of
violence while under the influence. These substances are much
less dangerous in this regard than alcohol.
4. Diversion of Resources from Treatment and Prevention
Prohibition diverts money that could otherwise be used
for preventing and treating drug abuse. Federal anti-drug
legislation provides a single budget for "supply reduction" and
"demand reduction" efforts. Law enforcement agencies have always
received much more than prevention, treatment, and research
programs combined. The ABA recently reported that "[s]ince the
early 1980s, treatment has been a declining priority. In 1991,
treatment received 14% of the $10.5 billion federal drug budget
compared to 25% ten years earlier." During the same period,
"federal spending on law enforcement increased 737%, with
interdiction efforts leading the increase." Ending drug
prohibition would, by definition, eliminate the need for any
special law enforcement funds for drug interdiction. It would
also allow for the redirection of law enforcement resources to
concentrate on violent crime and quality of life issues.
5. The Sense of Treating Drugs as a Public Health Problem
a. Treatment Works
The vast majority of resources in the United States
available to meet this country's "drug problem" have been
utilized for interdiction rather than education and treatment.
This allocation of resources has skewed the public's perception
of the problem, which is seen largely as one of law enforcement.
However, drug abuse and drug addiction are fundamentally a public
health problem.
Reallocation of resources away from interdiction and
into education and treatment is essential to the successful
management of this problem. Drug abuse and drug addiction are
health problems that can be treated. Dr. Herbert D. Kleber,
former Deputy Director of the Office of National Drug Control
Policy, now Medical Director of the Center on Addiction and
Substance Abuse and lecturer in psychiatry at Columbia University
College of Physicians and Surgeons, has identified a basic
fallacy responsible for the predominant pessimistic outlook:
Drug dependence has been viewed as a chronic
relapsing illness with an unfavorable
prognosis. However, there are thousands of
formerly dependent individuals in the United
States and elsewhere who have remained off
both illicit drugs and excess use of licit
drugs like alcohol for decades, functioning
as productive citizens . . . . [T]here are
already effective methods of treatment if the
right approach [and] the right person can be
brought together.
No one should conclude that treatment is not effective just
because drug abuse, like alcohol abuse and cigarette smoking,
often cannot be "cured" with a single treatment effort. Most
people who do conquer drug addiction succeed only after multiple
efforts and relapses. Because effective treatment depends on
finding the best method of helping a particular person at a
particular time, several attempts may be needed to discover what
will work.
b. Self-Help Groups
Some substance abusers manage their problem with the
help of Alcoholics Anonymous ("AA"), Narcotics Anonymous ("NA")
or similar groups. These voluntary self-help associations offer
the structure of a program following "twelve steps" to sobriety
and the support of fellow abusers in different stages of
recovery. Since these groups maintain members' confidentiality
and do not keep records of attendance at meetings, their success
has not been measured statistically; however, anecdotal evidence
of their effectiveness is strong. Additionally, many respected
treatment programs rely on methods developed by the self-help
groups and prescribe attendance at AA and NA meetings for their
patients.
c. Therapeutic Communities
One of the best-known methods of professional treatment
for drug abuse is a highly structured, long-term residential
inpatient program known as a therapeutic community. The
Committee visited three therapeutic community facilities in New
York City -- programs operated by Daytop Village, Project Return
and Phoenix House. Patients in therapeutic communities
generally spend one to two years, sometimes more, living and
working in the facility. Through individual counseling and group
therapy, the patients address the causes and effects of their
substance abuse and other problems and attempt to rebuild their
lives free of drugs. Education, vocational training and work
experience are important components of the treatment, because
therapeutic community patients frequently lack necessary skills
for making their own way in society. Successful patients
gradually re-enter the outside world, first obtaining jobs and
ultimately moving to homes outside the program.
