Yes, Even Heroin

by Belle Waring on November 2, 2007

I was going to respond at length to commenter sg in the thread to John Quiggin’s post, but decided I would just bump it up to a post. I think I may fairly summarize sg as saying that some drugs are so intrinsically harmful that they must be illegal. Further, that the US wouldn’t be awash in guns and drugs “if the US would actually try and police the drug trade.” This last is just madness, on my view, and anyone who thinks different should just go peruse Radley Balko’s archives. [In fairness, it seems sg is referring to more competent policing rather than more overwhelming force and aggressive raids, but I’m unclear on how this is meant to work.]

I wanted to talk about something that would-be legalizers often hear, namely, “you’re not willing to admit that under your system there would be lots more drug addicts, and being addicted to drugs is, in itself, a bad thing.” In my experience this isn’t right at all, and everyone who advocates decriminalization will admit that more people will use drugs if they are more widely available and there are no legal penalties. This means more people would become addicted to drugs. How could it be otherwise? This doesn’t mean that I think it’s good thing for people to abuse IV drugs—it’s obviously a bad thing. But the costs our own nation incurs in the War on (Some Classes of People Who Use Some) Drugs are crushing: citizens jailed for drug possession and minor sales; the wholesale violation of civil rights that attends aggressive enforcement of anti-drug laws; the fundamental unfairness of denying sick people access to drugs give them relief. With decriminalization we would need fewer police officers, and those we had could focus on violent crimes. We could reverse pernicious trends in which more and more African-American men are shoveled into the maw of the prison system. That’s not even considering the violence and misery spawned around the world by our insatiable appetite for drugs. You’ll pretty much have to convince me that decriminalization will mean free samples of heroin-enriched enfamil before I even bother to reconsider my cost-benefit analysis.

Those opposed to decriminalization are no doubt tired of hearing about the dangers of alcohol, but unfortunately it’s just a very telling point: everything that is true of other drugs is true of alcohol (it is addictive, impairs judgment, fuels crimes, can kill in large doses, etc. on down the line). Either all these things are so bad that we should return to the days of Prohibition, or these harms can be mitigated in various ways, or should be tolerated for the sake of liberty, in which case there’s no reason for other drugs to be illegal. I also think it’s worth considering that many of the people who would become junkies in my America simply become alcoholics now. Some people have addictive personalities; these people like to get fucked up wasted, and they’ll snort, drink, or inject whatever they can get their hands on. There will undoubtedly be more people with drug or alcohol addictions overall, but I think there will actually be a large amount of substitution.

sg objects that “the markets [for heroin and alcohol] are radically different, the drugs are radically different, and the drug use careers of their respective users are radically different. Libertarians (and, less criminally, left-wing drug decriminalization advocates) don’t admit this, and consistently fail to recognise the damage which would be done to society – and particularly to young people – if heroin use were to become more accessible.” This seems to overlook a few things. For one, many people use heroin without becoming addicted, or become slowly addicted but manage their drug use in such a way as to maintain a decent-seeming life for quite some time, before quitting or falling to pieces. NB: this is not at all a good idea, but it is a fact. Since these people aren’t getting dragged off into jail all the time before our eyes, we don’t think much about them, but a comparison of the “ever tried x” rates with the “did drug x last week” rates in any poll indicate that lots of people experiment with drugs and then stop. Lots of people descend into a nightmare of addiction and misery, but lots and lots of people descend into a nightmare of alcoholism and misery all the time, and we don’t seem massively exercised over that—at least not to the extent that we go all Carrie Nation on our neighborhood liquor store.

Further, there’s a causation/correlation problem. The type of person who, in our current society, tries heroin, is not just like the type of person who does not. Risk-taking, thrill-seeking people who want to get as wasted as possible with the world’s gold-standard high, are not plausibly a control group on which to test questions of relative addictiveness. If it turns out a lot of those people end up in messed-up life situations, well, it might not just be the drugs .

It’s true that I am probably imagining a society in which the use of hard drugs, while legal, is frowned upon in a way that drinking is not (anyone opposed to legalizing marijuana has just got their head up their ass, and I am unable to worry about a dystopia in which the ENDO act is passed). Perhaps after many years people’s attitudes would change to the extent that you might get offered organically produced cocaine sourced to various micro-climates in Bolivia on entering a fancy bar. That would be…not terrible. Not an intrinsic good, but on balance that world, with no DEA and many fewer citizens getting ground exceeding fine in the mills of the prison-industrial complex, would still be better than this one.

{ 94 comments }

1

SamChevre 11.02.07 at 3:10 pm

There was a study of opium use among Chinese laborers. It was reported on in the 1929 Encyclopedia Britannica. As I remember the findings, they were basically that opium users were pretty much identical in work performance to non-opium-users, so long as they had easy access to opium.

Best story on opium use is Kipling, Gate of the Hundred Sorrows

“If I can attain heaven for a pice, why hould you be envious.”

2

bi 11.02.07 at 3:19 pm

When someone mentions opium use in China, it makes me think of the Opium Wars.

3

david still 11.02.07 at 3:29 pm

I seem to recall having read that 10% of the population at any given time was prone to addiction of drugs and/or drink, and that would suggest that the same number, perhaps, would continue to be whether drink and drugs were outlawed or made legal. Drugs are outlawed but more problems clearly from drunk…yet we keep that legal and get lots of tax money from itl

4

rm 11.02.07 at 3:32 pm

The problem with this rational analysis is that American policies also serve irrational purposes. The drug war allows politicians to look tough by imprisoning a lot of African-Americans, which satisfies an unspoken cultural anxiety of a whole lot of white Americans (it became visible in the aftermath of Katrina, so we know it is still there). That has the added benefit of providing cheap prison labor, a quasi-slavery system, which some industries like. So if those politicians did not (for some reason I cannot type an apostrophe) have drugs as an excuse, they would either find some other excuse or . . .

. . . we might see some actual change for the first time since, I guess, the civil rights era.

So I wish we would try, but it ain’t gonna happen soon. And, to complicate things, drugs are bad in themselves.

5

John Emerson 11.02.07 at 3:33 pm

Anecdotal: I switched from marijuana etc. to alcohol about 1975. It just was easier and more convenient to drink — my schedule had changed, my friends were different, and alcohol was legal. There was no withdrawal, no decision or conversion experience, and I still would smoke a joint occasionally.

Leading up to the point that I’m not at all sure that I made the right choice. I’m in OK-to-excellent health and have had no dramatic disasters, but alcohol has taken its toll.

And I have at least four friends aged 40-to-67 who have been smoking marijuana on a regular basis since 1960 or 1980 (depending on their age). The 60-year-old has a moderate lung disease (he also used tobacco). No other ill effects, except possibly decreased ambition in a couple of cases.

Different anecdote: in 1887 or so the foreman of my g-g-grandfather’s brewery was tried for murdering a Prohibitionist, but acquitted by a jury of beerdrinkers. In 1888 the Selzer brewery (sioux City, IA) was closed down by Iowa’s imposition of prohibition. Had that not happened, I would be rich now, since Selzer was bigger than Budweiser then, and he only has a few hundred descendant today.

Other information: There’s a very small literature on long-term heroin users who have a steady supply of uniform quality and who take normal sanitary precautions. The medical effects are not dramatic: a certain kind of non-fatal lung disease, and increasing risk of overdose as the years go by. (The effective dose increases as tolerance rises, but the lethal dose remains the same).

Keith Richard has reported informally on his self-experiment of this type.

6

Cranky Observer 11.02.07 at 3:36 pm

> I wanted to talk about something that would-be
> legalizers often hear, namely, “you’re not willing
> to admit that under your system there would be
> lots more drug addicts, and being addicted to
> drugs is, in itself, a bad thing.” In my
> experience this isn’t right at all, and everyone
> who advocates decriminalization will admit that
> more people will use drugs if they are more widely
> available and there are no legal penalties.

An alternate theory is that the percentage of human beings who use mind-altering substances, and the percentage of those who destroy themselves with mind-altering substances (or adrenaline-based equivalents) has been pretty much fixed throughout human history. And that availability has very little to do with either percentage.

There is a lot of crystal meth around here and some people have certainly destroyed themselves with it – but I haven’t seen any evidence of the horrible scourge that is going to destroy our social structure that was predicted 10 years ago. The people who kill themselves with meth seem to me to be the same people who killed themselves with rock and synthetic equivalents 10 years ago – they just don’t have to rob as many others to get their meth as they needed to rob to get coke.

Cranky

7

robertdfeinman 11.02.07 at 3:44 pm

Perhaps instead of talking hypotheticals people should study how the Netherlands has fared with legal (or controlled if you prefer) drugs.

For some reason many in the US prefer to debate than to actually study the evidence. I’m no expert, but it seems safe to say that the Dutch society has not fallen apart as a result of their drug policies. They also have legalized prostitution and this has not caused the kinds of disasters predicted either.

I’m not saying that things are perfect, both arrangements have problems, but they are of a much smaller magnitude than what we have in the US.

One should also separate marijuana from other drugs when discussing decriminalization. Much of US drug policy is based upon theocratic beliefs which is disguised by a barrage of pseudo-scientific and -sociological blather.

A sane policy would be to decriminalize drug use and substitute public health support instead of incarceration for addicts, but this runs counter the the Puritanical streak that underlies much of US policy.

8

richard 11.02.07 at 4:09 pm

re 7: and yet, even in the Netherlands, a couple of high-profile cases seem to be able to dampen drug tolerance significantly (see recent news items on magic mushrooms).

Amsterdam is really an extraordinary experiment: it has a local, using population and, much more frighteningly, is a magnet for tourists who are temporarily escaping their own states’ prohibition laws and going on binge weekends. Somehow the city still functions and society seems to work just fine. It’s nicer, and safer, to walk around there at night than it is in London, where chucking out time is a revelation for those who defend the special status of alcohol.

Most of all, though, who bears the costs Belle cites? Not the people making the laws, who can get rich investing in prisons, get ‘tough capital’ fighting phoney wars and control the middle class with fear of the lower (and control the lower class with fear of the police/army).

9

eulogist 11.02.07 at 4:18 pm

Hear hear! Apart from the harmful effects (even to its stated goals) of the current prohibition, methinks its very premiss is wrong that “addictiveness” is some sort of chemical property of certain substances. Addiction is so much more complicated than that, and often depends more on the user and his or her social mental state and social context, than on the substance taken.

Plus, the classification of substances as legal or illegal, harmful or not harmful (given the amount taken and the method of taking it), makes no sense whatsoever.

Plus, the idea that the state dictates whether someone’s addiction does or does not constitute a Good Life is horrendously paternalistic. Any (real) conservative, Popperian or libertarian should be strongly opposed to such meddling in private lives.

