A Letter to the Drug Czar
The following is a letter that was faxed to our Drug Czar
by Tom O'Connell MD a doctor from California.

Dear General McCaffery:

I am a physician and, like you, concerned about our nation's drug policy and its impact. Therefore, I am using the occasion of your recently televised appearance at American University as an opportunity to address our differences.

I appreciate the energy and enthusiasm you bring to your new job. Your visibility and availability to the media are in sharp contrast to those of your predecessor. I have followed your pronouncements in the press and recognize many ideas contained in your formal presentation at AU from earlier, piecemeal reporting. However, your televised address was my first opportunity to hear you present and defend a coherent overview of present policy; so what may have become a standard recitation for you was a signal event for me.

A video of your appearance allowed analysis of present policy together with assumptions that policy makes about both the nature of addiction, and the proper role of government in dealing with both addiction and casual drug use.

Let me say that I am in profound disagreement with the crucial assumption of our policy that substance prohibition a useful tool of government, and with the assertion that it is only permissible way to deal with the "drug problem." This disagreement would apply even if the two most dangerous psychoactives, alcohol and tobacco, were also prohibited, which, of course, they are not.

The reason is simple. Substance prohibition laws inevitably create illegal markets endowed with potential for enormous profit. As you said:"..the corrupting power of money can absolutely pervert fundamental institutions in a democracy, the United States, Mexico, Panama, and any other country on the face of the earth." You also said (about coca raised by campesinos) in the next paragraph: "The drugs are essentially worth nothing." That statement applies equally to opioids.

Thus, almost all an illegal drug's street value is conferred by prohibition law which created the violent illegal market in which it is sold. The social evils decried in your speech are, on careful analysis, all direct results of that black market and not the drugs themselves. In describing that market, you say further: "the drug business does not display the classic signs of a supply-demand driven product. This is an illegal operation........It is not based on a standard distribution system. " Therefore I fail to understand the logic of a policy which insists that the only possible way to approach the issue of psychoactive harm to society is by substance prohibition.

In September 1945, the global market for illegal drugs, disrupted by six years of war, had nearly ceased to exist. Today, fifty-one years later, illegal drugs rival oil and armaments in dollar value. This growth has occurred despite a half century of continuous drug prohibition in the United States, a policy we successfully exported to the rest of the world via the Single Convention Treaty of New York in 1961.

Comparing the laissez-faire world drug market which existed between the end of the Second Opium War in 1860 and passage of the Harrison Act in 1914, our modern domestic addiction problem is no less severe, yet drug related crime is worse by several orders of magnitude. I do not advocate a laissez-faire drug market; I only point out that we were better off when not under prohibition.

Another unnecessary handicap imposed by prohibition: all economic data concerning illegal markets are suspect. Licit, regulated markets, such as alcohol and tobacco yield production and sales figures which are reliable, not only for measuring the market, but for determining patterns of use. An illegal market is obscured by a veil which renders most such figures completely unreliable, despite your citing them with seeming confidence. This inability to measure the illegal market allows institutionalized funding of the expensive panoply of interdiction techniques so prized by law enforcement.

Also, we cannot credibly measure the effect of draconian measures employed to effect change. Historically, this has created a cycle of increasingly harsh punishments with disappointing results in which the only certain measurements have been skyrocketing corrections budgets and lengthening rolls of prison inmates.

In that connection, your statement:"I am less concerned about a debate on how sad am I about 40,000 dollars a head for a federal high security prisoner than I am about the fact we spend an average of three dollars a head per child on drug education in America, " deserves comment. I agree more might be spent on drug education, but am saddened, as you should be, by diversion of 40,000 precious tax dollars into a futile, destructive effort and away from education or health care. The statement," We're going to have to incarcerate violent criminals, we all understand that, but right now we've got a system where of our 110 000 federal prisoners, 2/3 of them are in there for drug related offenses," hardly adds logical support for present policy.

The statement."you (we) cannot arrest your (our) way out of the drug problem." has gained wide publicity. I note with interest that you use it in this speech also. Then you say, "There are new techniques, new alternatives, We have some 89 federally funded drug courts in the United States nowadays. They give people an alternative to incarceration." I disagree, since one does not appear in drug court unless arrested, and the penalty for non-compliance with drug court is incarceration. Drug court is a device for extending the coercive power of law enforcement while holding down expenses. Studies of its application clearly show a disproportionate assignment of white arrestees to drug court and black prisoners to prison.

Prohibition is not a strategy of regulation, but of non-regulation. The ultimate sanction against a non compliant company in a regulated legal market is to bar them from that market, to make them outlaws. We start at that point with drugs. Present policy says in essence, that regulating drugs is so important to our well being that the only people we can entrust it to are criminals.