While many patients drop out of these challenging and
restrictive programs, research has shown that three-quarters of
the patients who stay for the prescribed course of treatment
remained drug-free seven years later. One study found that 56%
of the individuals entering residential treatment (including
those who dropped out) no longer used heroin or cocaine one year
later. By the end of the study, more than 80% of the patients no
longer used any prohibited drug other than marijuana. Another
different national study that focused on opiate addicts revealed
that nearly three quarters (74%) of the addicts who entered
therapeutic communities were not using opiates regularly (i.e.,
on a daily basis) three years later.
d. Other Inpatient Drug-Free Treatment Programs
Substance abusers with health insurance or other means
of payment often seek residential treatment in less restrictive
settings and for shorter periods of time. Two of the best-known
programs providing this sort of inpatient treatment are the Betty
Ford Center in Palm Springs, California, and the Hazelden program
in Minnesota. Patients usually participate in intensive
individual counseling, group therapy, and AA or NA meetings.
Patients most commonly stay for four weeks and are then
discharged to "aftercare" programs for continuing outpatient
treatment or are advised to seek AA or NA meetings in the
community. Many prominent citizens have testified publicly to
the efficacy and value of these sorts of treatment programs.
e. Outpatient Methadone Maintenance Programs
Methadone maintenance is the most widely used treatment
for narcotics addiction in the United States. Drs. Vincent P.
Dole and Marie Nyswander developed the treatment at Rockefeller
University in the early 1960s. Heroin addicts who are medicated
with an appropriate daily dose of methadone, a long-acting
synthetic opiate, lose the desire to use heroin but do not
experience either withdrawal symptoms or the euphoric or
impairing effects of narcotic use. Methadone patients can
function normally and perform successfully in the workplace in
jobs ranging from attorney to architect to bus driver.
In the early stages of treatment, methadone patients
visit the program daily to receive their doses. They are granted
more flexible schedules as they show progress in treatment by
remaining free of other drugs, maintaining steady employment, and
making progress in other areas. Methadone programs also provide
counseling and other health care and usually arrange for
vocational rehabilitation, education, and other services.
Successful methadone patients may remain in treatment for many
years, often at reduced doses; and some eventually leave
treatment entirely.
A high proportion of methadone patients stay in
treatment (more than two-thirds, by many reports), and more than
85% of those remaining in treatment for a year never use heroin
again. A substantial proportion also stop using alcohol and
other drugs. The results of research assessing the
effectiveness of methadone maintenance have been strikingly
consistent. One major study found that, within a year of
beginning treatment, 70% of those who had entered methadone
treatment were no longer using heroin. After three years, use by
patients who had remained with the program for at least three
months had declined by almost 85%. Another study examining
AIDS infection among injection drug users found that methadone
maintenance treatment effectively reduced intravenous drug use by
71%. An earlier study had found that more than three quarters
of the patients who entered methadone maintenance treatment were
still not regularly using opiates three years later.
f. Outpatient Drug-Free Therapy
Substance abusers who cannot commit themselves to
inpatient treatment and do not want methadone treatment (or would
not benefit from it because their primary drug of abuse is not
heroin) can participate in a variety of outpatient drug-free
therapies, including the full range of "talk" therapies,
supervised twelve-step programs, and programs that use
acupuncture to reduce the craving for drugs. Outpatient programs
often are recommended as follow-ups to short-term hospital-based
"detoxification" programs, which generally are effective only for
short-term crisis intervention purposes.
The Committee visited the Lincoln Hospital Substance
Abuse Division in New York City, which has been treating drug
abuse patients with acupuncture for more than 15 years.
Acupuncture treatment, which involves the insertion of five
needles in the outer ear while the patients sit quietly in a
common room for 30 to 45 minutes, is meant to control withdrawal
symptoms and the craving for drugs and to have a general calming
effect. At Lincoln Hospital it is used in combination with group
counseling on the Narcotics Anonymous model, as well as
urinalysis monitoring. Like methadone treatment, acupuncture
begins as a daily treatment, with successful patients
"graduating" to less frequent schedules. Outpatient drug-free
treatment programs, whether they employ acupuncture or not,
differ in the nature, length and frequency of treatment sessions.
The usefulness of acupuncture treatment for substance abuse has
been demonstrated in several studies.