You may want to read Foreign Policy’s September-October issue as well.

Another good source of information is the (former) drugs research centre CEDRO of Amsterdam University, which has a host of interesting literature on its website.

10

Karmakin 11.02.07 at 4:18 pm

The most likely result of legalization would be that pot becomes basically dime a dozen…dirt cheap really…and that it would crowd out the market for “mind-altering substances”, including alcohol and tobacco, and to a lesser degree coffee.

Also including more “hard” drugs, that people go towards for a stronger high for the same amount of money.

11

john m. 11.02.07 at 4:19 pm

I agree with a lot of this post but am not convinced that outright legalisation as set out above is the correct response to the (as far I’m concerned) undeniable fact that the “war on drugs” and criminalisation policies favoured not just in the US but the West in general have been, are and will continue to be a total failure. When this subject comes up it always strikes me as to how little thought has gone into alternative strategies. For example, I would not privatise the drug business (see alcohol & tobacco industries for reasons why) but govenrnment controlled production and supply could be interesting if thought through…

12

kid bitzer 11.02.07 at 4:20 pm

small point:

“That’s not even considering the violence and misery spawned around the world by our insatiable appetite for drugs.”

but if that particular violence & misery is the result of our *appetite* for drugs, then it will presumably go down only if our *appetite* for drugs goes down, right?

and legalization is not guaranteed to lower consumption, is it?

so: violence and misery that result from prohibition and enforcement may well go down with the end of prohibition and enforcement.

but violence and misery that result from our levels of consumption? i’m not seeing how legalization would reduce those.

especially since legalization here would not necessarily lead to legalization in foreign countries.

now–if you were referring to “violence and misery spawned around the world by our irrational anti-drug policies in colombia and afghanistan”, and went on to talk about that, it would be different.

13

JP Stormcrow 11.02.07 at 4:20 pm

My pop sociological view is that societies generally seem to have a small number of socially-endorsed drugs (ours are caffeine, alcohol, nicotine and maybe anti-depressants and non-opiate painkillers) that change only very slowly over time. Coca clearly was/is (except for our blundering bullyism) on the list for much of South America.

Other drugs may be rampant “underground” – but they don’t hit the mainstream societal narrative. (After a tough day you can say to your co-workers that you need a drink, but not a toke or a hit or a snort.) I think marijuana made a real run at it in the ’70s (and still has some steam). I recommend Larry Sloman’s Reefer madness: The history of marijuana in America from that time as a good resource from what to me seems about the peak of its “acceptance”. (Not sustainable as all of us punk-ass lame-o hypocritical Boomers moved into the work force. … Lyndon Larouche is right – we suck.) One of the “mainstream” knocks against marijuana versus alcohol was that it was “feminizing” – I do think that the approved drug list is tied in with a culture’s self-image narrative.

In the meantime, as others have pointed out, the persistence of the illegallity of other drugs is a great tool for selective enforcement and other forms of internal and external coercion.

14

Brett Bellmore 11.02.07 at 4:32 pm

“but violence and misery that result from our levels of consumption? i’m not seeing how legalization would reduce those”

For starters, if we legalized drugs, the imports would drop off substantially. We ARE an agricultural nation, after all; The only reason we don’t grow all the pot and poppies needed to satisfy domestic demand is that it’s illegal. Certainly, we’re perfectly capable of manufacturing all the synthetics, and with a lot better quality control if they were legal.

It’s important to point out that illegality is driving, to a signficant extent, which drugs are being consumed. Just like Prohibition drove the consumption of hard liquor instead of beer and wine, because it was more compact and easier to smuggle, the need to circumvent drug laws has driven the design of those synthetics. Americans might consume a bit more drugs if they were legal, but they’d almost certainly be less harmful drugs, if only because businesses prefer not to kill off their customers if they can avoid it.

Ironicly, even the tobacco companies tried coming up with nicotine delivery systems that didn’t cause cancer; They were stopped from marketing them by the fact that, if they didn’t include the cancer causing tobacco in the product, it became a regulated drug. Another casualty of the war on drugs.

15

Stuart 11.02.07 at 4:39 pm

and yet, even in the Netherlands, a couple of high-profile cases seem to be able to dampen drug tolerance significantly (see recent news items on magic mushrooms).

My understanding is that one of the major advantages of legalisation tends to be the drug user knows what they are taking, in terms of quality/purity and lack of substitution of alternate substances by the dealer. With magic mushrooms the effect can vary significantly even given the same amount taken, as some of the mushrooms generate much more of the active compounds than others.

There is also going to tend to be the problem of drug tourists taking a cocktail of different drugs during a short trip that might have a combined effect that is a problem, where individually it is unlikely to have been a serious issue – which I think was the case in one of the recent incidents you mention.

16

SG 11.02.07 at 4:42 pm

well Belle, I have (appropriately) been out drinking and it is late here, so I probably can’t reply to your post too effectively, though I suppose I should. Perhaps I could start by asking why you have turned one bored wanker’s comment into the basis for a whole post? Seems terribly … stern…?

Further, that the US wouldn’t be awash in guns and drugs “if the US would actually try and police the drug trade.” This last is just madness, on my view,

First, I should mention that when I said this I specifically said it only about drugs, not guns (I bracketed “at least the former” or some such comment). You say that you are “unclear on how [more competent policing] is meant to work”, but all I can do is recommend in response that you read about it. In a broad stroke – in 1996 in New South Wales, Australia, the Woods Royal Commission purged a large number of corrupt cops from the police force. Subsequently, recruiting standards were improved and proper anti-corruption measures instituted in a police force that had the fear of god put up it. In 1999 the new police came into the force at the same time as the “NSW Drug Summit” saw the expansion of treatment services, improved coordination of drug treatment, and a new found social commitment to fighting drug abuse. The Australian Customs Authority has always worked hard to fight drug importation and, once able to work with NSW police, improved its anti-drug work. So in December 2000/January 2001 the supply of heroin dried up, there was a massive reduction in its availability and, because of the social safety net, drug users only temporarily suffered. This has all been well documented, anyone who is interested can read about it. It is a policing success story.

Those opposed to decriminalization are no doubt tired of hearing about the dangers of alcohol, but unfortunately it’s just a very telling point: everything that is true of other drugs is true of alcohol (it is addictive, impairs judgment, fuels crimes, can kill in large doses, etc. on down the line)

As I said on the other thread, this isn’t tested. Alcohol really doesn’t kill young people in large doses, the addiction is much more manageable, and the crimes are nowhere near as severe. I quoted survival rates in that thread; young drinkers don’t get HIV, Hep C, serious brain damage and ultimately repeated semi-fatal overdoses. They don’t go to hospital as frequently, they don’t lose limbs to their injection practices, they don’t suffer potentially fatal blood poisoning, and they are no more likely to be bashed and robbed in their comatose state. Heroin users suffer a wide range of nasty consequences to their habit which don’t attend alcohol use, and one of them is most certainly sudden death.

For one, many people use heroin without becoming addicted, or become slowly addicted but manage their drug use in such a way as to maintain a decent-seeming life for quite some time, before quitting or falling to pieces

These people, I would argue, are an oft-quoted semi-mythical beast, and usually the examples given – Brett Whitely, that stupid American author who loves boys, Joy Division – end up dying by accident or are vastly wealthier and luckier than the rest of us. The vast majority of IDUs are addicted and unhappy, and no-one has yet managed to present a counter-example.

The type of person who, in our current society, tries heroin, is not just like the type of person who does not.

Precisely because it is stigmatised and illegal. The question is whether we think it is wise to extend this opportunity to others and make it acceptable for more people – do we think the improvement in civil liberties will offset the consequences.

anyone opposed to legalizing marijuana has just got their head up their ass

Wayne Hall is an example of someone who opposes legalizing marijuana. I don’t know that you could say he has his head up his arse on this topic.

Not an intrinsic good, but on balance that world, with no DEA and many fewer citizens getting ground exceeding fine in the mills of the prison-industrial complex, would still be better than this one

Like Slocum, you are confusing advocacy for the continuing illegality of heroin with advocacy for a US style war on (certain people who use) drugs. I thought I made my position on that clear, but perhaps you missed it. In any case, a review of the non-US approaches to drug use – in the UK, Australia, and Canada, for example – would suggest that there are other models of prohibition than those of the gun-toting US cop. While I go to bed to warm up, perhaps you should read up on them…

17

JP Stormcrow 11.02.07 at 4:44 pm

nicotine delivery systems that didn’t cause cancer

To Brett’s point, it is just not the “drug”, but the delivery mechanism that is subject to societal control. Chewing coca leaves is a far cry from smoking crack (not to mention the other alkaloids removed in the process). I think it was an old Odds Bodkins cartoon who was eating coffee directly out of a can saying “Why dilute it?”. (And of course the beans themselves can be chewed.)

18

nu 11.02.07 at 4:50 pm

For starters, if we legalized drugs, the imports would drop off substantially. We ARE an agricultural nation, after all; The only reason we don’t grow all the pot and poppies needed to satisfy domestic demand is that it’s illegal.

I thought Afghanistan, Burma, Colombia, Ecuador had a comparative advantage when it came to producing those products ?

but violence and misery that result from our levels of consumption?
especially since legalization here would not necessarily lead to legalization in foreign countries.

As far as say cocaine, and say Colombia, the violence doesn’t come at the producers level. They are quite happy and well paid and well treated. It comes at the Gang/Guerilla level, which is the distribution/capital level which is violent because it’s illegal.

Why don’t coffee exporters settle disputes by killing each other ?

19

engels 11.02.07 at 4:53 pm

Lots of people descend into a nightmare of addiction and misery, but lots and lots of people descend into a nightmare of alcoholism and misery all the time, and we don’t seem massively exercised over that

This isn’t a very good reason for not doing anything about the former, though, is it?

everything that is true of other drugs is true of alcohol (it is addictive, impairs judgment, fuels crimes, can kill in large doses, etc. on down the line). Either all these things are so bad that we should return to the days of Prohibition, or these harms can be mitigated in various ways, or should be tolerated for the sake of liberty, in which case there’s no reason for other drugs to be illegal.

This seems superficial. There may not be a difference in kind for the factors listed but there is clearly a difference in degree and this arguably justifies a different regulatory approach.

Much of this post evokes the pleasing aroma of freshly mown hay. It is clear from SG’s comments in the last thread that he was not defending the US “War on Drugs”, in either its conception or its (abjectly counterproductive) execution, so, for example, the passages like this–

citizens jailed for drug possession and minor sales; the wholesale violation of civil rights that attends aggressive enforcement of anti-drug laws; the fundamental unfairness of denying sick people access to drugs give them relief

seem decidedly off-target. Minor offences could be ignored, civil rights could be respected and proscribed drugs could be made available on prescription but this would fall far short of wholesale legalisation.

