“look at alcohol!”

Edited copy of Image:The Brewer designed and e...
Edited copy of Image:The Brewer designed and engraved in the Sixteenth. Century by J Amman.png (Photo credit: Wikipedia)

I frequently find myself in discussions about drug policy. I feel strongly that incarcerating people for possession is stupid and wrong, but I’m reluctant to legalize drugs. (I think there are a lot of options in between.) In these discussions, I inevitably hear someone say, “Look at alcohol. It’s way worse and it’s legal!” My response is always, “Exactly. Look at alcohol. It’s a public health and public safety disaster.”

Mark Kleiman points out that higher alcohol taxes would reduce battery, burglary and murder. The problem? The power of the alcohol industry’s lobby. Michigan has been incredibly revenue starved and we haven’t raised the beer tax since 1966. And, the beer tax is a flat tax per barrel, so there haven’t even been any increases in revenues because of inflation.

From a recent Kleiman interview [emphasis min]:

Matthews: No, of course not, single-malt all the way. But how much power do the spirits companies have? It seems like they’d fight any price increase.

Kleiman: Much power. The spirits guys are not really important because they’re not the real market. The real problem is beer. The beer guys are powerful. It’s two thirds of the market. Not only do they have heavy campaign contributions to politicians, because they’re state regulated and thus have a stake in state politics, but customers don’t dislike their beer company, so if they get a political message from the beer company, they’ll respond.

Contrast that with tobacco, with a smaller number of lower status users who hate their providers. The cigarette companies have absolutely no luck mobilizing smokers. Smokers hate tobacco companies. It’s easy to say it’s just a tax on responsible drinking until you do the math. It would cost a typical beer drinker $36 a year. The man who’d get hit is the 10 beer a day drinker, and he’s the guy we want to hit.

Taxation is just about the perfect way to control alcohol use. It’s not complete, because you need controls for the real problem drinkers. But if we tripled the alcohol tax it would reduce homicide by 6 percent. And you’re not putting anybody in jail. But instead we spend our time talking about doing marijuana testing for welfare recipients.

Sentences to Ponder

hash-bash-michiganDrug policy expert Mark Kleiman:

The question about my own use or non-use of pot always comes up, and I always answer the same way, with a polite (I hope) “None of your business.” I don’t think there’s any ill will involved in asking the question: journalists simply want to “place” their sources culturally on the hippie-to-jock spectrum. But I want to resist the whole idea that drug policy should be a clash of cultural identities rather than a serious discussion of harms and benefits.



I can’t sleep no more…

Ta-Nehisi Coates reminds us that human error will exist, whatever the drug policy, and uses a recent police killing of an unarmed 18 year old to point out that the stakes are very high when anything is criminalized.

When people talk about ending the War on Drugs, or decriminalizing marijuana, or reining in stop and frisk, they are not simply talking about the right of private citizens to get high, they are talking about the right of private citizens to not be subject to lethal violence at the hands of the state. … For all practical purposes, if an officer, pursuing an arrest, believes you have endangered his life, and can demonstrate that belief, he or she can kill you.

Now, this doesn’t suggest that our choices are criminalize or legalize and it doesn’t suggest that the costs of not enforcing drug laws are acceptably low.

There is no such thing as a problem-free drug policy, the questions we need to answer are:

  • Which problems are we not willing to tolerate?
  • Which problems are we willing to tolerate and how can we minimize them?
I don’t know all the details of this case and these things are usually more complicated than headlines suggest. It sounds like police may have been on edge because of recent shots fired at officers in the area. This interview includes leading questions that advance a narrative of police abuses of a minority community. I have no way of knowing the ways in which this narrative may be true or false, but the parents grief is heartbreaking.

Towards a smarter drugs policy

The new issue of the Lancet focuses on drug policy. One piece offers key points for formulating policy:

  • Drug policy should aim to promote the public good by improving individual and public health, neighbourhood safety, and community and family cohesion, and by reducing crime.
  • The effectiveness of most drug supply control policies is unknown because little assessment has been done, and very little evidence exists for the effectiveness of alternative development programmes in source countries.
  • Supply controls can result in higher drug prices, which can reduce drug initiation and use but these changes can be difficult to maintain.
  • Wide-scale arrests and imprisonments have restricted effectiveness, but drug testing of individuals under criminal justice supervision, accompanied by specific, immediate, and brief sentences (eg, overnight), produce substantial reductions in drug use and offending.
  • Prescription regimens minimise but do not eliminate non-medical use of psychoactive prescription drugs. Prescription monitoring systems can reduce inappropriate prescribing.
  • Screening and brief intervention programmes have, on average, only small effects, but can be widely applied and are probably cost-effective.
  • The collective value of school, family, and community prevention programmes is appraised differently by different stakeholders.
  • The provision of opiate substitution therapy for addicted individuals has strong evidence of effectiveness, although poor quality of provision reduces benefit. Peer-based self-help organisations are strongly championed and widely available, but have been poorly researched until the past two decades.
  • Health and social services for drug users covering a range of treatments, including needle and syringe exchange programmes, improve drug users’ health and benefit the broader community by reducing transmission of and mortality due to infectious disease.

It’s good stuff. I particularly like its willingness to give credit where credit is due. For example, supply control can help but the benefits are often unstable and have a lot of unintended consequences. I also like the affirmation of the diversity of perspectives on the benefits of policies.

Not surprisingly, the only thing that grates me is the pushing of opiate substitution. (They weigh in a little harder in the body of the paper.) I’ve got no objection to saying it should be part of the service menu, but when they argue that it’s got the strongest evidence base, shouldn’t we ask why that is? What drives the research agenda? Who decides what to research? Who decides what outcomes are important? What are their assumptions? What are their values? Who benefits from the research agenda?

I don’t fear substitution being part of the service menu, but I fear it becoming the standard of care. I fear it setting the bar unacceptably low and creating a reflexive loop that reinforces the assumptions of researchers and treatment providers and traps addicts in a state of permanent disability and dependence upon treatment providers who believe they’re incapable of recovery.

Would the researchers and doctors recommend this treatment to a loved one? To a colleague? (Hint, they definitely don’t recommend it to colleagues. And, it’s not too expensive for the rest of us.)