Praising Marijuana Prohibition

The view from the White House.

As regular readers of Addiction Inbox will know, I am on record as favoring some form of decriminalization for marijuana. But I also write regularly about the difficulties of marijuana addiction and withdrawal. And I have been critical of the operational strategies employed by the medical marijuana movement in the several states in which it now operates. What I have not done, to date, is offer up the official view of a drug policy analyst from the Obama administration who straightforwardly favors a continuation of the legal prohibition against marijuana. 

One of the architects of the current federal resistance to marijuana legalization is Kevin Sabet, an assistant professor and the director of the Drug Policy Institute at the University of Florida College of Medicine. Sabet served from 2009 to 2011 in the Obama Administration as Senior Advisor for the White House Office of National Drug Control Policy (ONDCP) under Drug Czar Gil Kerlikowske, and was influential in shaping federal marijuana policy. Sabet consults with governments and NGOs on a wide range of drug policy prevention issues, and recently debated legalization advocate Ethan Nadelmann on CNN. He is also a regular columnist for thefix.com  and Huffington Post. He agreed to participate in a frank and lengthy 5-question interview with Addiction Inbox. (Be sure to check out the comments below).

1. In his new book, Too High to Fail, journalist Doug Fine argues that "the Drug War is as unconscionably wrong for America as segregation or DDT." Would you comment on this sweeping condemnation?

First, I think it is interesting to note that only people who want to condemn all of our current drug policies use the term "drug war." No one in serious policy circles uses that term anymore, and that is because it is woefully inadequate and vague as a way to describe a whole slew of policies designed to both reduce drug prevalence and drug consequences. I think his comparison is clumsy and unfair. Do some drug policies hurt disadvantaged groups? Of course they do. Is it a moral imperative to fix those policies, learn from our past mistakes and make our policies better? Of course it is. There's no reason to think that those policies can't be changed—in the White House in 2009, for example, we drastically reduced the penalty for crack cocaine. But what makes Mr. Fine's comparison even more wrong-headed and backwards is that we know that if we scale-up—not eliminate, as he would—the policies we know do work in reducing drug use and its consequences, all communities in America would benefit. A handful include:

(a) community-based prevention that not only focuses on stopping drug use among school kids, but in changing bad local laws and ordinances that promote underage drinking, smoking, and marijuana use (so-called "environmental policies");

(b) early intervention and detection of drug use in health settings;

(c) evidence-based treatment, including methadone and buprenorphine, as well as 12-step programs;

(d) recovery-based policies that don't penalize people for past drug use and instead facilitate recovery;

(e) law enforcement based on credible threats and modest sanctions.

2. The Drug War is an industry—the DEA alone has a budget of 2 1/2 billion and employs almost 10,000 people. If we add in profits from the private prison industry, and the money-laundering banks, the money is staggering. Wouldn't it make sense to recoup those historical costs by legalizing and taxing marijuana?

That phrase assumes two things: (a) criminal justice and regulation costs would be drastically reduced, or eliminated, with marijuana legalization; and (b) the underground market would be eliminated with marijuana legalization. Both of those assumptions are huge leaps that don't stand up to our experience with our already two legal drugs—alcohol and tobacco.

First, we know that legalization means more consumption. More consumption means more regulation. Today we have liquor laws, laws against drinking and driving, laws against public drunkenness, etc. With regards to legal alcohol, we make 2.6 million arrests every year for the violation of those laws. Meanwhile, we arrest a million fewer times for illegal drugs (1.6 million/year). Legal alcohol costs us money with regards to crime and regulation. I think that is a big consideration in this whole debate that we rarely hear about. So that means we'd have to have more prisons, more police, and more regulation costs under legalization—especially since few people are in prison or jail solely for marijuana use.

And I'm not so sure the underground market would be eliminated with marijuana legalization. Especially if it is taxed heavily, the incentive for the underground market—having been painstakingly established for decades by multinational corporate structures (cartels)—is very little. We'll still need a black market for underage marijuana, for marijuana to be sold to repeat offenders, etc. I just don't see the cartels throwing up their hands and saying "OK, it's legalized. We're out of the game now. Let's get into the ice cream business."