As for this:

Risk-taking, thrill-seeking people who want to get as wasted as possible with the world’s gold-standard high, are not plausibly a control group on which to test questions of relative addictiveness. If it turns out a lot of those people end up in messed-up life situations, well, it might not just be the drugs.

Is this really a fair or accurate picture of the majority of heroin dependents? Or a stereotype of middle class “recreational” drugs users which does not carry over at all well to the situations which lead to drug abuse among the genuinely disadvantaged? I’m not sure.

20

Tim Worstall 11.02.07 at 5:06 pm

“This means more people would become addicted to drugs. How could it be otherwise?”

Well, Gary Becker has had a paper where he says that legalization and taxation would reduce consumption…but then I wouldn’t guess there are many Becker fans around here.

One of the little oddities about this argument is that one of my employers, the Adam Smith Institute (I write for them as a freelance), takes very much the same view as Belle here. Drugs aren’t exactly desirable but their illegality is even less so.

You might also like this letter from Milton Friedman to the Bush I Administration:

http://www.fff.org/freedom/0490e.asp

“In Oliver Cromwell’s eloquent words, “I beseech you, in the bowels of Christ, think it possible you may be mistaken” about the course you and President Bush urge us to adopt to fight drugs. The path you propose of more police, more jails, use of the military in foreign countries, harsh penalties for drug users, and a whole panoply of repressive measures can only make a bad situation worse. The drug war cannot be won by those tactics without undermining the human liberty and individual freedom that you and I cherish.”

“Your mistake is failing to recognize that the very measures you favor are a major source of the evils you deplore. Of course the problem is demand, but it is not only demand, it is demand that must operate through repressed and illegal channels. Illegality creates obscene profits that finance the murderous tactics of the drug lords; illegality leads to the corruption of law enforcement officials; illegality monopolizes the efforts of honest law forces so that they are starved for resources to fight the simpler crimes of robbery, theft and assault.

Drugs are a tragedy for addicts. But criminalizing their use converts that tragedy into a disaster for society, for users and non-users alike.”

“This plea comes from the bottom of my heart. Every friend of freedom, and I know you are one, must be as revolted as I am by the prospect of turning the United States into an armed camp, by the vision of jails filled with casual drug users and of an army of enforcers empowered to invade the liberty of citizens on slight evidence. A country in which shooting down unidentified planes “on suspicion” can be seriously considered as a drug-war tactic is not the kind of United States that either you or I want to hand on to future generations.”

21

Sebastian Holsclaw 11.02.07 at 5:12 pm

“but if that particular violence & misery is the result of our appetite for drugs, then it will presumably go down only if our appetite for drugs goes down, right?”

That is what she SAID, but there is context you seem to be missing. The violence and misery is caused by our appetite for drugs, which when made illegal forces the appetite’s satisfaction to go through illegal channels. This tends to encourage nasty levels of corruption, violence and misery in a way that our appetite for chocolate tends to produce less of. Imagine what a different country Colombia might be if it didn’t have drug lords sponsored by US junkies in charge of it.

22

Josh R. 11.02.07 at 5:19 pm

I’m not sure of the exact phrasing, but Bill Hicks astutely noted:

“My life has improved drastically since I quit taking drugs, but my life would have been inifitely worse had I gone to jails for taking drugs.”

23

eulogist 11.02.07 at 5:26 pm

Re 11: Could you elaborate on (i.e. substantiate) “violence and misery that results from our levels of consumption”? Gang wars are often used as evidence that “drugs make you aggressive” but I would contend that this again, like “addictiveness” depend very much on the substance, on the individual and on social context. And again, the classification of substances – all substances – should be evidence-based. Alcohol makes some people aggressive and others sleepy (and this may vary according to the circumstances). Many substances (e.g. cannabis, I think heroin too) actually reduce aggressiveness. Shouldn’t such properties, from your point of view, be an argument for their legalisation? And what about other common activities that promote aggression (like visiting football matches)?

Re 7/8/14: In fact, all (or very nearly all) of the mushroom death cases in the Netherlands were young tourists, who had often used mushrooms in combination with other substances. So varying quality of the mushrooms themselves probably is not the issue, but knowledge and information is. Another argument for keeping it legal.

Also, the prevalence of drug use in the Netherlands (including semi-legal substances like cannabis) is not higher (and often lower) than in other western countries. This should at least put question marks to the theory that drug use always goes up after legalisation. It depends, probably.

24

Gus 11.02.07 at 5:30 pm

I didn’t see a call for legalization or a mechanism for implementing it. There’s a big difference between decriminalization and legalization. Just ask anyone who’s been busted for misdemeanor amounts of pot.
I’m all for decriminalizing all drugs, if only to make them more controllable. It will undoubtedly lead to more addicts, but the main problems with addiction in a criminalizing society is the crime associated with the high prices that prohibition creates, and od’s caused by uncertain purity. I’m not holding my breath for a sane drug policy, though. It’s such an easy issue to demagogue.

25

brooksfoe 11.02.07 at 5:32 pm

“Legalization” is not the logical way to phrase this issue. The most effective strategy worldwide, pursued in the Netherlands and I believe in Australia, is lightening or forbearance of criminal penalties, coupled with medicalization. In the Netherlands, heroin addicts are given government-issued addict cards and allowed to shoot up, at limited times, at government-run safe injection clinics, with government-provided heroin, under medical and law-enforcement supervision. At the safe injection clinices, they are also encouraged to switch to methadone if they would like to transition to the straight life, and they receive HIV tests and other medical checkups. The atmosphere is deadly boring, unsexy, and highly non-Lou-Reed-like, but because you get a guaranteed fix for free, it chases private heroin dealers out of the market. There is nothing attractive about the lifestyle, and few young Dutch are sampling the drug. The number of heroin users in the Netherlands continues to shrink every year, and the average age of users increases by almost one year every year, pointing towards a gradual dying-out of the heroin user population.

It is not correct to simply claim that legalization leads to increased use. Intelligent policies of managed tolerance and harm reduction actually decrease use. But they are complicated and require less simplistic puritanism on the part of the public.

26

Slocum 11.02.07 at 5:32 pm

Great post, Belle, thanks.

Tim Worstall, I’d not seen the Milton Friedman letter before — it is a classic. But when he says:

“The drug war cannot be won by those tactics without undermining the human liberty and individual freedom that you and I cherish.”

We can now, given another decade and a half of bitter experience, say further that the drug war cannot be won even with the use of tactics that undermine cherished human liberty and individual freedoms.

27

robertdfeinman 11.02.07 at 5:38 pm

I can’t vouch for the site drugwarfacts.org, but:

(2000): “The leading causes of death in 2000 were tobacco (435,000 deaths; 18.1% of total US deaths), poor diet and physical inactivity (400,000 deaths; 16.6%), and alcohol consumption (85,000 deaths; 3.5%). Other actual causes of death were microbial agents (75,000), toxic agents (55,000), motor vehicle crashes (43,000), incidents involving firearms (29,000), sexual behaviors (20,000), and illicit use of drugs (17,000).”

But 85,000 deaths from alcohol doesn’t sound inconsequential. Also omitted is the cost of “wasted” lives of those who can’t function or who function at a lower level because they are alcoholics.

28

a 11.02.07 at 5:45 pm

I think there is a big gap between making heroin illegal and a War on Drugs, U.S. style.

OT, I’d like to see fewer dealers in jail and more upper-class users.

29

novakant 11.02.07 at 5:47 pm

Some people have addictive personalities; these people like to get fucked up wasted, and they’ll snort, drink, or inject whatever they can get their hands on.

The type of person who, in our current society, tries heroin, is not just like the type of person who does not. Risk-taking, thrill-seeking people who want to get as wasted as possible with the world’s gold-standard high, are not plausibly a control group on which to test questions of relative addictiveness. If it turns out a lot of those people end up in messed-up life situations, well, it might not just be the drugs

Wow, did a junkie snatch your purse recently or something? Your tone strikes me as rather callous when you’re talking about “those people”. While there certainly are people who are much more prone to addiction than others, it can happen to anyone. Furthermore the characteristics you’re describing apply to a large percentage of teenagers who will try anything simply because their peers do it, they’re bored, disoriented or just, well, young. And those teenagers who are not strong enough to resist or don’t get any help from others will make up the majority of hardcore drug users later.

We can talk about alcohol being really bad, no argument from me. Or we can talk about regulated and supervised legalization programs for existing users like they had in Zurich apparently with some success. But letting some of the most vulnerable members of society get on the path of hard drugs and and simply writing them off as hopeless because of some utilitarian calculus seems very wrongheaded to me. All good drug policy* should be focussed on the users above all else.

*Like sg, I don’t think the US policy is a good one, but am against full-scale legalization.

30

r@d@r 11.02.07 at 5:47 pm

perhaps my view is overly simplistic, and may have been stated more succinctly above, but for me to so-called war on drugs boils down to 4 words:

WE ALREADY TRIED PROHIBITION

31

JP Stormcrow 11.02.07 at 6:04 pm

path of hard drugs

And a “hard” drug is what precisely? And who has set that definition and categorization?

You can argue that there is legitimacy in a society setting the limits on what is an approved drug – but at the root it is an arbitrary choice.

32

novakant 11.02.07 at 6:09 pm

You can argue that there is legitimacy in a society setting the limits on what is an approved drug – but at the root it is an arbitrary choice.

That’s correct and I don’t disagree. But I do not think that widening the range of legal options would be a good thing. And despite the awfulness of widespread alcohol abuse in our society, there are certain mitigating factors to its use having to do with precisely the fact that alcohol has been a culturally accepted drug in our society for so long.

33

Brett Bellmore 11.02.07 at 6:12 pm

“Alcohol really doesn’t kill young people in large doses,”

You’re kidding, right? Alcohol has about the smallest difference between effective dose and LD50 of any psychoactive drug, and it takes long enough to absorb compared to how fast you can drink it, that’s it’s quite common for young people “chugging” to down a lethal quantity before they even get a buzz. Only the tendency to puke after drinking large quantities of fluid has kept the carnage down.

