Gun Prohibition Won't Work either

Gun Prohibition Won’t Work Either

Violence in the Mexican drug war is soaring to unprecedented highs. Latest estimates claim that at least half of the guns used in that conflict were purchased in Texas and smuggled into Mexico, which has outlawed personal ownership of firearms. The United States government has announced that it will step up its efforts to interdict those weapons at the border and prevent their movement into Mexico.

However, this gun prohibition will not work. It suffers from the same flaws that prevented prohibitions against alcohol, drugs, gambling, prostitution, or even against counterfeit Gucci bags or pirated movies from working. The harder interdiction is imposed, the higher the price for the contraband soars, and the more ruthless the dealers attracted to the trade become. The result is not suppression of the prohibited trade; it just becomes more expensive, corrupt, and violent.

The only effective means to suppress or moderate a functioning market are those that operate on the demand side of that market. The market for tobacco provides a good example. The number of tobacco users has decreased by about 60 per cent (from over half of the adult population to about twenty per cent) through the use of three techniques: research into the psychology and physiology of tobacco use, education of users and potential users, and limitations on advertising.

While those tools against tobacco use have taken about fifty years to work, in Mexico, the United States has a much stronger tool than any of these to use against the demand for guns. The United States government has total control over the more than $30 Billion that, each year, is spent by American users and fuels the Mexican drug wars. That sum is a conservative estimate of the amount that the U.S. drug laws pump into the Mexican economy annually: an amount that is one of the top four sources of foreign money in the Mexican economy.

This money generated by the American drug laws has two effects on the demand for guns in Mexico. The most important is that control of that money is what the cartels are fighting over and what allows them to fend off the Mexican government. The second is that the money is necessary for the purchase of the guns themselves.

While Mexican society has always had a machismo strain of violence dating back to at least the time of the Spanish conquest, the current cartel wars have multiplied that violence into a different phenomenon. The best comparison, although on a smaller scale, is the way civil unrest exploded in Colombia with the growth of the cocaine market in the 1980s. Mexico’s violence is similar to – but much larger than – the gang violence that erupted in Chicago when millions of illegal alcohol dollars flooded the city. Greedy, ruthless men fought and killed to get their share of the loot. Without the money, violence in Mexico would quickly fade to the much lower historical levels, just as it did in Chicago with the repeal of prohibition.

If large amounts of money were removed from the equation, the demand for guns would decrease for a second reason: guns cost money. And the military-grade arms now in demand cost a lot of money. A single rifle like a Kalashnikov can cost up to a thousand dollars. Machine guns and rocket launchers go for much more. Without the illegal drug money, the cartels would be limited to guns more typical of a street criminal than the Pentagon quality arms they now use.

However, this proposal rests on two other questions: can the United States afford to purge its laws of drug prohibition and how much would those changes affect the Mexican cartels?

The U. S. not only can, but should, change its drug laws from ones based on prohibition to a new approach based on regulating and lowering demand. Almost no one doubts that the current prohibition approach – now ninety-five years old – has been an abject failure. More people are addicted to opiates today than were addicted in 1914; and marijuana, used by fewer than 100,000 people in 1937 when it was outlawed, has been used by over 40% of today’s adults. The latest FBI data shows over 1.6 million drug arrests in 2009, but anyone in America can easily buy any drug in any community in the country. The War on Drugs has cost over $1 trillion, and the only results are increased drug use, the highest imprisonment rate in the world, and high levels of violence and corruption. When one finds himself in the bottom of a deep hole, he should stop digging and look for a way out.

Would changing American drug laws put the Mexican cartels out of business? Replacing prohibition with regulation would hurt the cartels in two ways.

First, illegal drug prices are at least ten times as high as the equivalent legal prices would be. The risk premiums associated with prohibition are the lure that attracts violent gangsters to the business in the first place. Legal heroin was sold for the same price as aspirin. Legal cocaine was cheap enough to be used as an ingredient in Coca-Cola and tooth powder. Marijuana is no harder to grow and process than broccoli. If ninety per cent or more of the money were withheld from the cartels, they would probably get out of the business. But even if they continued as dealers, they could not afford to buy black market military-grade arms.

More important, the very market supporting the cartels would probably disappear. Local American farmers can out produce and undersell Mexican competition. This displacement is already happening in California. Walgreens could buy legal cocaine directly from Colombia, bypassing the Mexican middlemen entirely – or they could grow and process it themselves in Hawai’i. Pharmacists already sell methamphetamine under the trade name Desoxyn. Mexican sources are just not needed.

The way to stop the arms traffic into Mexico is not to erect another form of prohibition scheme guaranteed to fail like all prohibitions must fail. The wise approach, instead, is to replace the current destructive prohibitions that fuel that traffic with a system of demand-oriented regulation controlling the demand side of the market.

A Bottomless Pit of Death

A Bottomless Pit of Death

“Bottomless Pit of Death” headlined a recent Houston Chronicle article about finding many bodies in an abandoned Mexican silver mine”. That headline could serve as a perfect title for the American War on Drugs, or for that matter, any form of prohibition.

The Volstead Act, instituting national alcohol prohibition, went into effect in January, 1920. Less than a week later, unidentified gunmen fired multiple shots at one of the new bootleggers on a crowded street. All of the shots missed him, and luckily missed all of the by-standers as well. Two days later gunmen killed him on another crowded street, and one of the most violent decades in American history began.

Chicago was the Juarez of its day. Mobsters introduced the Thompson submachine gun – a weapon not then used by either the army or the police. Speeding black automobiles with a Tommy chattering from the window as they drove down the street were a weekly occurrence. Bomb blasts and grenades were even more common. Mass killings with six or eight victims were frequent; and many victims were either by-standers or misidentified innocents.

Virtually all of this violence disappeared overnight in 1933 when Prohibition was repealed. Al Capone and Bugs Moran were replaced by Budweiser and Millers beers, and they have not used guns or bombs in any of their marketing disputes in the intervening seventy-five years.

But the street-corner heroin markets of the inner cities showed the same violence on a smaller scale. It returned in a big way with the flood of Colombian cocaine through Miami and later in the crack gangs of the mid-eighties.

What about these markets is so conducive to violence? First, the amounts of money involved are almost beyond imagination. The daily profit from Chicago’s alcohol was probably close to a million dollars a day, not corrected for later inflation. Current estimates have the Mexican drug traffickers grossing over $30 Billion a year.

And a very large part of that money is profit. Heroin, when legal, sold for the same price as aspirin. Now it sells for $100,000 a kilogram on the street. Marijuana is a simple annual herb that should cost no more than parsley or broccoli, yet it sells for more than $200 an ounce. If these drugs were legalized and sold through normal, regulated markets, at least ninety per cent of the traffickers’ money would disappear, and with it would go the reason for the violence and the money to buy the weapons and hire the assassins.

The other problem that illegal traffickers face is that they have no police or courts to protect them. The Chicago bootleggers discovered they did not have to brew their own beer: they could simply hijack the other bootleggers’ trucks, which in turn had to be armed to fight off the hijackers. The seller of a bad batch of hooch or a purchaser who didn’t pay could not be sued, only shot. Marketing wars were not fought with advertising campaigns and discount coupons, but with machine guns and bombs. The same processes are seen in Mexico today.

Illegal, but popular, markets with lots of money lead to crooked cops. One of the latest stories from Juarez is about actual fighting between police units on different sides of the struggle to market drugs. With both sellers and buyers willing participants, traditional police measures are ineffective against black market transactions, and police are led to cooperate with criminals to develop informants and stings. The large amounts of money – and the normally low wages for police – make it a question of whether the police are buying informants or the marketeers are buying protection.

The police also become more violent, substituting direct physical punishment for that which they know the courts will not provide. In one of the most notorious examples, two of the killers in Chicago’s Valentine’s Day Massacre were wearing police uniforms. This crime, in which eight members of the Bugs Moran gang were machine-gunned, was never solved: no killers were identified and no one was ever arrested. Even today when the crime is discussed, experts are divided about whether police were actually among the killers. They all do agree that, in Chicago at that time, a policeman-murderer would not have been unusual. The common saying, with slight, understandable exaggeration, was that Capone had the entire Chicago police force on his payroll.

Conviction of police for crimes of violence have continued non-stop throughout the era of drug prohibition. In 1999, the keynote speaker at the National Association of Police Chiefs said that corruption was the major problem then facing police administration. Convictions in Texas have included police officers caught providing armed escorts to large drug shipments.

Police are also recipients of prohibition violence. In Houston, a major drug transshipment point, a shoot-out involving an undercover operation gone wrong is an almost weekly occurrence. Usually the smugglers are shot, but in a large number of these cases, either the police or bystanders are injured.

One of the major reasons for repealing drug prohibition is to eliminate this resulting violence. Now is the time to replace these modern-day Capones with a pharmaceutical version of Budweiser and Coors. Dispute settlement by gun should be replaced by resolution by the judge’s gavel.

A Bus Named FURTHUR

I sometimes cannot prevent myself from committing poetry.  This time I'm going to inflict it on you:

A Bus Named FURTHUR

In memory of Aldous Huxley, the trailblazer and guide who has led the way, opening the

Doors of Perception for many to take the trip to

Furthur.