Outpatient programs, generally, have demonstrated a
fair amount of success in treating substance abusers. One
national study found that nearly three-quarters of the patients
who entered outpatient drug-free programs for opiate abuse were
not using opiates regularly three years later. A later study
of similar scope revealed that, after a year in treatment, 42% of
the regular cocaine users who stayed in outpatient drug-free
treatment for at least three months had stopped using cocaine
completely. Over three to five years, regular heroin use by
patients who had received treatment for at least three months
fell by half, and fewer than 20% of the patients who stayed in
treatment for at least three months were regular users of any
prohibited drug except marijuana.
6. Empirical Research on Effective Drug Treatment
Virtually all studies conducted over the last 20 years
show that the most commonly practiced methods of treatment do
work. Treatment has been shown to reduce substance abuse and
ameliorate its consequences. The outcome of treatment has not
been found to differ significantly with the type of treatment
received. Methadone programs, inpatient residential programs,
and outpatient drug-free programs all show dramatic results.
a. Studies Examining the Effects of
Treatment on Substance Use
The most comprehensive study of the effectiveness of
drug treatment, the Treatment Outcomes Prospective Survey
("TOPS") funded by the National Institute on Drug Abuse ("NIDA"),
strongly confirmed the efficacy of treatment in reducing drug
use. For up to five years after their treatment, TOPS followed
10,000 substance abusers who had been admitted to 37 different
treatment programs across the country. The programs included
residential and outpatient drug-free programs and outpatient
methadone maintenance programs. Heroin and cocaine use declined
significantly for patients in all treatment modalities. After a
year in treatment, heroin use by patients in methadone
maintenance programs declined by 70%, while 75% of outpatient
drug-free patients and 56% of residential treatment patients had
stopped using heroin or cocaine. By the end of the study, fewer
than 20% of the patients regularly used any illegal drug except
marijuana, and 40% to 50% of the patients abstained altogether.
Other studies have reached virtually identical
conclusions. A study sponsored by NIDA to address the risk of
AIDS infection for injection drug users found that methadone
maintenance treatment effectively reduced intravenous drug use by
71% among those who remained in the program for one year. An
earlier NIDA study based on the Drug Abuse Report Program
("DARP") tracked the drug use of 44,000 opiate addicts admitted
to treatment between 1969 and 1974. The study found that most
patients stopped using opiates daily and had not resumed daily
use three years after they were discharged from treatment. More
than three quarters of the patients who entered methadone
maintenance treatment (76%) and nearly three quarters of the
patients who entered therapeutic communities (74%) or outpatient
drug-free programs (72%) were still not using opiates regularly
three years later. A recent follow-up study of 405 of the
original 44,000 addicts found that 74% were not using heroin
regularly twelve years after their treatment ended.
Researchers have uniformly concluded that the three
most common forms of treatment are effective despite "the variety
of problems suffered by clients, their long histories of deviant
and debilitating lifestyles, and a lack of support in the
community" that lead so many addicts not to complete treatment
programs at all. Researchers also agree that the longer
addicts remain in treatment, the better their chances of success.
National studies of the behavior of thousands of addicts have
shown that, while one-third of the patients who stay in treatment
for more than three months are still not using drugs a year
later, two-thirds of those who stay in treatment for a year or
more stay off drugs.
b. Studies Examining the Effects of Drug
Treatment on the Consequences of Drug Abuse
Researchers have studied the impact of drug treatment
on many of the health and social problems that drug abuse
contributes to -- the spread of AIDS and other diseases,
premature death, crime, unemployment, costly medical care -- as
one way of assessing the success of drug treatment. Their
studies have shown that treatment reduces these associated
consequences of drug abuse.
Treatment prevents the transmission of HIV and other
blood-borne diseases that spread when addicts share needles or
sell sex for drugs. Two studies have shown that the rate of HIV
infection among heroin addicts in New York City not in treatment
(46%-47%) is twice the rate of infection among addicts in
methadone treatment programs (23%-27%), and a recent study found
that none of a group of methadone patients with ten or more years
in treatment tested positive for HIV.
Research has shown that treatment also prevents crime.