34

Kathleen 11.02.07 at 6:35 pm

Isn’t there an important distinction to be made between “decriminalization” and “legalization”? I am in favor of the former, and completely against the latter. Yes, I would agree that the “war on drugs”, draconian sentencing / mandatory minimums used as pretexts for racist social discipline, using drug interdiction as a pretext for intervening in foreign countries — all horrible policies. Making really harmful addictive substances more easily available? Also just an awful policy idea. Having seen both alcohol addiction and crack addiction in loved ones, I don’t think multiplying opportunities for vulnerable people to fuck themselves over is a great notion. In fact I think it has a real air of “let them eat cake”. Does this mean I believe in bringing back Prohibition? No. Before everyone dances around doing the “you’re a hypocrite” cha-cha, may I just say that if the aim is “creating an ideal outcome” MY vision of an ideal outcome involves wine with dinner. It doesn’t involve coke at dinner parties (which apparently it does for Belle, given the line about “organically produced cocaine selections”) and it for sure does not involve crack and heroin and crystal meth. I think it’s important to be honest about what our vision of the ideal outcome is, and to admit that most people’s visions of the ideal outcome involves inconsistencies (for me — social drinking yay, social cocaine no) — not to design a logically infallible diktat (no addictive anything! _OR_ welcome addictive everything!) and then shout at people about how they are hypocritical wankers if they don’t buy into one or the other wholesale. A nicer conversation could be had, I think, in terms of differing visions of ideal outcomes than differing visions of unsinkable! argumentation!!!!!!!!11!!!!!!!

Just to go a bit afield here — this to me is akin to denouncing factory farming as gross and pushing for humane practices in cattle raising, while STILL CONCEDING that ending up as dinner is not the best possible outcome for Bessie the cow either way, and that a purely logical conclusion from thinking about Bessie’s interests requires universal mandatory veganism.

35

richard 11.02.07 at 6:44 pm

Does anyone know of any good research on the pre-restriction days of alcohol and drug use in Europe, in the colonies, or even in Britain – ie the 18th and 19th centuries – and what the actual social situation was then, and what could be attributed to drugs?(1) Obviously, I’ve seen Hogarth engravings and Mayhew’s London Labour, but do we actually have a good data set anywhere from which we might track the effects of widespread drug use, or just myths of how grim it all was? Do we know exactly why drugs were restricted? My understanding is that alcohol licensing laws were an artifact of the mobilisation of the workforce during WW1.

I’m trying to figure out where, when and why the fear of drugs began.

(!) Leaving aside the current Netherlands, of course.

36

omg waring is wrong 11.02.07 at 7:02 pm

Er, no. Anyone who hasn’t seen the enervating effects of heroin on junkies need not apply.

Even mdma slowly turns your brain to mush. And marijuana has excellent retarding properties and fucks up your memory good and proper.

Seeing as you live in Singapore, Belle, do you ACTUALLY think it’s a good idea for this country to legalise drug-use after its Chinese majority has witnessed, at first hand, the deleterious effects of opium use in China?

You must be kidding.

If it wasn’t such an epidemic, it wouldn’t have needed eradicating. The problem isn’t that America regulates the drug trade too much, but that it regulates the drug trade too little. Raise the barriers to entry to prohibitive levels and you’ll see the narcos toeing the line. The communists did – addiction meant death in China.

In Singapore, even small amounts of possession nails you on a trafficking charge, and hanging works pretty good as a deterrence. Sure, the expat community has a drug party every now and again, but the last I heard, they’ve wound their necks in considerably. You underestimate the effectiveness of draconian measures in the war on drugs.

37

omg waring is wrong 11.02.07 at 7:04 pm

Yeah, you already “tried” Prohibition, but your prohibition wasn’t tough enough.

38

Sebastian Holsclaw 11.02.07 at 7:08 pm

“Gang wars are often used as evidence that “drugs make you aggressive” but I would contend that this again, like “addictiveness” depend very much on the substance, on the individual and on social context.”

I think this isn’t quite right. Gang violence isn’t really driven by the members being crazy high on drugs, but instead is often driven by turf disputes about who gets to sell drugs where. Or fights about the money they get from the drug trade. The point is that without the money from the drug trade, gangs in country and cartels out of country wouldn’t have much to work with.

39

Watson Aname 11.02.07 at 7:34 pm

35 is exactly correct. Any time you push a commodity onto a lucrative black market, you get associated violence.

40

John Emerson 11.02.07 at 7:48 pm

I think that the intensity of the war on drugs since 1968 or so has come from an attempt to objectify a state of mind so that it can be punished. The counterculture used marijuana and other drugs, and the counterculture had a lot of attitudes and behaviors which infuriated people, the way heresy and blasphemy do, but in a liberal society you can’t outlaw ideas, so (this is the point) fighting drugs was made into a crusade in which everyone was supposed to participate. (Drugs were already illegal, but after an early ralaxing of penalties and enforcement, penalties and enforcement were beefed up).

And in part precisely because marijuana is the least harmful drug, it’s disportionately the target — because marijuana users are the mildest-mannered drug users. And even though it’s the least harmful, marijuana stays in the system longer so pee tests especially catch harmless marijuana users.

41

John Emerson 11.02.07 at 7:50 pm

Expanding on #37, policemen would rather bust marijuana users because the danger to them is less. Meth freaks tend to be erratic.

42

Watson Aname 11.02.07 at 9:44 pm

John Emerson, would you disagree that there has been a shift in character of the `war on drugs’, from targeting counterculture to targeting the poor (particularly minorities)?

43

mpowell 11.02.07 at 9:55 pm

Brooksfoe hits a point I want to highlight here. We absolutely do not have to take as a given that legalization will lead to increased use of all drugs. Some drugs should obviously just be legal: marijuana is one. Others should see tighter regulation. And for the most damaging drugs, we would not prevent usage, but try to eliminate the market instead.

There are two forces, I think, that could actually lead to reduced use of the most damaging drugs. First, if drugs that were fun to use, but not particularly damaging were available and well understood, many people would use those instead. Secondly, you can also pursue the Netherlands approach to addictions to truly damaging drugs like heroin. Heroin is significant b/c a lot of the damage comes from the addiction plus lack of safe access. So if you make it freely available in government centers (but not transportable elsewhere) you remove the big, secure market on the street for heroin dealers. If there are other, less damaging drugs available, legal penalties in place for possession outside of a clinic (and far more severe penalties for dealing likewise), who is going to continue using heroin, much less deal it? I imagine the data on usage in the Netherlands is not anomalous and could apply to other hard-core, carefully selected drugs.

I do not question the integrity of those, like sg, who oppose drug legalization with good intentions. (unlike many politicians, whose intentions I seriously doubt) But I do not recognize the arguments as reasonable. First, they severely misunderstand the devastating costs of the war on drugs on a global level. And secondly, they are blind to the possibilities of a flexible and smart legalization regime.

44

redjellydonut 11.02.07 at 10:15 pm

Is it also plausible that with the wholesale legalization of all drugs the pharmaceutical industry would devote vast resources to fine tuning the drugs that would appeal to the most users, mitigating many of the deleterious effects? Imagine a chemically modified hydromorphinone that didn’t lead to crippling withdrawal symptoms? Or a THC combined with a stimulate that reduces the inherent lethargy associated with pot? The possibilities (and potential revenues) are limitless.

45

engels 11.02.07 at 10:55 pm

I think some people here are distorting what SG has said rather drastically. He didn’t discuss the Dutch approach at all (for all I know he approves of it?) but the approach of many libertarians and their liberal fellow travellers who wish to see all legal bans on drug use and other “victimless crimes” repealed. He didn’t mention marijuana but was talking heroin, cocaine and other “hard” drugs. He emphatically did not defend the US “War on Drugs”.

“Legalisation” is not a good way of describing the approach in Holland. Heroin and other “hard” drugs are very much illegal there, although exception are made for registered addicts who are treated in state-run clinics. Cannabis is technically illegal but its use is tolerated (within strict limits).

The Dutch policy as I understand it is based on the principle that drug abuse is a public health, not a “moral problem”, that policies that are pragmatically oriented towards minimising the harms to drug users and others provide the best hope of coping with (not eliminating) the social problems of drug use, and that a meaningful distinction can be made between hard and soft drugs and the two markets separated so that the likelihood of users of the latter coming into contact with the former is reduced.

All this is a far cry from the mixture of ideology, adolescent “liberty” rhetoric and wishful thinking which self-styled libertarians substitute for serious thought on this issue as on so many others. Unfortunately, this post and some of the comments to it don’t seem much better.

46

mpowell 11.02.07 at 11:16 pm


I think some people here are distorting what SG has said rather drastically. He didn’t discuss the Dutch approach at all (for all I know he approves of it?)

I suppose this is possible. But if he approved of the Dutch approach he could have said so. In the current political circumstances, it doesn’t really fall into the pro illegal camp. I regard the Dutch approach as the minimum that we should be doing. As I said, I don’t see any reason for pot to be illegal. I think it would work even better if it weren’t the case that there is just one city in the world people can do this stuff- it would relieve some of the pressure to go there and binge.

47

engels 11.02.07 at 11:48 pm

As far as I can see, SG’s point on the other thread was that the call put forward by many libertarians for the general legalisation of heroin and other hard drugs is crazy. Belle apparently disagrees (“yes, even heroin”) and thinks that a world in which cocaine was legally sold in “fancy bars” would be “not terrible”. On this specific point, SG is in accordance with official Dutch policy and Belle is not.* If we are to have a whole thread devoted to smacking down one commenter it doesn’t seem unreasonable to ask that people address things that he actually said.

* In the Netherlands possession of drugs for commercial use carries a penalty of up to 8 years imprisonment. Importing or exporting drugs carries a penalty of up to 16 years imprisonment.

48

engels 11.02.07 at 11:50 pm

Link for the information above.

49

Crystal 11.03.07 at 1:15 am

I think that pot should definitely be legalized and, in fact, available in every corner store. IMO, it’s a lot less harmful than alcohol. You’ve heard of “drunken rages” but never “pot-fueled rages,” for one thing. Driving while stoned is a horrible idea, and ought to be subject to penalties, but tokin’ it up in the privacy of your own home? Why not?

OTOH, drugs like crack and crystal meth – definitely reduce the criminal penalties and the whole “war on drugs” racist idiocy, but with crystal meth especially I’m hesitant on legalization or even absolute decriminalization. Meth can make people especially violent, delusional and unpredictable – destructive to both themselves and others. Also, the production of the stuff can result in toxic waste sites. Who wants to live in a house poisoned by the fact that it was used as a meth production site? This is where it affects other people, not just the user, in a deleterious way.

In any case, the racist “war on drugs” idiocy and waste ought to stop. As we all know, it’s more an excuse to put large numbers of black and brown people behind bars than to make society more safe.

50

engels 11.03.07 at 1:44 am

Is it also plausible that with the wholesale legalization of all drugs the pharmaceutical industry would devote vast resources to fine tuning the drugs that would appeal to the most users, mitigating many of the deleterious effects? Imagine a chemically modified hydromorphinone that didn’t lead to crippling withdrawal symptoms?

Indeed. It’s also possible that will have so much money left over afterwards they will be able to give everyone a pony.