1939 International Harvester

1960s sound and film

Day-Glo paints,

Mandalas smeared and loppy.

Destination sign reads “Furthur”.

Are you on the bus –

-- or off the bus?

Neal Cassady’s driving:

Dean Moriarity On The Road again.

Foot down hard, going fast;

Hands in air – he steers by mental force.

Non-stop monolog – Beat rap now decades long enchanting all around but the traffic cop who gets confused and slinks away silently

– not on the bus.



Merry Pranksters careering thru deserts and down to Houston;

Stop at McMurtry’s door:

Larry dazed and enraged

At Blanket Girl naked on his lawn.

You’re either on the bus –

-- or off the bus.

On to Gotham: McMurphy’s on the stage

And foiling Ratched – who missed the bus long ago.



Sometimes a Great Notion: on to Millbrook

And enlightened Guru Tim.

But Tibet chants and Book of Dead are just a killing bore.

Tim’s dropped out --

– and off the bus.



Back on the bus – and furthur west:

The Fillmore waits; Garcia has the band.

Light show flicker/flows and Owsley spikes the brew:

Orange Sunshine for the trip.



If you pass the Acid Test, no need to use the bus.

Your mind’s enough:

The trip is always FURTHUR.

Legalizing Marijuana -- But How?

Legalizing Marijuana – But How?

Many now advocate legalizing marijuana – several surveys indicate that a majority of the population does. The idea is so vaguely worded that it presents two questions: what does legalization mean and how can it be done? The first can be clarified rather easily, but the second presents a tangle of complication.

Those advocating marijuana reform fall into three camps: decriminalization, medical use, and legalization. Decriminalization means removal of criminal penalties from possession for personal use while maintaining criminal laws against growth, distribution and sale. About twelve states have taken this approach (with most retaining small civil fines for possession), as have The Netherlands, Portugal, Germany, Mexico, and Brazil. Other European nations have simply quit enforcing laws against possession. Fourteen states and the District of Columbia allow possession for medical use by those with a doctor’s recommendation, several of these also establishing approved production and distribution systems. The federal government has announced that it will respect these programs. Canada and most of Western Europe also allow medical marijuana. In most respects, recognition of medical use is a form of decriminalization.

The most comprehensive reform being advocated is legalization, or removal of all criminal penalties for growing, processing, distributing, or possession. This would be accompanied by laws regulating places and methods of sale, age of users, and liability rules for misuse or abuse. Taxation would probably follow. Legalization would result in a system much like that used for alcohol today.

Current nation-wide polls show that over sixty per cent, and possibly eighty per cent, of adults favor recognition of medical marijuana, while about forty-five per cent favor legalization. These surveys usually do not distinguish between legalization and decriminalization. Some kind of national reform looks likely, but the methods are problematic.

The major problem comes from the federal structure of the American government. Both the national government and the state governments (all fifty of them!) have independent jurisdictions to make and enforce laws against marijuana. If the federal law is reformed, a person would still be restrained by the law of whichever state she was in; and if a state reformed its law, its residents would still be in jeopardy from federal enforcement. The current efforts of states to allow medical use of marijuana illustrate this problem. Even though today’s national administration has pledged to respect the state laws, the effect of the federal laws on banking, marketing of medicines, education, employment, and other areas of life prevent full implementation of those laws. Federal and state laws must both be changed if reform is to be effective.

Under these circumstances, three approaches are possible. Reform in the states may be pursued first before challenging the federal law; federal law can be confronted first, followed by the states; or the two can be assailed simultaneously.

Groups are currently active on both the state and federal level, but with little coordination between them. The major defect in this approach is that it dilutes resources, scattering people and money among dozens of groups with minimal cooperation between them. The major advantage is that these many groups can create widespread public attention and enthusiasm.

Federal reform could be pursued first, allowing the states to follow at their own rates. This approach was the one followed in the repeal of alcohol prohibition, with some states still retaining prohibitory laws some eighty-five years later. The result is a confusing patchwork of laws across the country, but it does allow localities to control their own destinies.

The third approach is to concentrate on the states first. Pending referenda in California and Washington are examples of this approach. If enough states reform their laws, the federal government will be forced to follow. Federal law, even during alcohol prohibition, was forced to rely on state and local agencies for enforcement. A national police force large enough to enforce drug laws would be prohibitively expensive and most people would refuse to allow that level of federal policing in everyday life.

Even if marijuana were legalized, federal law would need changing to allow medical use. Ending prohibition under the Controlled Substances Act would still have medicinal marketing banned by the Federal Drug Administration. The FDA’s administrative approval for marketing as a drug is practically prohibitive. Normally, approval of a new drug costs several hundred million dollars and takes many years. However, the safety requirements for approval of marijuana can be met from current information, and at least one new study showing the effectiveness of marijuana for pain relief claims to satisfy FDA requirements for a Phase III study (a number of Phase III clinical studies are required for approval), possibly making approval more likely. If marijuana is approved for even one use, the doctrine of off-label prescription means that physicians can prescribe it for any therapeutic purpose and pharmacists may fill those prescriptions.

The question remains about whether to attack DEA scheduling of marijuana as having no medical use, which would allow sales subject to FDA regulation, or to first seek FDA approval, which would force DEA rescheduling. Currently both are being pursued in parallel.

However, a third approach is possible. In the 1990s Congress established a separate method for regulating herbal remedies and dietary supplements. This system allows products to be sold without prior approval but subject to FDA after-market supervision for both safety and misleading claims. Marijuana clearly fits into the definition of many products now subject to that law and is safer than many of them that are also psychoactive like St. John’s Wort and Kava. Congress could easily move marijuana from the CSA to coverage under this system without facing the stigma of legalizing drugs.

Some kind of reform of marijuana laws is probable. However, the route to that reform is more complex than most people assume. More thinking about the best path to reform is necessary.

Screening Children

Screening Children

The American Academy of Pediatricians (AAP) has recommended that doctors screen all of their young patients for alcohol use starting in middle school, the Wausau Daily Herald reported May 15. The AAP Committee on Substance Abuse released a revised policy statement on youth alcohol use on May 1. "A remarkable amount of brain development is still occurring for young people through their 20s," said report lead author Patricia Kokotailo of the University of Wisconsin School of Medicine and Public Health. "This policy statement provides better evidence about how alcohol affects the brains of young people and why it is important to screen children."

Those worried about problems of drug abuse and dependency should approve of this policy. So should those who know that the most effective public health programs focus on prevention and detection, not simply on developing after-the-fact cures.

Alcohol is, without a doubt, the most dangerous drug in society. Long-term alcohol-related diseases cause over 100,000 deaths a year in addition to several thousand acute intoxication deaths, most of these in young people. Over 15,000 die each year in car wrecks involving drivers who have been drinking. Alcohol is the only drug the consumption of which has been causally connected to violent crimes. Domestic violence is the most prominent of these, but homicides and aggravated assaults are also common. Alcohol abuse is also responsible for a significant part of lost productivity (including absenteeism) and workplace injuries.

What should screening accomplish? About two-thirds of the population consumes some alcohol and around ten to fifteen per cent of those develop a dependency on it. Those with alcohol dependencies display most of the abusive behavior, causing the problems described.

Early alcohol use is one of the factors with the highest correlation with later dependencies and abusive behavior. Screening will provide opportunities for intervention and possibly prevent later abuse and dependency. It will also allow long-term longitudinal studies of alcohol use for the first time, creating the data to determine the ways in which alcohol use develops in the individual.

One side effect of this screening may prove almost as worthwhile as the direct benefits. It should also provide a means for studying, predicting, and intervening in the abusive and dependent use of other drugs.

Early use of alcohol has been shown to be antecedent to excessive use of other drugs. Virtually all of those who use other drugs in a destructive fashion first began using alcohol by the age of ten or twelve. Although marijuana is often accused of being a gateway drug – a claim thoroughly rebutted in the 1995 Institute of Medicine report on medical marijuana -- the correlation of early use of alcohol with later abuse of other drugs is much higher than is that of any other activity, significantly higher than that of marijuana use for instance. Identifying, and intervening with, those children using alcohol by their middle-school years should greatly decrease the number of those abusing other drugs as these children mature.

While the number of users of other drugs is miniscule compared to alcohol, it is high enough to raise legitimate social concerns. Excluding tobacco and marijuana, less than ten per cent of the population uses drugs other than alcohol. Of those users, like alcohol users, only around ten per cent develop dependencies or use abusively.

Tobacco use has decreased from a majority of the adult population in the 1950s to around twenty per cent today. However, a much higher percentage – possibly as high as twenty per cent – of the tobacco users become dependent, and diseases causally related to tobacco result in over 400,000 deaths annually.

Many more people use marijuana than use any other illegal drug. Among the young, rates of marijuana use may approach those of tobacco. However, marijuana users develop dependencies at a much lower rate than the rates for other drugs, and those dependencies are much weaker and easily broken. The best estimate is that only about three per cent of marijuana users ever show any signs of dependent or habitual use. Marijuana use has few, if any, health consequences for the user and marijuana has not been shown to have a causal relation to any consequential social harm.