The rationale used to justify prohibition is fear of addiction, especially among the young. Meanwhile scientific study of addiction has been severely hampered for the past eighty years by insistence on criminal prohibition as the only possible approach. Our model also confines enforcement theory to what is described in drug policy literature as the "free choice paradigm" which sees drug use and addiction as equally tempting to all citizens, and therefore, equally punishable under the law. We cruelly and stubbornly limit replacement therapy for addicts to one agent (methadone) through officially designated treatment programs, even while acknowledging the inadequate number of places in those programs.

Paradoxically, a federal policy justified by claiming to protect society against the evils of addiction places nearly impossible burdens on the addict, risking his health and life while denying him humane legal treatment. He is literally consigned to the tender mercies of the illegal market or to untreated withdrawal in or out of jail.

Even the emergence AIDS has not modified our callous marginalization of addicts. This results in unnecessary spread of HIV, not only to addicts, but their consorts, newborn children and the rest of us. The federal rejection of the value of needle exchange is at least as ethically reprehensible as the continued observation of untreated lues practiced in the infamous Tuskegee study, and because of the much larger numbers involved, far more destructive.

In your address, you said preventing drug use and addictive behavior among the 68 million Americans under age 21 is the cornerstone of policy: "We know statistically that if you can get a young Americans between the ages of ten years old, and through the age of twenty-one without smoking cigarettes, without using illegal drugs, and I underscore this, abusing alcohol-that if you can get through the age of twenty-one without being involved in this addictive behavior, then the chances approach zero of you ever becoming one of the 3.6 million who are currently addicted."

I would suggest that this is a simplistic and unjustified interpretation of valid data. Thus, it may be quite reckless to base an expensive national policy on this interpretation. A far more likely assumption is that those engaging in addictive behavior in high school are defining themselves as peculiarly vulnerable to the risk of addiction and thus in need of special attention.

In support of that interpretation, I offer the following: there was an initial decline in daily cigarette use from about 2/3 of high school seniors immediately after World War II to present levels of about 30%. However, the percentage of new smokers has remained distressingly constant over the past several years, despite a well known and growing litany of adverse health effects of smoking.

Recalcitrant junior high and high school smokers have thus become a focus of national attention for two reasons:

1.) They are the replacements who make up the sales lost by tobacco
companies when older smokers either die or quit. The charge that tobacco
companies deliberately target this population with advertising has been
unconvincingly denied.

2.) These thirty percent or so of high schoolers who become tobacco
addicts include nearly all who in smaller numbers, become alcohol abusers.
Smoker-drinkers in turn, include almost all of those who later experiment with
cocaine and heroin. Although you focused on alcohol as the drug marking those
at risk for other addictions, it is equally true that juvenile smoking plays the
same role in designating future alcohol abusers.

There are two important correlates of these observations:

1.) Those who do not become cigarette smokers in junior high or high
school are at very low risk to become other than moderate users of alcohol or ever
to use illegal drugs, except for occasional marijuana. Extrapolating from the
behavior of this compliant group to draw conclusions about those exhibiting addictive
behavior is unjustified, yet such extrapolation forms the basis for current policy.

2.) The question of whether vulnerable students, as defined by cigarette
addiction in high school, can be persuaded not to experiment with tobacco has
never been translated into a valid experiment. This is an experiment which
needs to be done, yet is almost impossible to design in a climate of criminal
prohibition. If such a future cohort could be persuaded to eschew smoking
until age 21, the further question of how that might affect their ultimate
decision to smoke or their use of alcohol and other drugs is completely
unanswered.

Finally, a point, not specifically raised in your speech; the sustained reduction in both alcohol and tobacco consumption by Americans over the past 2 decades shows clearly that education and regulation short of prohibition can favorably impact patterns of psychoactive use. In other words, the favorable trends in consumption of legal alcohol and tobacco stand in stark contrast to the failure of prohibition to control illegal drug markets.

I am suggesting that you have accepted a position as spokesperson for a policy which is grievously flawed, and although perhaps historically intended to benefit society, has clearly had the opposite effect. Neither long duration of, nor widespread support for, flawed national policy validate persistence in that policy. We have only to look at our national experience with slavery, made law by our Constitution and survivor as policy for about the same length of time as federal drug prohibition has existed. I urge you to reconsider your own endorsement of this national folly.

Sincerely,
Thomas J. O'Connell, MD
San Mateo, CA

This letter was sent across the internet by the Anti-Prohibition League and is reprinted here without permission.