51

SG 11.03.07 at 1:53 am

Thanks Engels for actually reading what I wrote in the other thread. I didn’t talk about the Dutch experience because I was talking about the Australian system, which is broadly similar. Australia has free prescription methadone, free disposable needles available for all IDUs, a social safety net, a medically supervised injecting centre and (on a trial basis at present, I believe) methadone prescription in prison. We have free health care for all IDUs, and a treatment diversion system for young drug users to prevent them going to gaol. In some states (e.g. South Australia) cannabis is decriminalized, and in others (e.g. NSW) effectively decriminalized. I would have thought it was pretty obvious that I was talking about the Australian system, and anyone who wants to see an effective system for managing drug abuse as a public health and order problem should look into it.

Nonetheless, there are some stark facts about heroin use in Australia that we should all remember:

1) heroin overdose is the second highest killer of young people after injury. Alcohol kills more people but later in life, and probably not at the same rate given the relative levels of use

2) prevalence of Hepatitis C in Australia among IDUs is high – about 40-50% in older cohorts – and this disease is projected to become the leading cause of liver transplants, overtaking alcohol-related cirrhosis of the liver

3) incidence of hepatitis C among young IDUs is about 15 per 100 person years, making it an extremely rapidly spreading disease amongst new injectors

4) HIV prevalence in Australia is 1-3.5% among IDUs

None of these 4 problems is a consequence of the “illegality” of heroin:

1) most heroin overdose death is caused by mixing heroin with alcohol, injecting alone or being older, not (as was believed in the 70s) through fluctuations in purity alone

2-4) spread of these virusses is a consequence of how the drugs are used, i.e. through injecting. Whether they are doing it on the streets or at home or in an injecting centre, unless someone medically trained is there to help, they will eventually fuck it up or share a needle.

I should further point out that 10 year survival rates for heroin users are about 70%. Given higher survival rates for HIV (at least in civilised countries like Australia) these survival rates might go up to 80%, but really… does anyone think that any sport would last in legal form if it had these survival rates?

The question then remains, do you wish to privilege civil liberties over the life and future of an expanded pool of young people? I thought it was an uncontroversial conclusion of modern liberal society that certain “liberties” had to be constrained to protect people from themselves or others. We restrict gun ownership, we put speed limits on cars, power limits on motorcycles for learners, we have seat belt laws and we license pharmaceuticals and those who prescribe them. Why we should break this principle uncritically for a recreational drug with a high degree of risk just to react against a poor and racist US policy escapes me – especially when perfectly good alternatives are visible in the rest of the world.

52

SG 11.03.07 at 2:05 am

35, I recall from reading “The Victorians” that the situation in Victorian England before liquor licensing and prohibition of opium was nasty. The general level of alcohol abuse and associated squalor had a big effect on the women’s movement, who libertarians like to blame for introducing big government because of their prissy feminine objection to alcohol-fuelled street violence.

It’s generally a thing about libertarians – they want to return to Victorian era laissez faire capitalism. I don’t get the impression that there was much good about that time, except maybe the men’s fashion, and alcohol was certainly no exception.

53

LogicGuru 11.03.07 at 2:57 am

I keep wondering what happened. When I was in college we all smoked dope regularly and did various other drugs occasionally. We had a lot of fun, did well, graduated, went to grad school or got good jobs and joined the elite, or semi-elite. I assumed that when we got into positions of power and prestige, as we did, we’d take down these idiot, puritanical drug laws. But we didn’t. Why?

What happened?

You can niggle about addiction and social costs, about the danger involved in the use of some drugs. But we don’t prohibit extreme sports or a variety of other dangerous activities. Why are drugs a special case?

54

Roy Belmont 11.03.07 at 4:51 am

#50- “I don’t get the impression that there was much good about that time”
Maybe not if you weighed all human experience then and gave each person’s measurable quality of life an equally weighted vote, and then gave urban residents a more weighted vote still. Numerically the suffering poor being the far greater majority in urban 17th c., and being poor then being far more hellish even than now, the average life could be said to not have “much good about” it. It’s where and when we all agreed that was the only standard metric and would remain so that I missed.
Certainly great portions of the landscape then were still bearing a lot more of what grew up there as the glaciers retreated north across Europe than ours is. Healthy forests still in those days all over the place.
The value of that, how much it should matter in whatever equationing gives you the sum of “not much good”, as well as the well-being of (a few, some, most, all)peasants and indigenous people by their own unavailable testimony and measure, not to mention factoring in the “lesser” non-human lives around us, is something I’m sure we would disagree on.
#52 – An even more special case is the automobile, mortality rates for automobile travel make it the primary killer of those under 30 in the US.
Personally, I think the same conditions that created and maintain that particular weird lacuna in the public mind have left it without the necessary self-governance to handle a sudden rush of cheap legal access to powdered and crystallized hard drugs. This is not a rejection of legalization by any means. An immediate end to mandatory sentencing and a dramatic reduction in punitive criminal justice response would be a good place to start.
I do think legalization’s an important worthwhile goal in a social agenda, as is neutralizing the anti-Darwinian culling of the young in cars – it’s that you’d first have to get them away from those who prey on their appetites, or more analogously husband them and their shaped appetites like domestic animals.
Fed a steady diet of seductive encouragement to desire and gratify most have now adapted to what was asked of them, to want and to satisfy that, and view their own gratification as a birthright or even a civic duty and its lack as a symptom of something being wrong with their lives.

55

John Emerson 11.03.07 at 5:15 am

40: No. I didn’t make that point, but it’s a good one.

56

SG 11.03.07 at 5:15 am

roy the automobile is a good example, because probably the kind of behavioural traits of under-30 year olds which make the automobile so dangerous for them are the same traits which make heroin so dangerous. The difference I suppose is that cars are useful and getting high, in and of itself, is not. Also, the main way we reduce mortality rates on the roads is to restrict the civil liberties of car users. Generally every improvement in mortality has been caused by such a restriction. Why we should want to behave differently in regards to heroin escapes me.

57

John Emerson 11.03.07 at 5:20 am

And despite the awfulness of widespread alcohol abuse in our society, there are certain mitigating factors to its use having to do with precisely the fact that alcohol has been a culturally accepted drug in our society for so long.

Makes no sense.

There are specific very common problems associated with alcohol, many of them fatal: crime, violence, accidents, fires, other personal problems, and health problems.

Saying that these problems are “culturally accepted” doesn’t help.

58

Belle Waring 11.03.07 at 5:38 am

sg: I wasn’t intending to pile on you with my poster-ly authority–rather, I found myself composing a long comment and thought, why don’t I get off my butt and post something on this fine blog for a change.

novakant: um, how shall I put this. no junkies have stolen my purse, ever. junkies have, however, stolen my stash.

59

abb1 11.03.07 at 8:16 am

Question: can there be a hypothetical drug – so irresistible, instantly addictive and shockingly harmful that legalization advocates would consider a prohibition? Just curious.

60

john m. 11.03.07 at 8:44 am

Bill Hicks #2: “We’re fighting a war on drugs and the people on drugs are winning.”

61

Tim Worstall 11.03.07 at 11:45 am

Re Victorian England. No source I’m afraid, just something vaguely remembered. Opium consumption (usually as laudanum, ie dissoved in alcohol) was of the order of 250 doses pa per capita (man woman and child).
There were indeed a lot of awful things about Victorian England but I’d associate most of them with the poverty of the time, not the drug taking.

62

john b 11.03.07 at 1:02 pm

I should further point out that 10 year survival rates for heroin users are about 70%… does anyone think that any sport would last in legal form if it had these survival rates?”

As a commercial enterprise in the style of NFL or Formular 1, probably not. As a leisure activity that individuals could pursue on a not-for-profit basis without being thrown in jail, absolutely yes.

63

SG 11.03.07 at 2:04 pm

john b – you are aware that doctors regularly try to have boxing banned, aren’t you?

tim worstall – so you concur, poor people having access to drugs is a bad thing? I’m surprised. Laudanum, btw, is no comparison of any sort to modern injectable heroin.

belle, if you didn’t want to pile on with your poster-ly authority, perhaps writing a post which actually responded to my comment, rather than a distortion or misreading of it, and not labeling that misreading “boneheaded stupidity”, would have helped. Depending on who you were actually labelling, of course.

abb1 – I suspect the drug you are looking for would be heroin, if it affected rich white people

64

Chuck Darwin 11.03.07 at 3:53 pm

As someone who agrees that marijuana should be decriminalized (and, probably, legalized but regulated) I find the facile statements about the harmlessness of even occasional marijuana use by otherwise intelligent advocates of this position to be troublesome.

Leaving aside the psychosocial effects of marijuana use, numerous studies have indicated that, like smoking cigarettes (and the manner in which marijuana is smoked, along with the composition of a typical marijuana cigarette, makes a single joint the equivalent of several cigarettes at the level of chemical compounds introduced into the airway), use of weed incurs significant physiological damage to lung tissue, and several studies have shown small, but reproducible, correlations between smoking marijuana and several cancers. A recent review of the literature states:

“Studies that examined lung cancer risk factors or premalignant changes in the lung found an association of marijuana smoking with increased tar exposure, alveolar macrophage tumoricidal dysfunction, increased oxidative stress, and bronchial mucosal histopathologic abnormalities compared with tobacco smokers or nonsmoking controls.”

It would be alarmist to proclaim that these health issues outweigh the damage caused by the criminalization of marijuana. However, an honest argument has to take into account the very real health problems long-term marijuana use can induce.

65

Belle Waring 11.03.07 at 4:03 pm

sg, rich white people do use heroin. take my word for it. and though it wasn’t clear, I think the WoD is boneheaded stupidity, not your opposition to legalization, which is clearly based in your experience working with people who have serious drug problems.

66

Tim Worstall 11.03.07 at 5:43 pm

“so you concur, poor people having access to drugs is a bad thing?”

No, I do not concur. My own opinion, as the good little liberal that I am, is that poor people own their own bodies just as much as rich people do and they thus have the right to ingest whatever they wish and to find their own route to perdition, just as rich people do.

My point about Victorian times was that the things wrong with it were due to poverty, not to drugs (and to be clear, not the interaction of poverty and drugs either).

67

eulogist 11.03.07 at 6:09 pm

#51: Nonetheless, there are some stark facts about heroin use in Australia that we should all remember […] None of these 4 problems is a consequence of the “illegality” of heroin

But each of the problems you mention are related to the fact that heroin in Australia is, apparently, mainly used intravenously. I don’t know what the price level is in Australia, but the fact that the majority of Dutch users switched to smoking heroin (which is less cost-efficient) is usually attributed to the fact that street prices went down. Scarcity is one of the effects of prohibition.

The spread of viruses in Australia also seems to suggest that the needle exchange programme there (and/or medical supervision) is not functioning as intended.