Surprisingly little is known about drug dependency from a medical standpoint. So far debate still rages about whether it is a disease, a disorder, or merely a cluster of symptoms that may evidence other underlying diseases or disorders. Only a few rules of thumb have been agreed on. As already mentioned, early alcohol use is an almost universal precursor. Most of those dependent on drugs, including alcohol, experienced physical or sexual abuse as children. A large majority come from broken or dysfunctional families. Some genetic component or components are probably involved. Attempts at rehabilitation (except in the case of marijuana) are unsuccessful, with the best ones failing at a rate of over eighty percent, a rate that has not changed measurably since first determined among heroin addicts at the Federal Narcotics Farms in the 1930s.

Wide-spread screening of middle school children for alcohol use becomes important for several reasons. It identifies those likely to develop problems with all drugs (including alcohol) before dependencies and patterns of abusive use develop. It provides opportunities to intervene and prevent those dependencies from developing in the first place and to develop effective means for that intervention. But the most important benefit is that it will provide the data from large numbers of longitudinal studies that will eventually provide the scientific and medical knowledge necessary to prevent dependency and abuse problems in the first place.

The Way it Is Sold

The Way it Is Sold

On May 4, Washington, D.C., Assistant Police Chief Peter Newsham was quoted

in the Washington Post as saying, “People don’t feel marijuana is dangerous,

but it is because of the way it is sold.”

A doctor prescribes Desoxyn for a ten-year old patient diagnosed with ADHD. The prescription is filled routinely at a large chain drugstore like Walgreens or CVS at the chain’s standard price of $4.00 for a month’s supply of a generic drug. No one worries about the strength or purity of the drug because it was manufactured and distributed by a factory certified as following Best Manufacturing Processes and inspected by the FDA. Some of the pills will be turned over to the school nurse who will see that the child takes them when scheduled during school hours.

On the same day in the same city, a teenager tried to buy some crystal meth from a street dealer. When a police officer approached, the seller drew a gun and tried to run. The shoot-out ended with both the dealer and his young customer dead. When the police lab analyzed the drugs, they were found to be contaminated with several toxic substances. A search of the dealer’s motel room found a portable meth lab and some of the dangerous substances used in its manufacture.

The first of these stories is the outline of events occurring in the United States each week. The second is a composite of factors common in episodes also occurring daily in this country. The factor they have in common is that they both feature the same drug: methamphetamine.

Methamphetamine was invented almost a century ago, and from about 1940 until the mid 1960s was one of the leading prescription drugs. The amphetamine-like stimulants (amphetamine, methamphetamine, and Ritalin) as a group were the drugs most often prescribed during this period. They are grouped together not only because they are chemically similar, but because users cannot normally tell them apart. Today these drugs are primarily prescribed for attention spectrum disorders, extreme obesity, and some sleep disorders. Some doctors also prescribe them for the off-label use of increased mental functioning, or “brain-boosting”. Professor Rasmussen estimates that, counting these three drugs together and combining legal and illegal users, the percentage of the population using them today is roughly the same as in their heyday of the 1960s.

Meth for illegal use comes from three sources. A large amount, although only a small part of the total, is diverted from legal sources. Some of that comes from pharmacies, either through fake prescriptions or through burglaries. Holders of legitimate prescriptions provide a larger share by giving or selling some of their drugs to friends or through children rifling their families’ medicine cabinets.

By far the largest part of illegal meth is smuggled into the country. Most of that comes from small, unregulated factories in Mexico, but a portion comes from South and Southeast Asia. Mexican meth is a smaller trade than is the marijuana, cocaine, and heroin from that country, but it still contributes to the overheated competition between the drug cartels now causing so much damage in that country.

A very small part of the illegal meth in this country is produced in small “cookers” for local use. Many of these are set up in temporary locations like motel rooms and produce less than a pound of the drug. However, these cause damage greatly disproportionate to the amount of meth they produce. The people operating them are usually untrained in chemistry, trying to follow unreliable recipes they have gotten from the Internet or from other cookers. Their attempts often catch fire or explode, and the dangerous chemicals used and produced are thrown away so that intense local environmental damage results. Cleaning up these small disasters is tedious and expensive and exposes the responders doing the cleaning to great personal danger. If all of these small meth cookers were to disappear, the drug supply would not be appreciably diminished except in a few small isolated localities, but the dangers and harms to the surrounding communities would disappear with them.

Nothing about this portrait of a drug market should surprise anyone. It could also apply in detail to the market for alcohol during Prohibition.

Just as with Desoxyn, a legal market for potable alcohol existed. Doctors (including dentists and veterinarians) could prescribe up to a pint a week, and many drugstores became nothing but outlets for medicinal brand name whiskeys. Walgreens went from 20 stores to 525 during the decade. A family could have up to ten gallons a year of sacramental wines, and priests and rabbis were vested with authority to procure and distribute it. Since no official registry for rabbis existed, Jewish congregations sprang up in surprising neighborhoods with unexpected ethnicities. Farmers (meaning any householder) could “preserve” up to 100 gallons of their fruit crop by fermenting it. The market for grapes exploded, with California vineyards making more money shipping grapes than they had ever made selling wine.

Most of the market for alcohol was met by imports, although the primary source was Europe, not Mexico. While some of this liquor was the reliable brands people had long purchased, most of it was counterfeit: flavored grain alcohol with fake labels pasted on. One German company even marketed Black and White Horse Scotch.

And local cookers poisoned and polluted their neighborhoods as well. The South had a long tradition – dating back to the eighteenth century – of making moonshine. Their bootleggers stepped up production to meet the demand with sub-standard product, burning down the forests for fuel for their stills and dumping their wastes in the streams.

In the cities small distilleries presented the same kinds of problems that meth cookers create in rural areas eighty years later. Bootlegging gangs would pay tenement dwellers to operate small stills in their apartments. The five to fifteen dollars a week those stills brought in was a major incentive to these amateur operators, but these operations caused real problems to the neighbors in these crowded dwellings. The constant odors and heat and the continuing foot traffic were bad enough, but the frequent fires and explosions in the firetrap buildings became a serious public safety concern.

The sad fact is that the same stories can also be found two hundred years earlier when the British Gin Acts of the 1730s tried to impose prohibition on London. Einstein defined insanity as repeating the same experiment but expecting different results. Our current attempts to prohibit sales of drugs can only be seen as insane.

Federalism and Fiscal Policy

Federalism and Fiscal Policy

One objection to modifying state marijuana laws is that the state cannot act contrary to federal law. While that proposition may be correct as a general rule, the principles of federalism, or the allocation of power between the federal government and the states, are more nuanced than that broad statement would indicate. One part of the problem is what effect the enactment of a federal criminal statute has on a state’s ability to legislate on the same subject.

On the most fundamental level, the Supremacy clause of the Constitution requires that when congress enacts a criminal statute, all people in the country must obey it, including state officials and agents. A governor cannot have his own private stash of cocaine and a professor in a state university may not experiment on marijuana without a federal license to do so.

One major consequence of this principle is that state law may not overrule federal law and make it inapplicable within the state. Therefore, a state law legalizing marijuana would not nullify the application of the Federal Controlled Substances Act within the state. A state resident, even if in conformity with a valid state statute could still be convicted in federal court for possession or delivery of marijuana.

State laws may not hamper the execution of any federal project. When I was young, I was amused to find out the truck I drove for the Post Office had no state license plate and I could not be required to have a state driver’s license to operate it. (We were required to obey most local traffic laws because the Post Office ordered us to, but the local police could not give us tickets.) Likewise, local law cannot require federal law enforcement officers to get warrants from state courts before conducting searches or making arrests and the state cannot require federal officers to wear uniforms.

The states ordinarily are not obligated to enforce federal laws. Local police do not pursue counterfeiters nor screen people on the streets for illegal aliens. Likewise, federal officers are not in the business of catching murderers or pursuing speeders.

In some areas, state and federal responsibility may overlap. Robbing a bank is a state crime, and robbing a bank with a federal charter is a federal crime. Kidnapping is local, but if it crosses a state line it becomes a federal crime as well. In these cases, both sets of police agencies are active and usually cooperate with each other.

A major part of this separation of policing is fiscal. If the federal government were able to co-opt local police agencies, then the national government would, in effect, be determining how state and local governments allocate their tax dollars. This control would have the potential to allow the federal government to control all aspects of local government.

(When the federal government does need local assistance, they reverse this equation. It uses federal dollars to make grants to states and cities that fulfill the conditions imposed on those grants. This approach has mandated things like uniform national speed limits and drinking ages.)

While a state may follow the federal government by criminalizing the same conduct, making it a state offense as well as a federal one, the states do not have to do so. The Texas Court of Criminal Appeals once ruled that it was unconstitutional under the state constitution for the legislature to delegate its authority by enacting a statute that would automatically make illegal possession of any drug declared illegal by the federal government. The state was required to exercise its own judgment on the issue.

