Drugs and Drug Policy

Mark A.R. Kleiman is Professor of Public Policy at UCLA, editor of The Journal of Drug Policy Analysis, and author of When Brute Force Fails and Against Excess. Jonathan P. Caulkins is Stever Professor of Operations Research and Public Policy at Carnegie Mellon University. Angela Hawken is Associate Professor of Public Policy at Pepperdine University.

ACKNOWLEDGEMENTS; INTRODUCTION; WHAT IS A DRUG?; AND WHY IS DRUG USE A PROBLEM?; IF ABUSABLE PSYCHOACTIVES CAN BE USED SAFELY, WHERE DOES THE PROBLEM COME IN? WHAT DOES IT MEAN FOR A DRUG TO BE "TOXIC"?; WHAT IS BEHAVIOURAL TOXICITY? IS IT THE SAME AS INTOXICATION?; WHAT IS ADDICTION?L TOXICITY? IS IT THE SAME AS WHAT IS DEPENDENCY?; IS ADDICTION A DISEASE? IS IT A "CHRONIC, RELAPSING BRAIN DISORDER"?; DOES THAT MEAN THAT DRUG ADDICTS ARE NOT MORALLY RESPONSIBLE FOR THEIR DRUG-TAKING?; IS THE RISK OF ADDICTION LIMITED TO THOSE WITH AN "ADDICTIVE PERSONALITY," OR TO THOSE GENETICALLY PREDISPOSED TO ADDICTION? WHICH DRUG IS MOST DANGEROUS OR MOST ADDICTIVE?; ALL THOSE SOUND LIKE GOOD IDEAS. SO WHAT'S THE PROBLEM?CTIVE THEN WOULDN'T IT BE POSSIBLE TO HAVE NO COERCIVE DRUG ABUSE CONTROL POLICIES AT ALL? AND WOULDN'T SUCH A "NO COERCION" POLICY HAVE RESULTS BETTER THAN THE CURRENT MESS?; THE DAMAGE FROM COCAINE DEALING AND COCAINE ENFORCEMENT, AND THE CRIME COMMITTED BY COCAINE USERS TO PAY FOR THEIR HABIT, IS MUCH GREATER THAN THE DAMAGE FROM COCAINE USE. DOESN'T THAT PROVE THAT PROHIBITION DOES MORE HARM THAN GOOD?; IF THE RESULTS OF LEGALIZATION ARE UNCERTAIN, WHY NOT JUST TRY IT OUT, AND GO BACK TO THE CURRENT SYSTEM IF LEGALIZATION DOESN'T WORK?; WHY WOULD YOU EXPECT NEWLY-LEGAL DRUGS TO BE MUCH MORE WIDELY USED THAN THE SAME DRUGS ARE NOW? AFTER ALL, ANYONE WHO IS REALLY DETERMINED TO GET AN ILLEGAL DRUG CAN DO SO; BUT WASN'T ALCOHOL PROHIBITION IN THE UNITED STATES A COMPLETE FAILURE?; BUT EVERYONE KNOWS THAT PROHIBITION LED TO A BIG INCREASE IN HOMICIDES; BUT DIDN'T HOLLAND AND PORTUGAL LEGALIZE DRUGS WITHOUT ANY RESULTING DISASTER?; BUT DIDN'T HOLLAND LEGALIZE CANNABIS?; WHAT'S THE DIFFERENCE BETWEEN "LEGALIZATION" AND "DECRIMINALIZATION" OR "DEPENALIZATION"?; HOW MUCH OF THE INCREASE IN CONSUMPTION AFTER LEGALIZATION WOULD REFLECT INCREASED PROBLEM USE RATHER THAN INCREASED CASUAL AND BENEFICIAL USE?; CAN'T THE EFFECTS OF MARKETING BE REINED IN BY REGULATIONS AND TAXES?; WHAT ABOUT LEGAL AVAILABILITY WITHOUT FREE TRADE? COULDN'T THAT WORK?; COULDN'T YOU JUST LET USERS GO TO PHYSICIANS FOR THEIR