Another factor may be that heroin is uncool in Europe. Youngsters tend to prefer party drugs like XTC (mdma), of which the Netherlands is a major producer, and cocaine.

Are there any legal heroin supply programmes in Australia, like in Switzerland and the Netherlands? They seem to be significantly more effective than methadone programmes (in terms of health improvement, crime reduction, and even heroin use reduction).

Anyway, the fact that a policy does not work in country A but does work in country N should not be a reason to reject the policy and the results in country N, but to look for the reasons why the results are different.

68

gregory 11.03.07 at 7:23 pm

people underestimate the need for altered states… and of course drugs provide a simlation…. but it does not take long to understand that they get in the way of not only life but of true alteration, and so most people let go of them, sooner or later….

the seemingly most benign drug, leaf.. pot… is actually very damaging when used for years, because one does not get one’s emotional processing taken care of…

neither of these concepts are open to pro or con legislation, the general culture is not sophisticated enough to conceptualize in this way

69

sara 11.03.07 at 11:59 pm

The police no longer employed by the war-on-drugs prison-industrial complex would probably be transferred to enforcing the laws against driving under the influence (DUI) or driving while intoxicated (DWI). The American traffic casualty rate is high enough already, and Americans do everything in their cars, from eating, drinking (non-alcoholic or alcohol), watching DVDs, making out, applying makeup, etc. The Netherlands are really not a good test case for this, as people drive less. A drunk or high individual falling off his bicycle in Amsterdam is not going to kill someone.

As for alcohol vs. heroin fatalities, the chronic effects of alcoholism literally fill a medical textbook, from cirrhosis of the liver and its unpleasant complications, including high blood pressure, hemorrhage, and poisoning by your own metabolic toxins; chronic malnutrition in alcoholics who don’t eat; birth defects in the fetus; Wernicke-Korsakoff syndrome and more subtle psychological effects; the probability of dying in a coma. An old study of causes of coma in admittees to emergency rooms in Boston, MA was skewed by the large population of chronic alcoholics (when Boston was Irish and the Irish were hard-drinking).

Yet, after the failure of Prohibition, nobody has declared a “war on alcohol.”

70

Fr. 11.04.07 at 12:59 am

The conversation is revealing of the US approach that consists in waging war against basically any form of large-scale disaster. I cannot wait for the war on acid rains and melting icecap.

Belle, are you seriously arguing that alcohol has the same effects than “any other type of drug”? You would need to argue that there is such thing as a “drug” category. If you decide to use addiction as your crucial variable, you will have to discriminate drastically alcohol from the other substances you quote — foremostly heroin and esp. smoked heroin.

This is only one bit of the fallacy that runs through the argument — you are not taking into account the addiction trap and are treating drugs as merely consumption goods. Wrong.

71

novakant 11.04.07 at 1:27 am

they thus have the right to ingest whatever they wish and to find their own route to perdition

Sounds great, but the trouble is that you don’t seem to understand the nature of addiction at all.

You are presupposing rational and free choice, but addiction is negating exactly that and the number of addicts who are able to find their “own route to perdition” is minuscule. Those who think they will beat their habit solely of their own accord will almost certainly relapse, because they are unwilling to realize the power addiction has over them. The process of recovery can only begin if this illusion of control is crushed and the addict is able to temporarily let go of his ego so that he can rebuild it in interaction with others.

Now does this mean that I am for the criminalization of addicts or forcing all addicts into therapy – no. But one shouldn’t underestimate the crucial role of society in initiating the process of recovery through negative feedback (on several levels: family, friends, work, the law) as well as in helping addicts successfully complete that process through therapy and support. The myth of the rational individual making free choices is certainly very harmful when applied to addicts.

72

SG 11.04.07 at 2:26 am

belle – good guess regarding the basis for my opposition to heroin legalization. I think you are wrong, however, to claim that “rich people use heroin” except in the sense of a trivial fact – yes, some rich people do, but the vast majority of its users are poor, which has enabled a lot of middle-class idealistic dope-smokers to advocate its being treated the same way as dope without ever seeing the real consequences of its use.

eulogist – Australians are famous in international drug research circles for their willingness to inject anything, but there is more than just that involved. We get our heroin from overseas in an easily injectable form, while Europeans don’t. The process of injecting (in terms of thrombosis, etc.) is safer and more rewarding in Australia than Europe.

As for your suggestion that the Australian approach is not working because of the spread of blood-borne virusses (BBVs) etc., you are wrong. Australian IDUs have some of the lowest rates of BBVs in the world, precisely because of the excellence of our needle exchange program. The inability of needle exchange programs to make large dents on the prevalence of already widespread BBVs like Hep C is a sign that they are a problem fundamental to the process of injecting, not to the illegality of the drug. (Although I should mention that this “inability to have an effect” has probably reduced hcv prevalence by half in Australia relative to the US, where it has increased, over the last 30 years).

Australia does not have a prescription heroin supply program because of a conservative government decision in 1998, generally viewed in low regard by our harm minimization community. However you are wrong in your comments on its efficacy relative to methadone – methadone has generally better outcomes, particularly as far as work and social normalisation are concerned, but injectable heroin is considered to have better effects for a small, refractory group of methadone users. This was the basis of the proposed Australian trial (see Bammer et al for more details). It was scotched, interestingly, using the excuse of the US war on drugs (under the disguise of the UNODC).

Anyway, a long diversion aside – the Australian program is working very well to protect the health and well-being of IDUs and to contain the spread of drug use. But there are some problems associated with heroin use – particularly overdose and BBVs – which can only be prevented by either convincing IDUs to switch to smoking (unlikely, at least so long as injectable drugs are available) and/or preventing the spread of the behaviour.

(Incidentally, the Chinese would dispute eulogists claim that smoking heroin would be acceptable – they have long memories of the destruction of their working youth by opium, I am told).

Also tim worstall – what novakant said about the effect of opium on peoples’ ability to choose. Your understanding of alochol’s effects in Victorian England is probably also wrong and I would suggest you read up on it. I should also ask you, if addiction is no problem, how come we see so few people holding down a job and only using heroin on Fridays? Until 2001 in Oz, a decent hit on heroin only cost $25, no more than 5 beers in a bar. Why didn’t we see lots of people working their 9-5 jobs and just having a shot on Saturday night? Perhaps because heroin use is not the same as alcohol use or alcohol addiction.

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Roy Belmont 11.04.07 at 3:36 am

sg- More than any fact or argument I’m with you in the confrontation, against whatever takes down the promise of the people. Things get confused though, mixed up. We have in the US lots of mid-range pot dealers doing hard time whose lives are being damaged woefully by laws and sentences that began as attempts to confront just those things. Alcohol in indigenous communities is like that too.
So how much is cultural? Meaning how much is the lack of culturally tried and proven rituals and methods for use. The only cultural methods junkies have is other junkies, generally. There are still existing sub-groups of opiate users whose methods of use are harm-minimized and functional, outliers sure but there they are, though they get no public showing because of the Puritanical Judeo-Christian taboos against pleasure for pleasure’s sake and the anarchic outrage of non-authoritarian pain relief.
Alcohol has deep and massively buttressed cultural methods of use, in our/my culture. Again the lack of that in indigenous cultures is surely a significant factor in the bleak and devastating harm alcohol too predictably wreaks there. Right behind economic hardship comes the seductive proffering of cheap anodyne. Gin, junk, crack.
First the destruction of indigenous culture, then the drunkard’s progress.
It may be that poverty and heroin are linked for the same reasons that saw Victorian London’s abject poor and gin so tightly fit. Suffering and mercifully, relief of suffering.
Telling a street outreach worker that junkies are simply victims of capitalism isn’t much of a blow for human liberation I realize. On the other hand, raging against the most immediate symptoms of what is a complex and multi-masked disease that may originate not in any of its more obvious pathologies but in the fundamental values of our lives as lived, isn’t subtle enough to get the things done that need it.
Keep in mind the automobile and its unquestioned ubiquity have given us the paramount disaster of anthropogenic climate change.
Getting high may – sometimes, in some of us – circumvent the seductions of the Hive Mind, and that would perforce outrage the hive. Lots of kids in America today would rather be locked in a room with a running automobile, given the forced choice, than with a chain-smoking nicotine addict. Mostly because they don’t understand the car’s exhaust would kill them far more quickly. Because no one’s told them that.
But they’ve been thoroughly mind-washed about the dangers of smoking and that’s now been a couple of decades reinforced by the culture that’s raising them.
When I was a kid every adult I knew but one smoked constantly. It was a fact of life. That changed, but the big picture didn’t. In fact the same cunning manipulations that got people to smoke were used to make them stop. When it should have been obvious it was those manipulative tools and tricks themselves that were the problem.
People died from smoking, but they smoked because they were essentially tricked into it. Then they were tricked out of it. The problem may lie more with who’s doing the tricking and why, than any particular substance and its benefits and dangers.

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SG 11.04.07 at 4:46 am

Roy, I agree with you that our response to drugs is dependent upon a cultural effect, but I think there is more to it than that. Certainly the disaster that is alcohol abuse in indigenous communities must have a cultural component (although how a good researcher can separate “culturally unused to the invaders alcohol” from “invaded” escapes me). However, I think that there are also very real differences in effect between different drugs, and these differences do need to be considered. I think the inherent manageability of alcohol addiction needs to be considered. When one hears the word “alcoholic” one usually thinks of a 70 year old man with no friends and no life, in a bedsit, but the reality is that alcoholics are usually 30-something men (and increasingly women) who drink every night and then get blotto on the weekend. They hold down a job, a relationship and a social life, and manage their alcohol problem quite adequately. Now I am living in Japan, where alcohol has a religious as well as a social function going back millenia, and there is just as much if not more alcoholism as in Australia (the test: as soon as you sit down on a bus or train at the start of a journey, even in the morning, within moments you hear the click-fizz of a beer can being opened). So I think maybe culture is not enough.

The big difference is that alcohol isn’t, first and foremost, a painkiller. Once you get addicted to a painkiller you are well and truly fucked, because it is doing a qualitatively different thing. I don’t particularly subscribe to the idea that painkillers kill social pain either, though I think people with problems take to all drugs easily. A painkiller as potent as heroin will fuck you no matter how much social pain you are feeling – the only protection seems to be that you be feeling actual, physical pain for it to kill.

Also, as a strong adherent to the Social Democratic program, I don’t think it is necessarily the role of the government to attach strong long-term philosophical aims to its public order and public health responses (like, say, “let’s widen the range of available recreational drugs people are able to safely use, widening their minds to new experiences” etc.) because the governments job is to reduce inequality and maintain public safety. If your philosophical aim means making a bold public experiment with potentially lethal consequences, I think you should keep that goal in the realm of ideas, unless you are sure that the results of the experiment will increase equality rather than decreasing it. And giving people free access to guns, heroin, gambling or libertarianism does not increase equality.