The most famous example of a state’s refusal to copy the federal law occurred in 1923 when New York rescinded its own alcohol prohibition law and directed its law enforcement personnel not to enforce federal prohibition. The result was widespread drinking and a flourishing entertainment industry in spite of the actions of the federal revenue agents.

Many states are considering a similar action today. They are examining legalization of marijuana under state laws. While this legalization would not nullify federal law, it would remove state law enforcement and courts from acting against marijuana users or suppliers, saving those states very large sums and allowing the closure of some prisons. Those states would only be following the trail blazed by New York over eighty years ago.

If populous states like California, Texas, or New York were to change their laws in this way, national marijuana prohibition would probably end as well. The federal government has never been able to enforce its prohibition laws –alcohol or drugs – but has relied on the states for enforcement efforts. The DEA and FBI together do not have as many officers as some of the large municipal police forces. Any large city processes more criminal cases each year than do the federal courts, and the federal prison system holds fewer inmates than do several of the large states. The federal government would have to increase the size of the Department of Justice to a size comparable to the Department of Defense, and with a similar budget, to maintain the current level of drug law enforcement. A major question would be whether the citizens would accept a federal police force as large as their local police in their cities. That presence would be a revolutionary change in American politics.

If the states want to change their drug laws to be less comprehensive than the federal law, they have the right and ability to do so. The ultimate effect of those changes could be far-reaching and beyond what most of us can predict.

APA: Drug Test Results Often Flawed

This is the first time I have posted an article from somewhere else, but this one is so important that it needs the widest exposure possible (i.e., show it to your school board, your boss, and your congresscritters)

APA: Drug Test Results Often Flawed




By Kristina Fiore, Staff Writer, MedPage Today



Published: May 23, 2010



http://www.medpagetoday.com/MeetingCoverage/APA/20253



Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine,

University of California, San Francisco and Dorothy Caputo, MA, RN, BC-ADM,

CDE, Nurse Planner



NEW ORLEANS -- That poppy seeds can lead to false-positive results on tests

for opioid abuse is not just an urban legend, researchers said here.



Amounts as small as a teaspoon -- at least the amount on a poppy seed bagel

-- can trigger a positive finding, and can last for two to three days after

consumption, according to Dwight Smith, MD, of Boston Medical Center, and

colleagues.



The example is one of many suggesting that drug-abuse tests often give

inaccurate results, according Smith's presentation here at the American

Psychiatric Association's annual meeting.



Another example is that most standard drug tests don't screen for the opioid

drug oxycodone, as well as a handful of other opioids including methadone

and fentanyl, Smith noted. Physicians must specifically order these assays.



"There are gaps in our understanding of the science behind drug tests, and

how that leads to our interpretation of testing results," Smith said. That's

one of the reasons he and colleagues conducted a review of the literature on

drug tests, their scientific background, and potential clinical concerns.



The latter are particularly important because drug screens are so common,

Smith said. Last year, about 150 million drug tests were conducted in the

United States.



"We drug test everyone in the states nowadays -- our students, our

athletes," he said. "It's a condition for employment in many federal and

private agencies."



Still, many physicians may not be aware that ordering a general "drug test"

won't cover all their bases, or that half of patients who are abusing

substances will be missed.



One study in the review found 88% of physicians were unaware of the need to

request the specific oxycodone assay, and half did not know about the

false-positives associated with poppy seeds.



Opioid tests screen for morphine and codeine, which are two of the most

common metabolites of many -- but not all -- opioids. They're not

metabolites of oxycodone, methadone, fentanyl, tramadol (Ultram), and

buprenorphine (Subutex, Suboxone), Smith said.



"You need to order the specific assays in order to accurately interpret

those," he added.



Similarly, only certain metabolites of benzodiazepines are detected on most

assays. That means diazepam, nordiazepam, and oxazepam (Serax) will be

detected, but alprazolam (Xanax), lorazepam (Ativan), and clonazepam

(Klonopin) aren't frequently screened.



Part of the problem is that there are no federal guidelines for minimum

negative threshold levels for a positive test, Smith said. Plus, each

laboratory has its own guidelines and procedures for dealing with test

sensitivity and specificity.



In their review, the researchers found that drug tests generally have a

sensitivity of 90% to 95%, and a specificity of 85% to 90%. These numbers

are a "pretty good basis" for making clinical decisions, Smith said, but

that means "one in 20 [tested patients] are going to have inaccurate

results, and those are more likely to be false positive than false

negative."



By comparison, confirmatory tests such as gas-chromatography

mass-spectrometry have a sensitivity of 99% and a similar specificity, but

they are more expensive.



Physicians "trust in science, and we believe [sensitivity and specificity]

are going to be higher than that when they're not," he said. "We really need

to get tests confirmed."



Many substances aside from poppy seeds cause these false-positives. Cold

medications can give a positive read on amphetamines, as can bupropion

(Wellbutrin) and tricyclic antidepressants.



Sertraline (Zoloft) and oxaprozin (Daypro) can alert physicians to a

benzodiazepine problem when there is none.



The HIV medication efavirenz (Sustiva) can come up as a positive for

marijuana use, and dextromethorphan, rifampin, and quinolones could show as

an opioid problem.



"If a patient does test positive, you need to take a careful medical

history," Smith said.



Smith also did some myth-busting, finding that there's no possibility of a

false positive resulting from passive inhalation of marijuana or cocaine --

unless they are exposed to an excessively concentrated amount of smoke.



"If a patient comes in and blames it on any of these scenarios, you can say,

'Unless you were in the van with Cheech and Chong, that's not what

happened,'" Smith said.



As far as false-negatives go, Smith said physicians should be wary of the

methods for diluting samples used in drug tests -- an issue he calls "the

elephant in the room."



On average, such strategies appear to work 50% of the time. These include

bleaching urine or adding the household cleaner Drano or the eye lubricant

Visine to it.



Others have gone to great lengths to design battery-powered devices that

keep urine warm, and offer a prosthetic device "in three or four skin tones"

for the most cunning of drug test cheaters, Smith said.



A fail-safe would be to screen the urine for its standard specific gravity

of <1.003, or standard creatinine under 20 mg/dL.



Yet no studies have been done to show exactly how prevalent drug test

cheating is, Smith said, adding that the area urgently needs research.



His advice to physicians who want to know the quality and the specifics of

the drug test reports they receive: "Become friends with the toxicologist in

charge of the lab. It's particularly helpful if the results of the test are

unexpected."



The review was based on studies found via a PubMed search between Jan. 1,

1980 and Sept. 1, 2009.



Ronald Bugaoan, MD, medical director of High Point Treatment Center in

Brockton, Mass., who assisted in the study, said urine tests do indeed have

the longest window of detection for most substances.



However, gas-chromatography mass-spectrometry is the "gold standard" for

drug testing, and added that patients enrolled in the Massachusetts health

plan can get tests using it for only $12 apiece.



The researchers reported no conflicts of interest.



--

Primary source: American Psychiatric Association

Source reference:

Smith D, et al "An update on testing for drugs of abuse: Scientific

background and practical clinical concerns" APA 2010; Abstract NR7-05.



http://www.medpagetoday.com/MeetingCoverage/APA/20253

Alcohol and Marijuana

Alcohol and Marijuana

When Prohibitionists argue that we don’t need another legal intoxicant or when legalizers claim that pot is not as bad as alcohol they are both building on the public’s idea that all intoxicants are alike. The fact is that alcohol and marijuana have nothing in common except for their both being used in social situations.

Marijuana is not alcohol. This statement looks obvious, but both sides of the marijuana legalization debate regularly conflate the two. The result is debates that are heated and emotional but that do little to clarify the social issues at stake.

One of the more common arguments advanced by the anti-marijuana advocates is based on the problems with alcohol. They point out deaths among alcohol users – both acute poisoning and long-term illnesses caused by alcohol – and deaths caused by alcohol users in car wrecks and domestic violence. From there, they may go on to workplace problems: absenteeism, decreased productivity, and increased injuries and deaths. They then make the (unwarranted) assertion that marijuana is an intoxicant like alcohol. The next step is to combine the two to support the assertion that legalizing marijuana would create a second legal intoxicant – another alcohol as it were – and greatly increase the incidence of the social evils enumerated.

Both of these arguments share two faults. The most fundamental one is that alcohol and marijuana have almost nothing in common except for their use in social situations. The other is that they prey on the public’s ignorance of any altered conscience than that caused by alcohol.

The second problem is what makes the first one so vicious. Most people today have seen or dealt with someone who has had too much to drink. The local news highlights a drunk driver almost every night. If anyone has not had to deal with an alcoholic in the family, they will probably have coped with one at work. On the other hand, few have had encounters (at least that they knew about) with someone impaired with any other drug. The exception might be those who have experienced a slight high from nitrous oxide (laughing gas) at the dentist’s office or seen someone groggy after a night on sleeping pills. When the majority tries to imagine the effects of any drug used socially, the only experience they can call on is the one that they have derived from drinkers. The result is that when most people hear “legal marijuana” they see hordes of drunken – or at least tipsy – pot-winos staggering around. And this vision points out the major problem with these arguments.