The TOPS survey found that, in the six months following
treatment, 97% of the residential therapeutic community clients
and 70% of the outpatient clients who had admitted committing
predatory crimes in the year before they entered treatment
engaged in no criminal activity at all. Three to five years
after treatment, the proportion of addicts involved in predatory
crimes had fallen by one half to two-thirds. The DARP study
found that arrest rates fell by 74% after treatment, for all
treatment modalities.
Research reveals that treatment helps recovering
addicts work, as well. Only 33% of the 44,000 patients in the
DARP study worked in the year before admission to treatment, but
57% were employed in the year following their discharge. Two-
thirds of therapeutic community patients were gainfully employed
after discharge. The employment rate of clients tracked in the
TOPS study also surged. Three to five years after patients
entered treatment, the employment of patients admitted to
residential programs had doubled over pre-treatment levels, while
the employment of addicts receiving outpatient treatment rose by
more than half.
The costs of medical treatment for all sorts of health
problems decline when addicts receive treatment. As noted
earlier in this report, addicts themselves suffer many costly
illnesses as a result of drug use, ranging from hepatitis,
syphilis and tuberculosis to shingles, malnutrition and
psychiatric problems. In 1989, general hospital stays in which
drugs or alcohol were identified as a major factor accounted for
1.9 million days of hospitalization in New York State alone.
Using a conservatively estimated average cost of $500 a day,
that amounts to $9.5 billion worth of medical care. Successful
drug treatment starts addicts on their way to physical recovery
and therefore reduces these medical costs. Successful drug
treatment also prevents the spread of diseases to others, such as
children born to addicted mothers, and stems the cost of medical
care for them, as well as the cost of foster care for children
whose addicted parents cannot care for them.
Other benefits of treatment flow from its effects on
criminal behavior and employment. Treated addicts are much more
likely to be employed and therefore to contribute to the public
coffers rather than receive welfare. They make more productive
employees and are less likely to have accidents at work. Treated
addicts are far less likely to commit crimes and therefore will
save society the cost of property loss and prosecuting criminal
activity. One study that calculated the cost of crime, poor
employment activity, and medical treatment attributable to drug
addiction found that the total of these costs was ten to
twenty-five times the cost of treating drug addiction, depending
on the cost of the treatment chosen. The cost of treating an
addict in a long-term residential drug-free program, for example,
was found to amount to only four percent of the cost to society
of not treating the addict.
A comparison of costs also shows that treatment is much
more cost-effective than incarceration. In New York City,
residential drug treatment costs approximately $17,000 a year per
treatment bed, and outpatient treatment costs only $2,300-$4,000
a year per treatment slot; the annual operating cost of a prison
bed is about $40,000, and the cost of building new prison cells
exceeds $100,000 each. Diverting drug abusers from prison to
treatment therefore saves New York State or City half the
operating costs of incarceration. It also alleviates the need to
build expensive new prisons. If the proven effect of treatment
on criminal recidivism is included, the savings to the criminal
justice system in the future would be even more substantial.
Treatment works and is, in fact, a much more
cost-effective way of dealing with substance abuse than arresting
drug offenders and locking them in prison. Successfully treated
drug addicts give up crime, become productive and more healthy
citizens, and ultimately make fewer demands on the public for
social and medical services throughout their lives. Their cure
also reduces the overall demand for drugs.
7. Education Works
One way to reduce the demand for illegal drugs is
to prevent individuals at an early and impressionable age from
initiating drug use. Using the school system and community
programs to educate children about drug use and its destructive
consequences is an idea that would undoubtedly be supported by
many segments of society. Logic suggests that education programs
should be effective in diverting young people from experimenting
with drugs.
Mathea Falco, in her book The Making of a Drug
Free America, details both school-based and community-based
educational programs which have proven results in preventing
drug, alcohol and tobacco use. Education has been shown to be
effective in preventing and reducing drug as well as tobacco and
alcohol use among children and teenagers. Simply to advocate
"education," however, may not be enough; the assumption that
"education," and any type of education program, will be effective
may be erroneous. Studies of the effectiveness of drug
education and prevention strategies seem to suggest that long-
term programs geared towards examining the "social influences"
leading to drug, alcohol, and tobacco use are more successful in
diverting and reducing subsequent use of drugs, alcohol, and
tobacco. These successful educational programs are generally
coupled with community and home prevention and education
programs. In contrast, certain short-term education programs,
which lack the corresponding community programs, have not proven
effective in actually reducing drug use.
a. Life Skills Training Program
This 15 session curriculum, which is geared
towards junior high school students, is designed to teach
students personal coping skills so that they may be better able
to make decisions and feel more confident in social situations.