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Tim Worstall 11.04.07 at 7:58 am

“I should also ask you, if addiction is no problem, how come we see so few people holding down a job and only using heroin on Fridays? Until 2001 in Oz, a decent hit on heroin only cost $25, no more than 5 beers in a bar. Why didn’t we see lots of people working their 9-5 jobs and just having a shot on Saturday night?”

I agree that I’m no expert in drugs and or addiction. But I was under the impression that there are indeed people doing just that. Further, that addiction to heroin can indeed be combined with continuing to work etc., providing that the addict has access to reliable and pharmaceutically pure supplies. I realise that using a mass murderer here as an example doesn’t help my case but Harold Shipman continued to work as a doctor for a decade or more while regularly injecting, didn’t he?

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SG 11.04.07 at 12:26 pm

Yes Tim, these people do exist but, as I mentioned to Belle, they are a lot rarer than perhaps the 70s generation of drug decriminalisation advocates let on. I would go so far as to say they’re something of a myth. You’re right that Harold Shipman isn’t a good example – he was wealthy, and as a sociopath obviously driven by special needs. And didn’t he kill people for money…?

Another example of the irrationality of drug users in action is the street-based sex workers. In Australia methadone for heroin addicts is free. There are quite a few heroin-using women with serious habits who support these habits by street-based sex work, having to pull in $100, $200, or even more per day to support their habit. When they discover that methadone is free, why don’t these women stop using the heroin and maintain their sex-work lifestyle? A year at $1000 a week or more, cash in hand, would make them wealthy fast, but they don’t make the change. If you maintain that they decided rationally to choose this “road to perdition”, how come they don’t stop when they get to the point where they are living on the streets, having sex in very dangerous places with dangerous men, and shift the burden of risk towards supporting their future? Why do they have to go through multiple crises, gaol, overdoses, hepatitis C diagnosis, loss of their children, alienation from their family, and possibly even in many cases wait until they finally lose the power to earn income from sex work, before managing to make that methadone program stick and give up the drugs? And when they do give up the drugs, why do they always also give up the street-based sex work? Could it be that they weren’t behaving rationally during that period?

Of course, if you are a libertarian, your response would be the heartless “I don’t care, not my problem”. Or, I suppose, to think that these people will be okay once everyone gets wealthier (even though the women in question are already earning above-average incomes). But others would argue that as a society we should try to save these people from themselves, and make whatever effort is required to do so. And I would argue that part of that effort is punishing the kind of people who deal drugs (at a wholesale or middle-management level, especially) when they know that further down the scale, these women are making these kinds of decisions to support their irrational behaviour.

(And of course, any Republic lawmaker with any sense will realise that, since he regularly makes use of these sex-workers as part of his sleazy hypocritical “family values”, he should make sure they don’t have HIV…)

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Tim Worstall 11.04.07 at 2:42 pm

OK, leave aside the liberal, or libertarian, arguments and concentrate exactly on your sex workers. If heroin were legal then they wouldn’t need $200 a day to purchase it. More like $10 a day.
So the sex work to pay for it wouldn’t exist, would it?

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SG 11.04.07 at 4:54 pm

no Tim they wouldn’t. The heroin is $25 a shot now. They are working to pay for 8, 10, 15 shots a day. Why should you think that if the price of the heroin halves they won’t just double their use? The only way this will cause them to reduce their use to $10 a day is if the shots drop to $1 or $2. You can’t even buy alcohol for that… well, you can in Japan, but… we’re talking about a pharmaceutical here, so the price you suggest is unlikely to happen. Suppose it were, though…

then you could argue that $2 or $5 shots of injectable heroin are a good thing, but in this case you are suggesting that people should be able to buy, for a mere $10 or $20, 5 or 10 chances at killing themselves. Or getting HIV.

Unless of course you assume that the consumer is rational, and will only buy 2 shots. But our street-based sex workers were willing to go to extreme lengths to score the money for 10 shots. Why would you assume that, were the heroin cheaper, they would stop at 2?

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Tim Worstall 11.05.07 at 1:53 am

One story I’ve heard (and have absolutely no proof for) is that a day’s worth of heroin (and, of course, it’s necessary to define “day’s worth”), pharmaceutically pure, costs less than the price that the NHS in the UK charges for a prescription. Some £ 6 or so. And I repeat that I have no evidence whatsoever for this.

However, this does look interesting:
http://www.guardian.co.uk/drugs/Story/0,,506559,00.html

“In Liverpool, during the early 1990s, Dr John Marks used a special Home Office licence to prescribe heroin to addicts. Police reported a 96% reduction in acquisitive crime among a group of addict patients. Deaths from locally acquired HIV infection and drug-related overdoses fell to zero. But, under intense pressure from the government, the project was closed down. In its 10 years’ work, not one of its patients had died. In the first two years after it was closed, 41 died.”

I think, that in the context that you’re talking about sex work, we’d classify that as (well, it’s not a crime in either Australia or the UK) acquisitive behaviour, dangerous behaviour to aquire the money to buy drugs. A 96% reduction in such behaviour really does look very attractive, doesn’t it?

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Chris 11.05.07 at 2:46 am

It’s quite interesting to discuss whether the harms caused by heroin are exaggerated or understated, but it’s got nothing much to do with drug policy, which is about other things. Take the thought experiment of imagining a drug that has all the high of heroin but none of the physical downsides – that also, let’s say for the sake of argument, is trivially cheap and has no effect on workforce participation. It’s not inconceivable that such a such a product could be found; indeed, if it was seen as a solution then a reasonable fraction of the billions spent on prohibition would probably go into searching for it. The research isn’t done because a harmless drug isn’t seen as a solution, and it’s not seen as a solution because it’s not the downside that is objected to, it’s the upside. At the root our society’s objection to drugs is Macaulay’s comment on the Puritans – they objected to bearbaiting not because it gave pain to the bear but because it gave pleasure to the spectators.

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SG 11.05.07 at 3:26 am

Tim, as regards the price of heroin in a legal framework, I doubt it would be that cheap. In Australia for example, pharmaceuticals are generally $16 a script, but this is because they’re subsidized by the PBS. If you assume that heroin is not going to be subsidized by the PBS for personal fun (draconian I know…) then probably the price of prescription heroin would be roughly the same as some other over-the-counter non-subsidized injectable drug. From memory, the cost of a vitamin b12 injection is about $12. The cost of a non-subsidized course of the HPV vaccine is about $350, or just over $100 a shot (it’s 3 shots right?) So you’re looking at probably between $12 and $100 a shot, more likely I would say in the $12 end of the scale. That’s half the price that we know the drug was selling for on the streets in 1999. When the price doubled (to about $50 a shot) in 2001, the death rate halved (this happened dramatically – it took 1 month for the death rate to plummet). So presumably halving the price would cause the death rate to go up. It’s also worth noting that when that price went up, it stayed up and deaths stayed down. But crime only went up for a month or two, then returned to previous levels. This suggests that more effective prohibition in combination with good harm reduction measures will cause a reduction in the bad effects of drug use, without necessarily causing an increase in the bad effects of prohibition.

As for the Dr. Marks experiment, you are presenting an age-old defense of substitution therapy. No-one (well, no-one in civilised countries) disputes the importance of substitution therapy, and in Australia substitution therapy is the first line of treatment for heroin addiction. As I mentioned above, we wanted to introduce heroin prescription as part of our approach to heroin addiction. The debate amongst professionals in this field concerns whether or not heroin or methadone are equally effective, so as to determine the best way to target each treatment, not whether or not we should not use heroin substitution. The problem with the Marks experiment is that he was the only source of prescription heroin in England, a lot of his clients had been on his program for a very long time, and it is likely that he had a highly self-selected group. The reality of substitution therapy is that the more widely you make it available, the less effective it becomes (as the self-selection effects are reduced). This is why no modern methadone program outside the US can reproduce the results of the 70s studies in the US – the progams have been extended beyond the highly committed treatment participants of those early trials, and suffer very high drop out (from memory of the data I saw, many programs in New South Wales, Australia, had woeful retention compared to those early US studies, which were the “gold standard”). All the effects described by Marks happen as a consequence of methadone substitution therapy, just not as dramatically – it is not unique to heroin. The heroin prescription he did does not serve in and of itself as an argument for legalisation, either, because he was running a treatment program, not a heroin bar. In order to believe that no-one would die using legalised heroin – similar to Marks’ unique results – you would need to be able to guarantee that they could take their drugs in a medically supervised environment. As a libertarian I’m sure you would object to government subsidised free heroin-injecting facilities just so dole-bludgers can have more fun, right? You’d want people to be able to pick their shot up and go home to have it with a beer, if that is the road they want to take to perdition, right? As soon as you allow this you are back to the naked truth – in 1999 in Australia, 980 people died of heroin overdose, from a suspected population of 74000. That’s 13 deaths per 1000, and we have some evidence that the death rate follows the price. Can you think of any other situations in recent memory where a population had an excess death rate anywhere near that high? (Hint: think of a controversial study of a war zone).

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Tim Worstall 11.05.07 at 8:47 am

“As a libertarian I’m sure you would object to government subsidised free heroin-injecting facilities just so dole-bludgers can have more fun, right?”

I’d certainly prefer that to the current War on Drugs, yes. Perfectly happy to put the high falutin’ rhetoric aside for prgamatic solutions in the face of such absurdity.

“(Hint: think of a controversial study of a war zone).”

Ouch, don’t, I’m still stinging from the slapping I got around here over that.

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SG 11.05.07 at 1:24 pm

So here we have a libertarian who supports government subsidized heroin bars, in which people get state-sanctioned and provided heroin, rather than working productively? You realise we would need quite a few of these, don’t you? Are you sure you aren’t confusing your ideal legalised-marijuana world with the current world of state-supported treatment facilities? Perhaps you misread my comment..?

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Tim Worstall 11.05.07 at 2:37 pm

I’ve noted here before that I self-identify as a classical liberal, not a libertarian.

But yes, I’d certainly prefer state funded heroin bars to the mess that is the current War on Drugs.

One point I should make: I’m from UK, you’re in Australia, so the details of the systems currently in place are different. My real scorn is for the (as I regard them) insane US laws on the subject, where doctors get jailed for “over prescribing” opiates.

Or if heroin bars goes to far for it actually to be practicable, why not registered addicts get it on prescription? Not, to my mind, quite the perfect solution but even then vastly better than what we have in either the US or UK.