The first difference between them is that alcohol is a deadly poison and marijuana is virtually harmless. Drinking leads to over 100,000 deaths a year from consequences of alcohol-related diseases and several thousand deaths from acute intoxication. Marijuana has never been identified as the cause of a single death resulting from consumption. Long-term studies, some covering over forty years, involving thousands of patients, show no measurable health differences between marijuana users – even heavy daily users – and those who do not consume it.

The second major difference is in their relations to violence. Alcohol-related car wrecks kill over fifteen thousand people a year in the United States. Studies by four national governments, including the National Transportation Safety Board of the U’s., show that drivers who have consumed marijuana are a safe as unimpaired drivers. While marijuana does impair scores on laboratory reaction tests, since it does not impair judgment, drivers are conscious of that impairment and adjust for their slower reactions.

Alcohol is the only drug the consumption of which has been linked to violent crime. While many criminals are high on stimulants when arrested, the drug use itself was not a direct cause of their criminal behavior. Those crimes committed for the purpose of obtaining drugs result from the economics of the drug laws, not from the action of the drugs themselves. Alcohol is a factor in a significant number of domestic violence cases, and entertainment venues serving alcoholic beverages are centers of many assaults, fights, and shootings. Marijuana, if it has any effect at all in these situations, tends to reduce aggression.

Alcohol has marked effects as a cause of workplace injury and decreased productivity from both absences and from lowered efficiency. None of these factors have been associated with marijuana.

Alcohol is also highly addicting. Around ten per cent of all drinkers become addicts, for whom withdrawal can even lead to death. Marijuana is not addictive, although a few users, around three per cent, develop habitual use that may require some slight help in stopping.

All of these differences stem from the differences in the way the two drugs effect the brain.

Alcohol is a sedative that decreases the functioning of all parts of the brain. It first lessens the activities of the pre-frontal and frontal cortexes, which are responsible for judgment and higher mental functions. One consequence is that one who has had a few drinks will think that he is a skilled race driver, not one too impaired to drive. Alcohol then hampers the motor centers of the brain, leading to slurred speech and uncoordinated movement. Ultimately, it will suppress consciousness and even respiration, leading to death.

Marijuana, on the other hand, affects only specialized cannabinoid receptors in the nervous system. This results in its effectiveness in treating pain, spasms, and nausea. Its other major effect is as a mood elevator, making the user more relaxed and more cheerful.

Both those wanting to legalize marijuana and those opposed to the idea can find some data to support their positions. But if they truly want to convince people that they are correct, their arguments should be based on fact and evidence. The most basic fact they must both deal with is that alcohol and marijuana are different and have almost nothing in common.

Medical Marijuana Needs Legal Marijuana

Medical Marijuana Needs Legal Marijuana

Fourteen states have changed their laws to allow residents to use marijuana medically and at least five or six other legislatures are examining the issue. The federal government has announced that it will not enforce the federal drug laws against those acting in compliance with the state statutes.

As these laws have come into effect their shortcomings have been revealed. For medical marijuana users to obtain full relief, total legalization of marijuana, at both state and federal levels, is needed.

Medical marijuana’s shortcomings stem from two sources. First, these laws are structured as exemptions from the criminal law. Second, marijuana remains outside of the normal systems of oversight and regulation.

The laws against marijuana encompass much more than mere possession. Excusing medical users from the criminal sanctions still leaves them subject to many restrictions. Three examples illustrate this issue.

Medical marijuana users are subject to dismissal from jobs even if they do not use it while working or under conditions in which it could affect their job performance. For instance, all employers with federal contracts are required to test their employees for illegal drugs, including marijuana, and either fire those who fail those tests or force them into rehabilitation programs. Likewise, no exceptions are made for probationers or parolees so that testing positive for marijuana, even with a state medical marijuana card, will result in a revocation and a trip to prison.

Most colleges and universities have federal contracts or receive federal grants that require them to remove anyone possessing marijuana from student housing. Inability to live in dormitories places some students using medical marijuana at a disadvantage compared to those who may be using amphetamines for Attention Spectrum disorders or strong opioids for pain. While the student using medical marijuana may be barred, one receiving methadone maintenance for a heroin addiction is allowed in the dorm.

Local governments in California and Colorado have used the general illegality of marijuana as an excuse for using zoning or land use ordinances to deny permits or business licenses to marijuana distributors otherwise in conformity with state law. Local police have also used that excuse to conduct excessive surveillance of dispensaries or for stopping and searching medical users.

* * *

Medical marijuana users’ major problems arise because the plant, as illegal contraband, is excluded from normal oversight and regulation. Marijuana’s illegality shields it from most of the controls that govern the marketing of legal products.

First, those purchasing marijuana must deal with professional criminals somewhere in the distribution chain. The obvious dangers are that dealing with outlaws exposes the customer to violence and to enviromental harms from unregulated production methods. The other problems are less obvious.

Price is probably the greatest problem. Generally, contraband items sell for about one hundred times what the same product would bring legally. Good quality marijuana now sells for around $400 an ounce, while the legal price for it would be a few dollars at most. Even the quasi-legalization of medical marijuana in California has lowered prices by over twenty percent.

The purchaser of contraband never knows what he is buying. Legal consumables like food and medicines are required to have labels listing all of the contents. These goods are also tested to insure that they do not contain contaminants, including pesticides, bacteria, and fungi. While some dispensaries are labeling wares with THC content and varietal names, this practice is not uniform and is not regulated or supervised.

In licit markets consumers rely on brand names as assurance of effectiveness and quality. Manufacturers devote major efforts to building and maintaining brands and trademarks. In illicit markets manufacturers are fly-by-night and consumers have nothing to rely on. Even if they are able to build a trusting relationship with their immediate supplier, neither they nor that supplier can trust the source of his goods. The old maxim of caveat emptor applies with a vengeance, but the buyer has no reliable way to exercise that wariness.

The major defect of an illegal market for medical marijuana is its divorce from science. When the AMA’s representative testified to Congress in opposition to the 1937 Marihuana Tax Act, his major objection was that the law would hamper, if not totally preclude, further medical research on cannabis. The areas he suggested were those in which use of marijuana has become prominent: pain relief, control of spasms, and nausea control.

The seventy years since the passage of that act has been the golden age of pharmacology. The first two modern drugs, sulfas and amphetamines, had just appeared on the market and the first antibiotic was still a few years in the future. Medical drugs for management of psychological disorders were still fifteen years in the future. Several hundred research papers on marijuana have now been published and its basic medical value is no longer in question. One can only wonder what the situation would be if the pharmaceutical companies and medical schools had been able to attack the issue as aggressively as they did other drugs and botanicals in the 1950s.

State medical marijuana programs are a step forward, but they are only partial solutions. Legality at the federal level is the only way in which those relying on marijuana’s benefits can receive the best medical care and be assured that they will be protected in their homes, work, and lives.

Why Drug Testing?

Why Drug Testing?

In large segments of American business one must pass a drug test before being employed and may be subject to random drug testing during the entire term of employment. Hundreds of local school districts require high school students to subject themselves to random drug tests. Thousands are serving multi-year prison sentences only because they flunked one drug test while on probation or parole. The only people exempt from these tests are elected officials, candidates for office, and police. What’s going on here?

Drug testing was instituted under the Reagan administration as part of the enhanced War on Drugs. Just like Nixon, Reagan had trouble being Tough on Crime because most street crimes are the states’ responsibility. Drug-dealing is almost the only common offense toward which the federal government can take action. His political problems were two-fold: first to build public concern about the drug “problem” and second to show the public that he was doing something about it.

Nancy’s “Just say ‘No’” program took care of the first part, especially with its stress on drug use by children. The army had found an answer to the second one.

In the early 1970s the army was shocked to find that many (some sources say as many as 25 per cent) of the troops in Viet Nam were using marijuana or heroin. The Defense Department instituted drug testing and required a clean test before anyone would be allowed to return to the States. To the surprise of almost everyone, virtually all of the personnel returning to America remained heroin free. The military then began requiring routine testing for all personnel.

Reagan used this model as a way to publically demonstrate his desire to eliminate drugs. He required testing on all employees in safety-related positions over which he had authority, both federal employees like air-traffic controllers and postal truck drivers and those in private industry over whom the government had regulatory authority. This group included airline pilots, railroad engineers, and interstate truckers and bus drivers.

However, the federal jurisdiction did not extend to most employees in the country, who were outside the reach of the interstate commerce powers. Congress stepped in and required insurance companies, which were subject to their regulation, to give discounts on workers’ compensation premiums to employers who tested their job applicants and employees. These discounts were substantial enough for employers to save money by testing.

The Department of Education got into the act by making grants to local school districts to pay for student drug testing. The Supreme Court held that this testing was constitutional if the school board found an existing significant problem of drug abuse and the testing was limited to students voluntarily participating in extracurricular activities like sports teams.

Further expansion of drug testing ran into legal problems. Most cities were precluded from testing members of police forces and fire departments by collective bargaining agreements. Public service unions have refused to renegotiate those provisions.

Louisiana tried to impose drug testing on candidates for public office. When one candidate challenged that law, the Supreme Court held that no relationship existed between the testing and qualification for office and held those tests to be an unconstitutional invasion of privacy.