RECREATIONAL DRUGS, AND MAKE IT THE DOCTOR'S BUSINESS TO TRY TO PREVENT THE DEVELOPMENT OF PROBLEM USE PATTERNS?; BUT ISN'T IT IMPOSSIBLE TO MAKE SOMEONE BETTER OFF BY COERCING BEHAVIOURAL CHANGE? IF PEOPLE WANT DRUGS, DOESN'T DEPRIVING THEM OF DRUGS MAKE THEM WORSE OFF BY DEFINITION?; IF SOMEONE CHOOSES TO HARM HIMSELF WITH A DRUG, WHY IS THAT ANY OF ANYONE ELSE'S BUSINESS?; BUT WOULDN'T ANY INCREASE IN ADDICTION TO NEWLY-LEGALIZED DRUGS BE MATCHED BY A DECREASE IN ALCOHOL ABUSE?; ISN'T EVERYONE WITH AN ADDICTIVE PERSONALITY ALREADY ADDICTED TO SOMETHING?; SHOULD WE GO BACK TO PROHIBITION, THEN? OR LEGALIZE THE OTHER DRUGS?; DOES THAT MEAN THAT WE'RE STUCK WITH OUR CURRENT ALCOHOL PROBLEM?; ARE HIGHER TAXES THE ONLY PRACTICAL ROUTE TO A SMALLER ALCOHOL PROBLEM?; IF NOT ALCOHOL, SHOULD WE PROHIBIT TOBACCO?; HOW IS DRUG ENFORCEMENT UNLIKE ENFORCEMENT AGAINST OTHER CRIMES?; WHY ARE ILLEGAL DRUGS SO EXPENSIVE?; DOES ENFORCING PROHIBITION MORE AGGRESSIVELY DRIVE UP PRICES STILL HIGHER?; DO HIGH PRICES DISCOURAGE DRUG USE? OR WILL ADDICTS ALWAYS GET THEIR HIGH?; ARE HIGHER PRICES GOOD OR BAD?; DOES REDUCED AVAILABILITY DISCOURAGE DRUG USE?; DOES CATCHING DRUG KINGPINS MAKE DRUGS LESS AVAILABLE?; WHAT ARE PRECURSOR CHEMICALS AND PRECURSOR CONTROLS, AND HOW DO THEY AFFECT THE PRICE OF DRUGS?; WHAT IS MONEY LAUNDERING AND CAN WE STOP THE FLOW OF DRUG MONEY?; ARE PRISONS FULL OF NON-VIOLENT DRUG OFFENDERS?; DO LONG SENTENCES FOR DEALERS REDUCE DRUG USE?; WHY HAVE CRACK DEALERS BEEN PUNISHED MORE HARSHLY THAN POWDER-COCAINE DEALERS?; WHAT IS THE DIFFERENCE BETWEEN FLAGRANT AND DISCREET DRUG SELLING, AND WHY DOES IT MATTER?; DOES THE EXISTENCE OF FLAGRANT SELLING PROVE THE POLICE ARE CORRUPT?; CAN STREET DRUG MARKETS BE BROKEN UP?; CAN PREVENTION AND TREATMENT HELP DRUG LAW ENFORCEMENT?; WHAT ARE DESIGNER DRUGS?; HOW DOES THE INTERNET COMPLICATE DRUG CONTROL?; SHOULD THE POLICE BE ABLE TO CONFISCATE DRUG DEALERS' ASSETS?; WHAT ARE RISK FACTORS FOR DRUG USE? PROTECTIVE FACTORS?; DO DRUG "PUSHERS" HOOK UNSUSPECTING CHILDREN?; CAN WE PERSUADE CHILDREN NOT TO USE DRUGS?; WHY DO HIGH EXPECTATIONS FOR PREVENTION PERSIST?; CAN WE DESIGN PREVENTION SPECIFICALLY TO ADDRESS THE NEXT DRUG EPIDEMIC?; HOW DO DARE, LIFE SKILLS, AND THE GOOD BEHAVIOUR GAME DIFFER?; WHAT IS THE "GOOD BEHAVIOUR GAME"?; IS MARIJUANA A "GATEWAY DRUG"?; COULD THERE BE A VACCINE AGAINST DRUG ABUSE?; WHAT IS SECONDARY OR INDICATED PREVENTION?; DOES DRUG ABUSE SPREAD LIKE AN EPIDEMIC DISEASE?; SHOULD DRUG POLICY VARY OVER THE