Evaluations of this program, which has been taught in 150 junior
high schools in New York and New Jersey for the past ten years,
show that rates of smoking and marijuana use are one-half to
three-quarters lower among students who have participated in this
program than those who have not.
b. Students Taught Awareness and Resistance
This program, taught to first-year high school
students, combines a thirteen session classroom curriculum with
coordinating community, media, and family programs in an effort
to teach resistance skills to teenagers and reinforce the social
desirability of not using drugs. The program is followed-up with
a five-session booster course the following school year. This
program, in a five-year follow-up study, has been proven
effective in reducing the rate of tobacco, marijuana, and alcohol
use by 20% to 40% and cocaine use by 50%.
c. Project Healthy Choices
This program, geared towards sixth and seventh
graders, integrates discussions about drugs and alcohol into the
everyday curriculum by training teachers to incorporate the
discussion of drugs and alcohol into their teaching of academic
subjects. This program is currently implemented in approximately
one hundred New York City schools. It is believed that this
approach will reinforce prevention messages as the students will
hear this discussion as part of their learning on a wide variety
of subjects. The long-range effectiveness of this approach has
not yet been determined.
d. Student Assistance Program
This program, which has been implemented in junior
and senior high schools in twenty states, offers counseling
during the school day on a voluntary, confidential basis. A
study of the Westchester County, New York school system where the
program was originally implemented showed a significant reduction
in alcohol and marijuana use. More significantly, studies showed
that the rates of drinking and drug use were 30% lower among
students at schools which implemented the SAP program.
e. Smart Moves
"Smart Moves" is a program operated out of Boys
and Girls Clubs in the inner-cities where children live in high
crime neighborhoods. By offering after-school prevention
programs and recreational, educational, and vocational
activities, this program attempts to teach children to recognize
the pressures to use drugs and how to develop the verbal and
social skills to resist these pressures. Again, studies have
shown that this type of program can reduce cocaine and crack use
and improve school behavior and parental involvement.
f. Seattle Social Development Project
This comprehensive program seeks to strengthen the
bond between children from high crime neighborhoods and their
families and schools. The program provides to parents techniques
to monitor their children better; teachers get better training to
maintain order and resolve conflicts; and children, as in the
other programs, are taught skills to resist peer pressure.
Interestingly, while the program has shown results in deterring
girls from alcohol, tobacco, and drug use, it has not shown
similar effectiveness with boys.
g. Programs for Children of Addicts
Finally, a number of cities are attempting to
develop prevention programs geared towards the children of drug
addicts. These programs attempt to teach parents communication
and parenting skills and provide children with support and social
skills. Two such programs are "Strengthening Families," which
has been implemented in Salt Lake City, Detroit, and Selma,
Alabama, and the "Safe Haven" program in Detroit. Evaluations of
the "Strengthening Families" program suggest it strengthens
family and school relationships and affects attitudes towards
alcohol and tobacco use.
This provides a summary of the types of successful
programs already available in the communities. Their success
depends upon a school and community commitment to implementing
comprehensive programs geared towards preventing drug use by
children. The diversity of the structure of the programs
illustrates the complexity of the problem. In addition to
reaching out to the "average" school age youth and warning them
about the dangers of substance abuse, there are children in
high-risk homes and crime-ridden neighborhoods who need
additional support structures to resist the pressures of drug
use.
III. TOWARD A NEW DRUG POLICY
Joycelyn Elders, the United States Surgeon General, has
suggested that a study be made of our current drug policies and
perhaps a new drug policy adopted. Despite the
Administration's rejection of her suggestion, public perception
is that she may be right. Our government tried to prohibit
alcohol consumption and found it did not work. As demonstrated
in this report, drug prohibition is also a failure that causes
more harm than the drug use it is purportedly intended to
control. The obvious answer is that we must take the necessary
steps towards a new approach to drug policy.