Except for politicians, police officers, and firefighters, drug tests have become almost universal. What good have they done?

The answer is somewhere between minimal and none.

School drug testing has been examined thoroughly. Across the nation only about 1% of the tests are positive for drugs. Proponents argue that the low rate of positive results shows that the tests are convincing (or frightening) students not to do drugs. However, repeated surveys comparing testing school with non-testing schools show no measurable difference in drug use.

Employment testing is even more marginal. Only about 0.5% are positive. No adequate studies show the extent, if any, to which drug users are deterred from applying for jobs. The problem is that failing a drug test for anything other than marijuana is easy to avoid. Twenty-four hour abstinence before the test is usually sufficient. Opioids and stimulants (cocaine, amphetamines, Ritalin, etc.) are purged from the body in less than 48 hours, and alcohol is cleared in even less time. A Saturday night binge will be undetected by a Monday morning test.

No studies have been publicized showing that employers that test have safer work places than those that do not. On the other hand, early studies showed that productivity was lower in companies that tested than in comparable companies in the same industry that did not.

A major problem is that drug testing is not comprehensive. Alcohol is the only drug that has clearly been shown to adversely affect work place safety, but drug tests do not test for alcohol. Even airline pilots, who are barred by regulation from drinking for twelve hours before flying, are not tested for alcohol. Many people take legal drugs that are required to carry warning labels against driving or operating heavy equipment. These range from over-the-counter preparations like Benadryl to strong opiates like OxyCotin. Many of these drugs are not tested for. For others, including opioids and amphetamines, prescription users are exempt from testing.

Many of the strongest degraders of work place safety and efficiency are non-pharmaceutical. Talking on a cell phone while driving has been shown to have the same effect on driving ability as drinking four beers, and texting while driving is the equivalent of being legally drunk. Insomnia, strained domestic relations, financial worries, and other similar personal problems also measurably degrade performance.

An employer interested in improving work place safety or productivity would not use drug testing. Performance degradation tests, easily administrable in less than a minute at the beginning of a shift, would show actual decreases in ability and would cost much less to use. Some of these are descendents of the old pursuit-rotor tests and may be administered with a small computer or keypad. Of course, this solution presents the problem of what a bus company would do if a substantial percentage of its drivers were incapacitated because of fights with their spouses or aching teeth.

In short, employment and school drug testing is an expensive feel-good propaganda effort with no beneficial effects. They should be stopped and replaced by ability testing in those positions in which safe performance is critical.

Notes from The Broccoli File

Notes from the Broccoli File

I have been interested in the question of what legal drugs should cost for a long time (see “Legalizing Marijuana II: The price of Drugs”, Aug. 11, 2009). The question is hard because no legal market has existed during the lifetime of any living person.

My starting point was to compare marijuana to other, legal plant-derived psychoactive compounds: coffee, tea, and tobacco. My conclusion was that $1.00 an ounce would be a reasonable price for legal marijuana. A recent PBS cooking show highlighted broccoli hand-grown on small organic plots for specialty restaurants in San Francisco. That broccoli sold for $3.50 a pound (about $0.20 an ounce).

Since then my motto has been: “Marijuana is Broccoli” and I call my collection of drug price information the “Broccoli File”. Here is a sample of Broccoli file entries, both current and historical. These are just raw data: I have attempted no analysis. I hope someone among the readers with more skills in economics and historical economics than I have (a frighteningly low level to meet) will attempt to give some meaning to them. The usual method for comparing historical prices is to use a ratio based on the daily or yearly earnings of an average worker, but that method is tricky when comparing the two ends of the twentieth century. The changes in productivity caused by advances in technology and automation have dramatically changed the structure of the work force, and those same technological changes have caused greatly different comparative changes in the cost of producing goods based upon the technologies used.

First are some gleanings from recent news stories:

-- Street prices for marijuana in Los Angeles dropped over 20% when the medical marijuana dispensaries opened and some dealers started offering home delivery.

-- Public meetings in Humboldt County, California (heart of the “Green Zone”) express concerns that state legalization will lower marijuana prices at least 50%.

-- Street quality dried and trimmed marijuana may be purchased in one-pound, plastic-sealed packages for $25 at the farms in the Mexican interior.

-- A story about the war in Afghanistan mentioned in passing that American troops in that country were buying hashish for $1.50 an ounce.

I have also gone back and mined some of the standard histories (primarily Musto, “The American Disease” (Expanded edition), Acker, “Creating the American Junkie”, and Tracy and Acker (eds.), “Altering American Consciousness”) for information about drug prices, both legal and illegal, in the 1900 – 1940 period:

--When the import of smoking opium became illegal with the Opium Exclusion Act of 1909, the price of a can of opium jumped from $4.50 to over $9.00. Two factors probably prevented from price from increasing more. First, smoking opium is very dilute, being only 5 -8% morphine while normal opium latex is about 10%, and second, opium, morphine, and heroin were all still available for open purchase. Heroin sniffing became much more popular after smoking opium was banned.

-- Bayer introduced heroin in 1898 and sold both heroin and aspirin at the same price during the period when heroin could be sold legally.

--An addict in 1919, when enforcement of the Harrison Act became rigorous, complained that a dose of 5 gr. of morphine that he used to buy from the drug store for 25¢ now cost $5 from the dealer. (For those as illiterate as I was in apothecary weights, 1 grain = 60 mg.)

--By 1921, when alcohol prohibition had been in effect for a year, a shot of whiskey that had cost 25¢ or 50¢ in a legal saloon had been replaced by a cocktail selling for $3.50 – 5.00 in a speakeasy.

--Dr. Charles Terry, director of the Jacksonville, Florida municipal narcotics clinic, mentions giving prescription for a “dose” of cocaine (probably an ounce) that could be filled for 50¢.

--The New Haven, Connecticut, clinic between 1919 and 1921, was showing a substantial profit dispensing heroin at 4¢ a grain.

-- Pennsylvania still had over 17,000 opiate addicts being maintained on compassionate exemptions to the Harrison Act in 1930. They received about 10 grains a day at a cost of under $4.

Let me end with one last modern case. I recently filled a prescription for a generic equivalent of Vicodin (hydrocodone with acetaminophen). I received twenty 5 mg. tablets for the chain pharmacy’s standard price of $4 for a generic prescription. Therefore, I received 100 mg. of hydrocodone – or 1 tenth of a gram – for $4. This amount is the equivalent of about 1.7 grains for comparison to the earlier prices.

A lot more examples of prices from this crucial 1900 – 1930 period are available for someone willing to do the digging. I hope someone will follow up on these clues and tell us more about the effects of the Harrison Act and the Volstead Act on prohibited substances.

Ain't No Such Thing as Dangerous drugs

Ain’t No Such Things as Dangerous Drugs

For almost a century Americans have been warned against “dangerous drugs”. In this context, the term is usually synonymous with “illegal drugs”. However, this term as used is totally without meaning. It is strictly a propaganda tool. Even worse, this misleading concept has led to counterproductive, expensive, and dangerous public policies.

The problem with the misidentification of illegal drugs with dangerous drugs is that it leads to misconceptions in the formation of policy. These misconceptions arise mainly in three areas: that illegal drugs are a separate category, medically distinguishable from legal ones; that illegal drugs are a distinct category, related to each other physically and biologically; and that the dangerousness of drugs can be measured on some kind of absolute scale.

However, the only distinction between legal and “dangerous” drugs is the arbitrary delimitation drawn by Congress in a rather zigzag fashion. Two of the scariest dangerous drugs are cocaine and methamphetamine, but each of these is also a legal drug that can be prescribed by a doctor. Cocaine is used by doctors as a local anesthetic in some nose and throat procedures for which the synthetics are not as effective. Methamphetamine, under the trade name Desoxyn, is prescribed for children with affective spectrum disorders and as a diet pill for some cases of extreme obesity. For most people methamphetamine and amphetamine, also used for ADHD either directly or in a time-release form as Adderal, can be used interchangeably.

Heroin is the classic dangerous drug. Chemically, it is diacetylmorphine, and it is converted to morphine in the body. Experienced addicts cannot tell whether an injection they receive is heroin or morphine; the two drugs are indistinguishable to the user. The other opioids all have the same effects on the body although they may differ in strength, speed of onset, and duration of effect. These include the synthetics like methadone and fentanyl as well as the opiates derived from opium like OxyCotin, Percoset, and Vicodin. Surveys indicate that today the majority of new heroin users developed dependencies on prescription opiates and turned to heroin because it was cheaper and more readily available than the OxyCotin or Vicodin they had been using.

OxyCotin is a time-release formulation of oxycodone, one of the two active ingredients of Vicodin. Ironically, the other ingredient of Vicodin is acetaminophen, a “safe” drug available over the counter under trade names like Tylenol. Acetaminophen is actually the more dangerous of the two drugs, causing severe liver damage and resulting in more deaths each year than all of the opioids combined.

One surprising development of the past decade or so has been that many problems of dependencies and fatalities have involved legal prescription drugs like Valium, Xanax, and Paxil. Many seem confused by the idea that these “safe” legal drugs can cause such problems.