EPIDEMIC CYCLE?; WHAT'S THE POINT OF WORKPLACE DRUG TESTING?; DO ALL DRUG ABUSERS NEED TREATMENT?; WHAT IS "BEHAVIOURAL TRIAGE"?; DO USERS HAVE TO "HIT BOTTOM" BEFORE THEY RECOVER?; WHAT ARE THE TWELVE STEPS?; WHAT IS DETOXIFICATION?; IS DETOXIFICATION TREATMENT?; WHAT IS METHADONE?; DOES METHADONE DETOX WORK?; DOES METHADONE MAINTENANCE WORK?; WHY IS METHADONE CONTROVERSIAL?; WHY NOT TIGHTEN UP THE RULES IN METHADONE CLINICS TO REQUIRE CLIENTS TO ABSTAIN FROM DRUG ABUSE AND DIVERSION?; WHAT IS BUPRENORPHINE?; WHAT IS HEROIN MAINTENANCE AND IS IT TREATMENT?; DOES SUBSTITUTION THERAPY WORK FOR ILLICIT DRUGS OTHER THAN THE OPIATES?; HOW DOES TREATMENT FOR STIMULANTS SUCH AS COCAINE AND METHAMPHETAMINE WORK?; WHAT IS A THERAPEUTIC COMMUNITY?; WHAT IS "CONTINGENCY MANAGEMENT"?; WHY IS THERE A SHORTAGE OF DRUG TREATMENT?; HOW DO YOU TREAT A DRUG-INVOLVED TEEN?; HOW ABOUT JUST GIVING ADDICTS THE DRUGS THEY CRAVE?; IS IT DRUGS THAT CAUSE CRIMES, OR DRUG POLICIES?; HOW ARE DRUGS USED IN DATE RAPE?; ARE THERE OTHER WAYS THAT DRUGS CAUSE CRIMES?; HOW ABOUT OFFERING DRUG TREATMENT IN PLACE OF PRISON?; WHY HAVEN'T TREATMENT DIVERSION PROGRAMS PERFORMED BETTER?; WHAT ARE DRUG COURTS?; WHAT IS HOPE?; CAN HOPE REALLY SOLVE THE DRUGS-CRIME PROBLEM?; CAN ABUSABLE DRUGS BE BENEFICIAL?; CAN ABUSABLE DRUGS BE BENEFICIAL OTHER THAN AS MEDICINE?; CAN ABUSABLE DRUGS BE BENEFICIAL OTHER THAN AS MEDICINES AND OTHER THAN AS SOURCES OF PLEASURE FOR THE USER?; WHY SHOULD MERE PLEASURE COUNT AS A BENEFIT?; DOES ANYONE REALLY DOUBT THAT SOME ABUSABLE DRUGS ARE MEDICALLY USEFUL?; WHAT MEDICAL CONDITIONS CAN ABUSABLE DRUGS TREAT, OR PALLIATE?; PAIN; SLEEP DISORDER; APPETITE ENHANCEMENT AND NAUSEA CONTROL; PSYCHIATRIC DIAGNOSES AND ATTENTION DEFICIT/HYPERACTIVITY; DISORDER (ADHD); DO ANY "STREET DRUGS" HAVE POTENTIAL FOR TREATING PSYCHIATRIC DISORDERS?; ARE DRUGS USEFUL FOR MOOD MANAGEMENT?; CAN DRUGS BE USED AS PERFORMANCE ENHANCERS FOR PEOPLE WHO DO NOT HAVE ANY DIAGNOSABLE DEFICIT?; CAN DRUGS ENHANCE ATHLETIC PERFORMANCE?; ARE THERE TRUE APHRODISIACS?; WHAT ABOUT COGNITIVE ENHANCERS?; CAN DRUG-TAKING ENHANCE THE APPRECIATION OF MUSIC AND THE VISUAL ARTS?; CAN DRUGS ENHANCE CREATIVITY?; DO ALL PERFORMANCE ENHANCING DRUGS WORK THE SAME WAY?; WHAT RULE CAN DRUGS PLAY IN RELIGIOUS AND SPIRITUAL LIFE?; DO INTERNATIONAL PROGRAMS OFFER A QUICK FIX TO DRUG PROBLEMS?; CAN WE SEAL THE BORDERS TO DRUGS?; DOES BORDER INTERDICTION HAVE ANY EFFECT ON DRUG USE?; DOES CROP ERADICATION HELP?; CAN ALTERNATIVE DEVELOPMENT