Several different alternatives to drug prohibition are
being discussed. Federal District Judge Whitman Knapp suggests
that Congress should repeal all federal laws banning drug sales
or possession and permit states to devise alternatives to
prohibition. This is the present approach to alcohol in the
United States since the repeal of the 18th Amendment and the
Volstead Act. Federal District Judge Jack Weinstein suggests
"standing down" and making fewer arrests, having fewer
prosecutions, and spending more money on treatment. M.A.R.
Kleiman of the Kennedy School of Government at Harvard suggests
as a solution to the drug problem a "grudging toleration"
allowing for sale of certain drugs through state-regulated
stores, but the strategy would be to discourage consumption.
These and other alternatives to drug prohibition should
be thoroughly considered so that our society may choose a new
approach that will avoid the widespread evils caused by the
current drug laws. Any alternative to drug prohibition should
allow continued criminal sanctions against conduct affecting
others (the most obvious example being operating a vehicle while
under the influence).
It is the Committee's belief that a new approach to
drug policy should leave state and local governments free to
employ the full panoply of coercive penal sanctions when drug use
is relevant to conduct affecting others. For instance, as
mentioned above, operating any vehicle while under the influence
of drugs is not tolerated and that should not change. Although
in New York, voluntary intoxication remains relevant to negate
specific intent, the Legislature may wish to restore individual
liability in this area and make any intoxication that is
voluntary irrelevant as to mitigation, on the theory that by this
voluntary act the actor will be held responsible for the
consequences of his conduct while under the influence. Such a
sanction is hardly unreasonable, nor would it strike anyone as
being unfair, especially if facilities to deal with cases of
actual addiction were readily available.
Finally, any alternative to drug prohibition should not
preclude state and local governments from addressing "quality of
life" issues. Government should not be powerless to control
persons who are obviously and publicly intoxicated. Through
enforcement of the existing laws dealing with public behavior, or
appropriate amendments to such laws to include specific conduct,
government intervention would have greater effect and would be
readily accepted as appropriate by the overwhelming majority of
the population.
IV. CONCLUSION
The Special Committee on Drugs and the Law has spent
the better part of a decade examining this country's "drug
problem" and the mechanisms utilized to manage it, principally a
federal and state system of criminal proscription.
In recent years, the criminal penalties for possession
and distribution of proscribed drugs have increased, with
mandatory sentences being imposed at both the state and federal
levels. The prison population in the United States has more than
doubled in the past ten years, largely as the result of these
prohibitionist laws. The scarce resources of the federal and
state judiciary have been increasingly devoted to drug cases.
Despite all of these efforts, the drug war rages on.
The Committee recognizes the urgent and compelling
need to make additional resources available for education and
treatment. We believe that even at increased levels, however,
treatment and education are not enough to control this country's
drug problem. The Committee opposes the present prohibitionist
system and recommends the opening of a public dialog regarding
new approaches to drug policy, including legalization and
regulation.
KATHY HELLENBRAND ROCKLEN, CHAIR*
ANN ROBERTSON, SECRETARY
Hon. Harold Baer Jr. Stephen L. Kass
Nancy A. Breslow Charles Edward Knapp
Kenneth A. Brown Daniel Markewich
Ellen M. Corcella Eleanor Jackson Piel
Edward John Davis James Warwick Rayhill
Eugene R. Dougherty Chester B. Salomon
John H. Doyle, III Hon. Felice K. Shea
Virginia M. Giddens John Trubin
* The Committee wishes to express its special thanks to the
Honorable Robert W. Sweet, the former Chair of the Committee and
a tireless advocate for drug policy reform.
Justice Shea and Ms. Corcella abstained from voting on the report.
Mr. Doyle and Mr. Markewich dissented, in part. See, Separate
Statement, infra.