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SG 11.05.07 at 2:55 pm

That would have been pretty much the Australian system, Tim, but for our conservative government scotching it. I think otherwise yours and our systems are pretty similar, bar a few tiny details (all the main needle exchange, methadone, health care, other treatment systems are pretty much the same). As I said above, for most of the sensible health systems in the world (in Europe, the UK and Australia, for example) heroin prescription is debated primarily in terms of its efficacy, not its desirability. As soon as we get a slightly left-wing or sensible government in place, when the need is there they will allow heroin prescription. In the meantime, it’s no big deal – for the majority of heroin users, methadone is probably a better option in any case.

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Tim Worstall 11.05.07 at 3:22 pm

One thing this has done is to get me to go and look at what the prices are for pharmaceutical heroin (diamorphine isn’t it?). I’ve also called the only licensed manufacturer in the UK and am waiting for a response from them.

Here’s one thing.

http://www.sid.u-net.com/monkey/i7a11.htm

” Diamorphine lasts about eight hours in the body, while methadone is effective for twenty-four hours. As they are both of similar potency, this means you have to prescribe about three times as much diamorphine per day as methadone. However, I usually find that someone on 100mg IV methadone is likely to require about 400mg diamorphine to be comfortable. This much diamorphine costs about £18 per day, or about £6,500 per year. Two 50mg methadone amps cost £4 per day, or about £1,500 per year. In both cases dispensing charges have to be added, which comes to about £500 a year (for daily dispensing). In other words, the diamorphine would cost the NHS £5000 per year more than the methadone amps. This kind of figure is not calculated to cause delight in our finance departments.

You are right that diamorphine is much cheaper if it is dispensed in the form of powder. 400mg costs £2.60 per day, or £950 a year; not much difference from methadone mixture. We cannot prescribe it in this form for two reasons. Firstly, it is not guaranteed to be sterile. Therefore if you injected it and acquired an infection, you could rightly complain of poor medical practice. Secondly, the Home Office does not allow it. They argue that powder is more easily sold on than ampoules, because it can be readily cut down with other substances. I’m not sure they are right about this, because there is a ready market for diamorphine ampoules. Nonetheless, they are the ones who are in charge.”

And in the prices the NHS paid in 2001:

http://www.publications.doh.gov.uk/generics/index.htm

Diamorphine HCl Injection 100mg 5 Ampoules, £22.49

Diamorphine HCl Tablets 10mg 100 pieces £12.30.

Those two sets of prices seem to be comparable, 18 and 22 pounds a day for ampoules. It also seems that for directly injectable I was wrong about heroin being cheaper than the cost of a prescription: it’s about 3 times it.

From a purely pragmitic point of view, from the cost to the taxpayers, it looks as if it would be much cheaper to provide it for free to addicts rather than continue with this War on Drugs nonsense.

Of course, it’s not just slighly left wing governments which would bring in heroin prescription. I and my muckers at the Adam Smith Institute are usually regarded as swivel eyed loonies from the far Thatcherite right (slightly unfairly I feel, but that is how many regard us) and we’d do it too. Be the second thing on the list, right after hounding Polly Toynbee out of the country :-)*

*No, that is not the official policy of the ASI. Don’t be absurd.

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JEFF 11.05.07 at 6:35 pm

I have a friend that is a owner-operator truck driver for a moving company. All his movers are crack-heads. I asked him how he can stand having crack-heads work for him. He said they get their work done fast, because they want to get home & use crack, so he’d rather employ crackheads since he pays them by the hour…

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SG 11.06.07 at 12:17 am

Tim you need to remember that prescription heroin as treatment is not the same as legalised heroin, which would be available in much the same way as alcohol or cigarettes to users.

In the former case (prescription heroin) rational health care systems will introduce it on the basis of its cost effectiveness – methadone for the majority of users, heroin for those whom methadone fails. The need to inject heroin 3 times a day means it is essentially impossible to hold down a job on a heroin prescription program (you can’t do your job if you’re on the nod). So in this regard it is only a treatment for addiction, not for all the lifestyle problems that go with it.

In the latter case (heroin legally available like alcohol) the need to prescribe treatment heroin 3 times a day should give you a hint – addicted users of this legally available heroin won’t be able to work. Also, the prices you gave are for prices the NHS paid, not retail prices, so it’s likely to go up in price considerably (especially if demand rises!) This latter situation – treating all recreational drugs like alcohol – tends to be the argument I have seen from libertarians*, which is what I was talking about in the last post. You won’t find any objections here about prescription heroin, which is an entirely different kettle of fish. But we need to get our terms right, because “heroin prescription” and “legalised heroin” (which is what your swivel-eyed mates want) are very different.

*since we’re doing this footnote thing now, I’ll try it too. It’s worth pondering under this scheme (legal heroin that is, not footnotes) exactly who will be selling this heroin. It won’t be your corner dope dealer, that’s for sure. You will be buying it from some kind of pharmaceutical conglomerate. I imagine the kind of company which sells a known deadly and highly addictive drug that kills nearly 1000 young Australians a year is likely to be quite a nasty company. I would think we are looking at a kind of bastard offspring of Big Tobacco and Big Pharmaceuticals, with a good moral contribution from the alcohol sector. I can’t imagine that such a company is going to be a force for social good. But it’s funny how libertarian policies always seem to point to the biggest, nastiest corporation on the block isn’t it?

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Andromeda 11.06.07 at 1:37 am

I quote what I just IMed my husband:

“We should just make Belle world dictator. The world would be more sensible, intelligent, stylish, *and* wacky.”

Throw in Tyler Cowen as your finance/culture/figuring out the pesky implementational details minister and hell, everyone would have a pony. Maybe everyone would BE a pony. I’d be happy.

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Jer 11.06.07 at 7:32 pm

Hi:

If it took a constitutional amendment to enforce prohibition of alcohol, why do we not require a constitutional amendment to prohibit other commonly available drugs?

After all, marijuana is a common weed, it grows nearly everywhere…

Jer

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McDuff 11.06.07 at 9:15 pm

Looking at this from a purely technical point of view, one thing strikes me as amazingly obvious. Whatever else it does, whatever side-effects it has on our society and our prison population, what prohibition of drugs doesn’t do, and obviously doesn’t do, is prevent people having access to and using drugs. I mean, seriously. 80% of my friends use weed, getting cocaine is slightly harder than getting hold of thai basil (but not by much), and as we’ve just been discussing, heroin is available to someone who wants it by going to the right part of town and laying down a tenner. So whatever else it does, can we at least accept that prohibition does not in any conceivable sense prevent people getting hold of drugs?

Once we’re there, admitting this basic fact, we can examine the various different legal frameworks we can impose over the drug-filled society we’re going to have anyway, eh?

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SG 11.07.07 at 3:19 am

I don’t think that’s necessarily entirely true, mcduff. Certainly in Australia you have to know where to go to get heroin, you can’t just get it anywhere, and you can’t just get it from anyone (like, say, dope). You have to take risks to get it, too, which most people aren’t willing to run, and as prohibition gets more effective the price of the drug goes up accordingly. In 2001, for example, the price doubled and after a brief period in which dealers became more visible (out of desperation) they had to disappear into the backstreets and deal increasingly through phones and existing networks. This necessarily makes heroin (and the dealer’s other favourite drug, cocaine) a lot harder to get.

The point I made originally is that effective prohibition (as opposed to straight-out repression) hasn’t been tried in many countries, and when prohibition is actually conducted as one might expect it to be when one says “let’s ban drugs!”, it can work. Obviously not perfectly, but enough to prevent a lot of people getting easy or cheap access to a drug we don’t want them to.

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SG 11.07.07 at 3:20 am

Also effective prohibition does not necessarily require heavy-handed street-level repressive tactics. Highly effective border control in countries like the UK, US or Australia can stop the importation of heroin, for example, rendering street-level control almost unnecessary.

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Roy Belmont 11.08.07 at 3:26 am

sg- We parted company back there somewhere. Whatever personal difficulties have led you to this:
…to prevent a lot of people getting easy or cheap access to a drug we don’t want them to.
and this:
Highly effective border control in countries like the UK, US or Australia can stop…
those statements have left me behind entirely. They cross each other up, and you say, or imply, two contradictory things at once.
Too close to Big Brother’s Good Intentions Highway. Benevolent fascism. Fooey.
“We” actually don’t care who has cheap access or easy, “we” just don’t want people messing our lives up. Junkies in this culture at this time are prone to mess our lives up, or are perceived to be.
The campaign to get recognition for the destructive harm of the automobile and its appurtenances has been waged mightily for decades and mostly futilely for most of that time. Perception not being much of a gift in that case. The utility argument blocked so much of what was really there.
The utility of self-prescribed opiates, and/or “dope” as you seem to be calling marijuana – in the subculture I’m most familiar with “dope” is heroin – isn’t up for debate because the dissenting side faces criminal prosecution or at best suspicion and loss of reputation for even trying to make its point.
Hedonism as cultural safeguard for dangerous substances is where we’re at. But since hedonism is the global religion it goes unchallenged. Reactions to the symptoms elide the cause and go toward subjective motive – pleasure, escape, as though these things were always wrong.
Laws against suicide come out of that same weird tangle of interiorized Puritanical obsessions, Pavlovian child-rearing, and Skinnerian education, with the ramified addenda of graphic proofs, like Hogarth’s rakes and whores and drunkards and their little arcs of tragic waste updated and spun – these things are witnessed and documented however simplistically and ultimately falsely, not to mention carrying in-built apologiae for what is a far more heinous but murkier “things as they are”.
Crack cocaine being in my experience the most pernicious of all contraband substances, and crack cocaine proceeding straight out of the consumer-hedonist amorality this culture is driven by. A Big Mac and a crack pipe as points on a line, iterations of each other.
That same status quo ante has just in my lifetime been stripped of most all its overt racism and much of its overt smugly paternalistic sexism, both aspects easily shown to have traditionally generated their own justifications – the obvious inferiority of blacks and Mexicans and women and homosexuals being the first obstacle to progressive change. And that change what there was of it did come awful hard.
Clearly executing all junkies as soon as they become noticeable would bring a similar relief to your “highly effective” interdiction and prohibition. It’s almost as though you already wanted the drugs banned and were using the not-so-obvious-to-me list of inevitable harms and damages ensuant to justify that pre-existing desire.
Indians in the American West’s early 20th c. were widely ridiculed for their drunkenness and social uselessness, and this was for years grounds for a pat assumption of their unfitness for civilized society. Lo and behold the rage and grief of their lived experience may have had somewhat of a lot to do with those asocial symptoms.
Lo and behold that same civilization has shown itself to be little more than cheap cosmetics lavishly applied, the real face under the makeup looking as savage as savage could be, both in historical retrospect and in its overt presence worldwide right now.
So, more briefly, having the same dim bulbs who’re running things these days – drug policy, foreign policy, you name it policy – given more enforcement powers seems pretty much backwards progress, not to mention a recipe for doom.

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