WOO FARMERS AWAY FROM GROWING DRUG CROPS?; WHY NOT JUST BUY THE COCA AND POPPY CROPS?; CAN WE FORCE COLOMBIA, MEXICO, AND AFGHANISTAN TO STOP EXPORTING DRUGS?; WHY ARE DRUGS COVERED BY INTERNATIONAL TREATIES?; ARE DRUGS REALLY THE LARGEST COMPONENT OF INTERNATIONAL TRADE?; HOW DO TERRORISTS GET A CUT OF THE DRUG BUSINESS?; HOW MUCH MONEY IS INVOLVED?; MONEY ASIDE, WHAT ARE THE OTHER LINKS BETWEEN DRUGS AND TERRORISM?; HOW DOES CORRUPTION FIT INTO THE DRUG-AND-TERROR PICTURE?; IF DRUG DEALING HELPS TERRORISTS, DOES ENFORCING DRUG LAWS HELP CONTROL TERRORISM? IS "COUNTER-NARCOTICS" AN INTEGRAL PART OF "COUNTER-INSURGENCY"?; HOW DOES DRUG LAW ENFORCEMENT GIVE TERRORISTS AND THEIR CLIENTS A COMPETITIVE ADVANTAGE?; WHY DOES DRUG LAW ENFORCEMENT IN DRUG-EXPORTING COUNTRIES INCREASE THE AMOUNT OF MONEY IN THE ILLICIT DRUG TRADE?; WHY NOT JUST BUY THE OPIUM CROP AND PUT THE TRAFFICKERS OUT OF BUSINESS?; WOULD RURAL ECONOMIC DEVELOPMENT PROVIDE AN ALTERNATIVE TO POPPY-GROWING FOR POOR FARMERS?; CAN'T EFFECTIVE ENFORCEMENT TAKE A COUNTRY OUT OF THE DRUG-TRAFFICKING PICTURE ENTIRELY?; SHOULD WE LEGALIZE DRUGS AS A COUNTER-TERRORIST MEASURE?; SHORT OF LEGALIZATION, HOW CAN WE REDUCE THE CONTRIBUTION OF DRUGS, DRUG LAWS, AND DRUG LAW ENFORCEMENT TO THE TERRORISM PROBLEM?; HOW ABOUT FIGHTING CORRUPTION?; WOULDN'T PREVENTION AND TREATMENT HELP?; WHY DO ARGUMENTS ABOUT DRUG POLICY GET SO IRRATIONAL AND SO MEAN-SPIRITED?; AREN'T THE CULTURE WARS MOSTLY BEHIND US?; WHY CAN'T THE POLITICIANS AND THE CULTURE WARRIORS JUST STAY OUT OF IT AND LET SCIENCE DECIDE ON DRUG POLICY?; WHAT ELSE KEEPS SCIENCE FROM CONTRIBUTING MORE?; THEN HOW CAN WE IMPROVE OUR EVIDENCE BASE?; WHAT ROLE DO THE MASS MEDIA PLAY?; HOW DOES RACE INTERSECT WITH DRUG POLICY?; WHY ARE SO MANY BLACK AMERICANS IN PRISON FOR DRUG CRIMES?; BUT DOESN'T THE CRACK/POWDER DISPARITY REPRESENT RACISM IN ACTION?; CONCLUSION: WHAT IS TO BE DONE?; THE CONSENSUS LIST; FOR THE PRAGMATISTS; A BRIDGE TOO FAR; APPENDIX: HOW DO DRUGS WORK IN THE BRAIN?; HOW DOES THE NEURON-TO-NEURON COMMUNICATION PROCESS WORK?; AND HOW DO DRUGS FIT IN TO THIS PROCESS?; ARE THE AGONISTS THE SAME AS THE STIMULANTS, AND THE ANTAGONISTS THE SAME AS THE DEPRESSANTS?; HOW DOES ALL OF THIS RELATE TO ADDICTION?; SO IS ADDICTION JUST IN THE NEURONS?; CAN ANTAGONISTS BE USED TO DEAL WITH ADDICTION?; CAN THERE BE VACCINES AGAINST ADDICTION?; HOW ABOUT FINDING LESS DAMAGING SUBSTITUTES? WHY CAN'T WE MAKE NON-ADDICTIVE VERSIONS OF TODAY'S DRUGS OF ABUSE?; BIBLIOGRAPHY; INDEX