SEPARATE STATEMENT TO A REPORT OF THE SPECIAL COMMITTEE ON
DRUGS AND THE LAW ENTITLED "A WISER COURSE: ENDING DRUG PROHIBITION"
We are in agreement with the Report insofar as it calls
for the opening of a public dialog regarding new approaches to
drug policy but disagree with its conclusion that drug
prohibition should be ended. Our disagreement is based upon our
concern that the legal sale of drugs would increase substantially
the number of persons who use and/or become addicted to drugs,
causing harm not only to themselves but to society. Such harm
would, in our view, outweigh the benefits of eliminating drug
prohibition.
1. Legalizing Drugs Would Reduce Their Cost to the Public,
Thereby Increasing Demand, Use and Addiction
The theory of drug legalization is that it would take
the profit motive out of illegal drug dealing, eliminating the
evils of drug prohibition. In order to accomplish this result
drugs would have to be sold at prices lower than their present
illicit levels. Many commentators have reached the conclusion
that lower prices would increase the demand for drugs. In
Searching For Alternatives - Drug-Control Policy in the United
States, Edited and With Introduction by Melvyn B. Krauss and
Edward P. Lazear, Hoover Institution Press, Stanford University,
Stanford, California (1991), the authors have compiled commentar-
ies from both proponents and opponents of drug legalization, most
of whom acknowledged that lessening cost and increasing access
may create higher drug use. See, e.g., id. at 22-25; 83; 107.
2. The Report Fails to Provide a Concrete Proposal
The Report states that "The Committee opposes the
present prohibitionist system . . . ." However the Report
provides no concrete proposal that would permit us to determine
whether any net benefit to society would result from legaliza-
tion. Should we endorse either (i) the legal sale of crack,
amphetamines, hallucinogens and similar dangerous drugs or (ii)
the sale of drugs to minors? Certainly, if we accept the propo-
sition advanced by many commentators that the legal sale of
drugs, at lower prices than the prices of illegal drugs, would
greatly widen demand, we should reject the proposal that such
harmful substances as those mentioned above be legally sold or
that any drugs be sold to minors. On the other hand, prohibition
of sale of those substances, or of drugs generally to minors,
would give illegal drug traffickers a continuing opportunity to
exploit these markets, and thus by definition the proposal would
not end the evils of drug prohibition.
The Report's failure to provide a specific proposal
leaves these critical issues unresolved. We agree with the
Report's statement that "These and other alternatives [types of
legalization proposals] should be thoroughly considered so that
our society may choose a new approach that will avoid the wide-
spread evils caused by the current drug laws." A simple end to
drug prohibition, however, cannot be accepted as a solution to
these evils, because the "solution" would produce greater social
harm than the present system.
3. The Report Does Not Set Forth Any Convincing
Basis for Its Conclusion That "Use in
Continued Moderation" Would Be The "Much More
Likely Result of Decriminalization"
The Report states that "the available evidence does not
support [the] assumption" that the current prohibitionist laws
discourage many people from using drugs, citing: rising levels
of drug use, arrests and seizures; recent declines in alcohol and
tobacco consumption; the role of drug pushers in boosting demand;
a description of Prohibition suggesting no correlation between
prohibition and use; the results of a 1970's experiment in which
10 states decriminalized possession of small amounts of
marijuana; and a poll taken of the general public. The Report
also cites drug use trends in the Netherlands and England, where
the problems are less severe than in the United States.
Since neither the United States nor any other developed
country has legalized the sale of drugs, there is, of course, no
empirical evidence directly on point. None of the evidence cited
in the Report refutes the strong likelihood that reducing prices
and facilitating access would significantly increase demand for
drugs.
Recent reductions in use of tobacco and alcohol are not
reliable guidelines for legalized drugs because the pleasure-
enhancing and tolerance-producing (i.e., addictive) characteris-
tics of cocaine, crack and heroin are far more powerful than
those of tobacco and alcohol. See, id. at 18, 24, 78.
The results of Prohibition suggests a correlation
between prohibition and use. Alcohol use declined at the outset
of Prohibition and then increased to only 60% to 70% of pre-
Prohibition levels. Immediately after Repeal, alcohol use re-
mained the same, but it increased to pre-Prohibition levels
during the next decade. See, Miron, "Drug Legalization and the
Consumption of Drugs: An Economist's Perspective", published in
Searching For Alternatives - Drug-Control Policy in the United
States, at id., pages 74 to 75.
