A commenter posted the following question on the last post, about the economics of drug abuse:
Based on your experience as an ER doctor, I was wondering what your thoughts are on the drug use, specifically the drug war. Do you see legalization as an option for some drugs? What do you think of the Portuguese model of decriminalization and treatment?
Will drug users just always be drug users?
Far be it from me to opine on something that's not really my field of expertise. Wait, no, never mind, that's pretty much my stock in trade around here: wildly unsupported opinions about whatever occurs to me at any given moment. So here goes!
First of all, the easy one: Pot. That should be decriminalized. It's not exactly benign, but it's probably less dangerous than alcohol, and it is inarguable that the black market for pot funnels a LOT of money into dangerous drug cartels. More to the point, it's just not the case that marijuana addiction necessarily harms people any more than alcohol, and I think that for consistency if you're gonna prohibit something it should be worse than the things you leave legal. I favor pot because it's largely harmless and my inner libertarian thinks the government shouldn't prohibit an activity absent compelling proof it is in the public interest. Pot fails that standard. Legalizing pot has practical policy benefits that we've all heard hashed to death in the wake of Prop 19, so I won't belabor the point.
But I think that is not what the reader was asking about, and that the real question revolves around the harder drugs: should they be legalized? In this case, my answer is no, I think they should remain illegal. This is a case where my inner libertarian yields to my inner paternalist. The hard stuff: meth, cocaine and heroin are potent. Really potent. These drugs have such a powerful effect on the brain that they drive behaviors that are all but impossible for people to control. Not all, but a predictable and significant number of people. It robs them of their agency, because the desire to obtain more drugs is so overwhelming that addicts cannot control it. They say meth is so great that all it takes is one time to hook someone for life. They're too dangerous, and too unpredictable. Nobody who uses them for the first time can predict in advance whether they will be able to use them responsibly and occasionally (which is possible for some) or whether they will become enslaved to a lifelong addiction. Nobody makes an informed decision to become an addict: they make a mistake and get trapped. And the life-wrecking power of these drugs is so obvious that I don't need to expand on the point, but meth in particular seems to do something to the frontal lobes that fries them; chronic meth users are functionally lobotomized. It's terrible.
So these drugs are so dangerous that I think it is essential that the government continue to make them illegal. But, as I said, the interdiction strategy has completely and utterly failed. I'm not saying that we should give up on stopping the drug traffickers, but that a lot of resources spent on that effort could be redirected elsewhere with a lot of benefit. Economics dictates that where there is sufficient demand, supply will develop to meet it. Ignoring the demand problem while trying to kill the suppliers is like fighting entropy: it's a futile effort.
So how do we stop demand? Sure, sure education in schools and "just say no" and all that is good stuff, but it's clearly ineffective. If we cannot prevent the drugs from getting to market, and we can't, then we also can't stop people from experimenting with them. What we need to do is identify the addicts who can be rehabilitated early and dedicate the resources to getting them off -- and keeping them off.
There's loads of evidence that drug treatment works. Not for everybody and maybe not permanently. No cure is perfect. But it massively mitigates the problem, and the return on the investment in drug treatment is equally massive, from the savings in incarceration costs, to less violent crime, to the economic benefits of returning people to the workforce. So we should be redirecting resources from enforcement/punishment to treatment and rehabilitation. There are all sorts of smart, proven strategies, from drug courts to needle exchanges to brief interventions in the ER. Unfortunately, it turns out that in times of recession, the first thing that gets cut is social services. Take this recession, in our liberal state: We lost our state-funded in-ER chemical dependency counselors, we lost at least three local detox centers, and we lost the state-run secure detox facility. The police budget is sacrosanct: that's "Public Safety" and woe to the politician who cuts it. But drug treatment? Ah, fuck 'em. Addicts don't vote.
Which is maddening because it's dumb. Why would you cut the cheapest and most effective tool in your arsenal?
I am obviously frustrated with the current situation, but I should point out that I think a lot of progress has been made in the drug war since the panicky days of the 1980s. Things like needle exchanges were politically controversial -- even radioactive. Now they're accepted and unremarkable (so long as the money is there). Drug courts have gained widespread acceptance. Cocaine, heroin and meth use are all well off their historical peaks. Prescription drug abuse is on the rise, but otherwise, things are steady-to-improving. It's not all doom and gloom