If the line separating legal drugs from illegal ones fades to invisibility when examined, the fence gathering the illegal drugs into one “dangerous” category never existed. When the Harrison Narcotics Tax Act was passed in 1914, it classified both opiates and cocaine as narcotics, and the confusion has worsened ever since. If heroin, cocaine, LSD, and marijuana, are taken as representative of the four major classes of illegal drugs – opioids, stimulants, psychedelics, and euphorants – one would be hard pressed to find any similarity other than legal status among them.

The opioids – along with legal drugs like alcohol, Xanax, and Valium – lead to classical addictions, with reward, tolerance, craving, and withdrawal. They can cause death by overdose, but have no other significant medical or behavioral consequences.

The stimulants, which include cocaine, the amphetamines, Ritalin, and caffeine, can lead to habitual dependency in heavy, frequent users, although this is not a classical addiction. They are frequently involved in binge usage, with paranoid behavior accompanying the binges. Death can result in users with pre-existing heart conditions. Long-term heavy use can result in psychotic episodes.

The psychedelics – which include LSD, psilocybin, and mescaline – are non-addictive and have little or no risk of overdose deaths. They induce visual hallucinations and some time distortions in users but do not interfere with normal intellectual functioning. Many of them have significant evidence of medical effectiveness.

The euphorants are marijuana and MDMA. They are non-addictive, although a small number of marijuana users develop weak habitual cravings. They are non-lethal, although in the early days of MDMA, a few users died of associated heat exhaustion. They elevate the user’s mood and may temporarily decrease muscular coordination and reaction.

The last irony is that no relationship exists between dangerousness and illegality. Danger in this sense includes both short- and long-term risks to the user’s health and risks imposed on surrounding non-users. Dangerousness is not an absolute measure, but is relative to the intended use. After all, a few dozen people die each year from water overdose, and over-the-counter pain relievers kill more each year than all of the illegal drugs combined. Many of the Drugs for cancer chemotherapy are deadly poisons that are used only in carefully controlled hospital settings, but as alternatives to certain impending death, most assume them to be reasonable risks.

By any measure, the most dangerous drugs are alcohol and tobacco. They cause deaths and injuries in numbers many times greater than any other drugs.

Over 400,000 people die each year from deaths medically related to tobacco consumption. Although tobacco is used primarily as a delivery mechanism for nicotine, tobacco is the main problem since most of the diseases come from ingestion of the smoke from burning tobacco, not from the nicotine. Acute overdoses from nicotine are rare. Most direct injuries are caused by fires started by negligent smokers.

Alcohol probably wins the title of most dangerous drug. Although the 150,000 or so deaths from alcohol-related illness are not nearly as many as those caused by tobacco, it presents two other risks. First, overdose deaths from binge drinking are significant. Second, alcohol use imposes severe social costs. Alcohol-related traffic deaths are around 16,000 a year – more than the total deaths from all illegal drugs. Alcohol is the only drug the use of which has been causally related to violent behavior, domestic violence being the prime example.

On the other hand, the risks associated with the illegal drugs are primarily the costs of their illegality. Almost all crime associated with drugs are crimes arising from the black markets in which they are bought and sold. Even the illnesses associated with illegal drugs are actually the illnesses of poverty brought on by the exclusion of users from normal economic activities.

Even the drug risks themselves are law-related. Opioid addicts in legal regimes, like heroin users in Switzerland or the Netherlands or methadone users in the U. S., practically never die of overdose and function normally in work and family.

These three misconceptions have led the country into a failed, expensive, and harmful set of drug laws. The time has come to recognize the failures of these policies and look for a new reality-based approach.

Source Suppression: Part II

Source Suppression: Part II

Opium’s universality makes it hard to suppress. Attempts to limit the sources of other drugs add additional problems to that approach. Cocaine, marijuana, and amphetamines provide examples of these complexities.

***

Coca leaves have been used as a stimulant and appetite suppressant by the inhabitants of the Andes for hundreds of years, but cocaine was not separated from those leaves until about one hundred fifty years ago. Cocaine hit the world as a miracle drug in the 1880s. Doctors quickly became disenchanted with it, and it was displaced by safer synthetics like Procaine and Novocain for most – but not all – medical uses by 1900. The social world continued to be smitten by it until the 1920s when it faded from the scene. When cocaine resurfaced as a recreational drug in the 1970s, the American government was taken by surprise.

The government’s primary reaction was to try to eradicate the Andean coca bushes. Hundreds of millions were spent in the effort. The result? According to both the United Nations’ studies and satellite images, the acreage planted in coca remains about the same; and the growers have improved their plants and methods so that yield per plant is up over ten per cent.

By 2000, cocaine prices in the U. S. had fallen sharply and purity was much higher than it had been. Colombian cocainieros were diverting much larger shares of their product to Europe, where prices were still high and demand growing. These trends are evidence that the American market was saturated, not that the supply had been curtailed in any way.

The irony of the failed attempt to suppress coca is that, contrary to popular belief, the plant is not limited to the Andes. Shortly after 1900, the Dutch established coca plantations in the Netherlands East Indies (now Indonesia). From 1910 until the outbreak of World War II all of the world’s cocaine was manufactured by labs in the Netherlands, Germany, and Japan using East Indies coca leaves. The British also established successful coca plantings in the imperial territories in India and Ceylon (now Sri Lanka). But the Empire was having political problems shutting down Indian opium plantations as it voluntarily withdrew from the Chinese opium trade, and the Raj decided against commercial coca growing. Coca-Cola experimented with coca growing in Hawaii as well. The plants flourished, but governmental security requirements were so onerous that Coke abandoned its efforts and continued to rely on leaves imported from South America. Cocaine may not be as ubiquitous as the opium poppy, but if it were banished from the Andes, it could find a home in many other places.

***

Marijuana came to the U. S. with Mexican nationals fleeing the revolution of 1910. Until marijuana use ballooned in the 1960s, most of it still came from Mexico. After the failure of Nixon’s Operation Intercept, mentioned in the first part of this article, Gerald Ford convinced the Mexican government to cooperate with a program using U. S. planes and chemicals to spray large parts of the growing Mexican marijuana with herbicide. However, the growers merely speeded up their harvest and flooded the American market with paraquat-soaked weed. When the news leaked out, the Ford administration was accused of trying to poison American teenagers, and the program was cancelled.

But by the 1970s, American troops were returning from Viet Nam with samples of high quality marijuana from Thailand and Burma, and Colombian growers began exporting their cannabis to the north. In fact, most of the later cocaine smuggling routes were first pioneered by the marijuana traffickers.

U. S. efforts were primarily directed at tightening the southern borders, but Californians discovered that they could grow much better marijuana than they were getting from Mexico. Marijuana growing became a major industry in the rural areas of Northern California.

The DEA countered by staging major raids to uproot the crop just before harvesting season. These have become an annual ritual. Each fall the police confiscate hundreds of thousands of plants, generating headlines, but the majority of the crop continues to satisfy the market.

This Darwinian competition between Narc and grower had two other results. The competing growers developed cross strains that were more powerful and tasty and that grew into smaller plants. They also moved to indoor cultivation, pushing horticultural technologies to new highs.

Today marijuana cultivation is widespread across the United States. In some Californian communities, it has become the economic mainstay of entire towns. Jon Gettman’s studies claim that marijuana is one of the top four cash crops in the U. S., and is the leading crop in California and Kentucky. High technology indoor growing operations appear in every section of the country.

The growing demand has even increased international trafficking. British Columbia, Canada, now exports over $5 billion of high quality marijuana to the U. S. each year. While Mexico is no longer the most important source of American pot, about half of Mexico’s $30 billion in drug sales still consists of marijuana.

The cannabis plant is as universal as the opium poppy and easier to grow and harvest. But while attempts to eradicate the poppy encouraged growth around the world, attempts to suppress marijuana have created a major domestic industry. The U. S. had fewer than 100,000 total users according to government estimates when marijuana was first banned in 1937. Today government estimates show over 100 million adults who have used it at least once and over 15 million who currently use it more than once a month.

The government has also tried to suppress the supply of stimulants, especially methamphetamines. While the legal prescription supply of these drugs is somewhat limited, the sources for the street markets still exist. Most of the illegal methamphetamine now comes from factories in Mexico. A small, but significant, amount comes from small individual “cookers” in the U. S., whose careless methods present dangers of fire, explosion, and toxic chemicals in residential neighborhoods across the country.

Source suppression for drugs has never worked. Even the British Gin Acts of the 1730s were dismal failures. Parallels to all of the events described here were part of the attempts to prohibit alcohol in the 1920s. Drug control policy directed at suppressing the source will always fail.

Source Suppression

Source Suppression

When Nixon began his War on Drugs in 1971, he based it on three legs: treatment and rehabilitation for users, increased domestic law enforcement, and suppression of illegal drugs at their source. Of these, source suppression was the least effective, most pernicious, and the most strongly supported even today.