England and the Netherlands both prohibit drug traf-
ficking and have relaxed enforcement only at the level of the
consumer or patient. The experiences in those countries do not
provide any basis for predictions as to the impact of drug
legalization in the United States where there are far higher
levels of both supply and demand of illegal drugs. See id. at
172-188. Similarly, the ten states where possession of small
amounts of marijuana was decriminalized are not reliable indica-
tors because trafficking and sale continued to be prohibited.
4. The Report is Mistaken in Characterizing Drug
Abuse as an Individual "Right" rather than
as a Social Evil
The Report argues that "Ending drug prohibition would
enable the Court and our society to recognize the right of indi-
viduals to alter their consciousness (the most private of mat-
ters) so long as they do not harm others." Consistent with this
approach, the Report notes that "Any alternative to drug
prohibition shall allow the continued minimal control of conduct
affecting others (the most obvious example being operating a
vehicle while under the influence)."
In characterizing drug abuse as a "right of individu-
als" the Report ignores its social costs, which include physical
damage to babies born of drug using mothers; abuse and/or neglect
by users of parents, offspring, friends and relatives; death by
overdose; teen suicides; homelessness; drug-induced altered
states of consciousness producing violence, particularly from the
use of cocaine and crack; loss of productivity of drug-using
workers; waste of educational resources used in attempts to teach
drug-abusing students; the ripple effect on the economy from the
presence of large numbers of incapacitated or impaired individu-
als; and the enormous cost of drug treatment programs. See,
Commentary by various authors in Krauss and Lazear, supra, at
pages 97-107; 202-206; 227-236.
5. The Report Should Stress the Need to Reduce
Demand for Drugs Without Endorsing Legalization
The Report is enormously thoughtful and comprehensive
and deserves the most serious study. It describes accurately and
completely the importance and effectiveness of harm reduction and
drug treatment programs. For the reasons stated above, however,
the Report should not recommend ending drug prohibition. Because
of the risk of catastrophic social harm from legalization, many
of the most thoughtful recent works on this topic do not recom-
mend this approach. Mathea Falco, in The Making of a Drug-Free
America (1992), cited in the Report, urges against a "bigger drug
war" (emphasis supplied) and that "[w]e need an entirely differ-
ent approach" . . . "one that puts into practice what we have
learned in recent years about reducing the demand for drugs."
Id. at 191, 201. The author points out that ". . . law enforce-
ment plays an important role, but it should not be the center-
piece of drug policy." Id. at 199. In Reckoning Drugs, the
Cities, and the American Future (1993), Elliot Currie, while
noting the same evils of drug prohibition relied upon in the
Report, states:
". . . no one seriously doubts that legalization
would indeed increase availability, and probably
lower prices for many drugs. In turn, increased
availability, as we know from the experience with
alcohol, typically leads to increased consumption,
and with it increased social and public health
costs."
Id. at 187. In Addiction From Biology to Drug Policy (1994), Dr.
Avram Goldstein recommends retaining the present prohibition on
heroin, cocaine and the amphetamines while endorsing a variety of
harm reduction and drug treatment methods aimed at reducing
demand. Id. at 268-285. In Drug Use in America (1994), (Peter
J. Vesturelli, Editor) Prof. Patricia A. Adler recommends a
"middle ground . . . between the extremes of legalizing all drugs
and bearing the costs of the zero tolerance approach." Id. at
260. The author endorses the regulated sale of marijuana with
the use of law enforcement savings for anti-drug abuse programs
aimed at heroin and cocaine. Id. at 262. Prof. Nadelmann has
commented, and we agree, that: "Today, studies similar to that
of the Wickesham Commission and the Rockefeller Foundation report
[on prohibition and alcohol-control strategies respectively] are
necessary to any systematic evaluation of drug prohibition and
its alternatives." Krauss & Lazear, supra, at 242.
CONCLUSION
For the reasons above stated we agree with the emphasis
of the Report on further public dialog, harm reduction and drug
treatment but disagree with its conclusion that drug prohibition
should be ended.