Five drugs were of major concern at that time. Of those five, three – marijuana, heroin, and cocaine – were imported; and each of them seemed to come from a single geographical source. Heroin came from Turkey, cocaine from Colombia, and marijuana from Mexico. Each of these drugs was produced from a plant growing in that area. The idea was that if the plants could be destroyed or greatly reduced in number, then the related drug would either be removed from the American markets or become so scarce with a price so high that buyers would be unable to purchase it.

Amphetamines and barbiturates were treated differently. These were synthetic drugs, manufactured by highly regulated American pharmaceutical companies and distributed by prescription. The government did not consider foreign sources to be a problem with these drugs.

Nixon’s first move predated his War on Drugs. In 1969 he instituted Operation Intercept, stopping and searching each person and vehicle entering the U.S. from Mexico. Delays immediately arose, with even the simplest border crossing taking over 24 hours. Complaints led to cancellation of the program after only two weeks. During that time, not a single shipment of marijuana was detected, but the supply on American streets continued to grow. The smugglers merely moved a few miles away from the entry points and crossed the largely unpatrolled border.

The first application of the War on Drugs was more successful. Turkey, except for a brief period during WWII, had always been the major source of opium and opiates in America. Nixon reached an agreement with the Turkish government so that Turkish farmers were paid a bonus to destroy their opium and were given seeds, equipment, and training to grow different crops. The government arranged to transport these to market; and the farmers were paid a supplement to make up for the lower prices of their new crops. Turkish opium disappeared for all practical purposes.

But the American heroin market never lost a sale. The tribes in the Golden Triangle of Southeast Asia immediately stepped in. They not only supplied the heroin labs in France that had traditionally converted Turkish opium into heroin smuggled through America’s east coast, they also set up their own, new routes across the Pacific Ocean into California and through Mexico. Mexican farmers, whom the American government set up in opium growing when the U. S. lost access to Turkey for medical opium during WWII, continued producing heroin for Americans as well.

The attempt to excise the cancer of Turkish opium had only caused it to metastasize. In the 1980s, the Afghan tribesmen financed their resistance to the Russian invasion by growing opium. When the Soviet Union withdrew and American aid to these nationalist fighters stopped, they became aligned with the Islamic fundamentalists and rapidly increased their opium production. By 2000, Afghanistan was producing over 90% of the world’s illegal opium.

Additionally, the Andean cocaine traffickers decided to diversify their business in the late 1980s. They started growing opium poppies along with the coca bushes and requiring their cocaine purchasers to become heroin distributors as well. Anyone wanting to buy 10 kilos of cocaine was forced to buy one kilo of heroin as part of the deal. This kind of tying arrangement appears in any unregulated monopoly market. For the first time, American heroin distributors had a choice of suppliers. They could get Afghani heroin shipped through Central Asia, Golden Triangle product coming in through the West Coast, black tar heroin grown and processed in Mexico, or the new Andean dope as well. The market was becoming competitive, and as the twenty-first century opened, prices fell and purity increased.

The prospect of suppressing opium is even more futile than this brief sketch has suggested. Poppies will grow in almost any arable land outside the polar regions. Legal poppies for medicinal opium are now grown in Australia, India, Turkey, France, Spain, and at least two of the eastern European republics. Canada is about to begin legal culture of a high theobaine, low morphine poppy for medicinal use.

In prehistoric eras, opium was found in China, the Indian sub-continent, Greece, and central Europe. People in the Fens district of England grew poppies in kitchen gardens for use in a steeped tonic.

The United States has its own history as a source of opium. Thomas Jefferson grew poppies as part of his diversified farming operation. During the Civil War, the Union blockade cut the Confederate States off from their usual sources of opium. They met their army’s demands for medical opiates by growing their own.

In 1872, the Massachusetts State Board of Health complained that opium growers in Vermont and New Hampshire were flooding Boston with several hundred pounds of their surplus product. They also noted some opium from commercial growers in Florida and Louisiana coming into the state, while the center of the opium industry was in California and Arizona. An Arizona farmer, they said, could produce 1200 pounds of opium a year from only ten acres. The opium poppy became the state flower of California.

The poppy seems to be a plant that can grow anywhere in the world, and hopes of suppressing it are futile.

In the next installment, we will examine attempts to suppress coca and marijuana and take a look at suppression of the synthetics, amphetamines and MDMA. We will also draw some conclusions about the idea of source suppression itself.

William Stewart Halsted, M.D.

William Stewart Halsted, M. D.

Imber, Gerald, M. D., Genius on the Edge: The Bizarre

Double Life of Dr. William Stewart Halsted,

Kaplan Publishing, 2010 (355 pp. and end materials)

Dr. William Halsted is known as the “Father of Modern Surgery”. Many of the techniques and devices he invented are still in use. He was one of the founders of Johns Hopkins Hospital and Medical School, where he was chief of Surgery for some thirty years.

And he was also addicted to morphine and cocaine during the whole period. He continued to use those drugs until his death at the age of seventy in 1922.

A new biography by Gerald Imber, M. D., thoroughly discusses the interplay between his genius and dedication to scientific medicine with his dependence on these drugs. It places both within the context of his times. In addition to being a biography of Halsted’s professional life, it is also a good introduction to the birth of modern surgery and medical education and tells the story of the world’s introduction to cocaine.

Halsted was a fresh rising star on the New York medical scene when cocaine appeared as a new miracle drug. He began experimenting with it and developed the technique of local anesthesia, including the concept of nerve blocking. His oral injection sites are still used by dentists today.

As was usual at that time, he experimented on himself and his students. Unfortunately, his experiments were so enthusiastic that he – and several of his students as well – became addicted. Halsted’s cocaine use became so excessive that his work deteriorated to an embarrassing level.

His mentor, William H. Welch, intervened to save his protégé. He took Halstead on a sea voyage to withdraw him, but that trip ended in scandal when Halstead broke into the ship’s medical locker. The next step was to admit Halsted to Bishop’s Hospital, an institution specializing in cure of addictions.

Bishop’s used the best and most medically accepted medical cure of that time for cocaine addiction. They treated Halsted with large, regular doses of morphine. The result was that Halsted, while not totally able to abstain from cocaine, was able to limit his use to binges during vacation times for the rest of his life. However, he also developed an addiction to morphine, injecting himself two or three times daily (totaling about 130 mg. per day).

Welch had become head of the new Johns Hopkins hospital and would soon organize the Johns Hopkins medical school. At that hospital he brought together the four men who would create modern scientific medicine and medical education: Welch, Osler, Halsted, and Kelly.

He knew about Halsted’s morphine addiction (it is unclear whether he knew about the continuing cocaine use), but hired him as chief of surgery anyway. After all, about ten per cent of the medical profession at that time regularly used morphine or opium.

“Osler’s concern at that time was Halsted’s dose management, and not his ability to function. In that regard, morphine was significantly less destructive than alcohol. Halsted’s condition, and his struggle to contain it, were seen as both tragic and heroic, but not incongruent with a productive life. To Osler and Welch, Halsted was a professional equal with a chronic, but not debilitating, disease. Halsted announced his shame by working to hide all evidence of his problem.” (page 181)

Halsted arranged his life so that his drug dependency did not interfere with his professional activities. He scheduled surgery, clinical rounds, and writing during the times he was most alert and lived privately the rest of the time. During the academic year, he refrained from cocaine, but from May through September, he left the hospital. He would spend several weeks at his wife’s family farm in North Carolina, growing prize dahlias, riding horses, and serving as veterinarian to the neighbors’ animals. He would then travel to the surgical centers of Europe. During these travels he would disappear for extended periods. These times are probably when he indulged in cocaine binges, but no direct evidence has surfaced.

This discipline enabled Halsted to stay at the pinnacle of his profession for over thirty years. He was still chief of surgery at Hopkins at his death in 1922. By any measure his career was outstanding.

And what a career it was. Halsted developed the doctrine of aseptic surgery, making possible invasion of the body cavity in that age before antibiotics. Every doctor or nurse who has donned scrubs or worn rubber gloves is following the rules first laid down by Halsted. He then devised radical mastectomy for breast cancer and the repair for inguinal hernia that was used until the invention of the laparoscope. His non-crushing clamps for blood vessels still fill the instrument trays in every operating room. He painstakingly developed the anatomy and physiology of the aorta through years of research, and while the supporting technology did not allow him to repair aortal aneurisms, his work was the basis of Dr. DeBakey’s success in the 1950s. His residents became surgical professors and chiefs of service at the schools in the forefront of modern medical education. “Father of Modern Surgery” is a reputation Halsted clearly earned.

However, he was fortunate to live when he did. Although the Harrison Narcotics Tax Act of 1914 allowed people to possess opiates and doctors to prescribe them, only in 1919 did the Treasury officials adopt the thinking of the alcohol prohibitionists and begin trying to prevent personal use or possession of opiates. In 1925, three years after Halstead’s death, they forced the closure of the last opiate maintenance clinic in the U. S., and then made the status of being an addict a crime (a statute held unconstitutional in 1962). Had Halstead lived two decades later, he would have likely ended up in prison or on the streets.

Imber’s book is a fascinating and informative look at an unusual man and a critical period in the history of medicine and drug policy. And for today, it makes us take a hard, critical look at the current attempts to regulate drug use. I recommend it for everyone.