3. A "Pax Cannabis" would require rescheduling marijuana at the federal level, with an overt recognition that marijuana has some redeeming medical value. What's the argument for maintaining cannabis as a Schedule 1 drug along with heroin, a drug with which it has almost nothing in common? Could you comment on the upcoming U.S. Appeals Court consideration of medical marijuana?

Rescheduling marijuana is one of the biggest red herrings I can think of in this debate. If rescheduled tomorrow, it would do nothing to allow marijuana to be sold legally. Rather, it would be a huge symbolic victory for marijuana advocates -- but it would be wholly wrong on the science. Placing a drug in schedule 1 simply means the drug has no medical use and a high potential for abuse. It has nothing to do with the other drugs in that category (e.g. heroin). If it were a drug, a telephone would also need to be in Schedule 1 - I'm addicted to my cell phone and I know it has no medical use. That doesn't mean a phone is as dangerous as a syringe of heroin.  Today, cocaine is Schedule 2 because it has some very limited hospital use. Can a 21-year-old kid with no medical knowledge sell cocaine from a "dispensary" called "Happy Clinic" legally? Of course not, though that is what is happening [with marijuana] in California.

In order to be used for medical use, a specific product needs to be approved by FDA. Marijuana's specific product, so far, is Marinol, a Schedule 3 drug which has been approved by FDA and is used by people throughout the world. Crude, raw marijuana is not a specific product. The best way I can put it is this: We don't smoke opium to get the effects of morphine, so why do we think we need to smoke marijuana to get its potential medical effects? We have non-inhaled medications that are approved and we have others on the way. For a lot more on this, you can check out an article I wrote for Join Together. I think the District court opinion will rest on the science and agree with the Department of Health and Human Services that raw, crude marijuana is not medicine.

4. Alaska decriminalized marijuana in 1975, and only recriminalized after lengthy pressure from the Reagan administration. Isn't cultivation of this flowering weed for personal use the most obvious and straightforward solution?

The Reagan Administration could have cared less about Alaska, frankly. Alaska recriminalized because voters there wanted that to happen. They didn't like the effect of decriminalization on their state. That said, I don't think many people are in favor—and I am not—of locking up people smoking small amounts of marijuana. That isn't happening anywhere. One notable exception is New York City where they impose 24-hour detentions for public use and selling as part of their broken windows approach to crime control.

Indeed, in the 1970s, twelve states formally decriminalized marijuana. This meant that persons found to have a small amount of marijuana were not subject to jail time, but rather they would receive a civil penalty, such as a fine. The discussion in the United States is highly complex because even in jurisdictions without a formal decriminalization law, persons are rarely jailed for possessing small amounts of cannabis. A rigorous government analyses of who is in jail or prison for marijuana found that less than 0.7% of all state inmates were behind bars for marijuana possession only (with many of them pleading down from more serious crimes).[1] Other independent research has shown that the risk of arrest for each “joint,” or cannabis cigarette, smoked is about 1 arrest for every 12,000 joints.[2] This probably explains the fact that the literature on early decriminalization effects on use has been mixed. Some studies found no increase in use in the so-called “depenalization” states, whereas others found a positive relationship between greater use and formal changes in the law.[3]

The more recent discussion about state-level legalization may provide more insights. Two RAND Corporation reports concluded that legalization would result in lower cannabis prices, and thus increases in use (though by how much is highly uncertain), and that “legalizing cannabis in California would not dramatically reduce the drug revenues collected by Mexican drug trafficking organizations from sales to the United States.”[4]

5. Marijuana advocates don't like to hear it, but pot is addictive for some users. Where do you stand on this controversial issue?

Science tells us that marijuana is addictive—about 1 in 11 people who ever smoke marijuana are addicted; but if you start in adolescence that number climbs to 1 in 6. That's not anyone's opinion but rather the result of rigorous scientific research done by the National Institutes of Health and confirmed by other international scientific bodies. Is marijuana as addictive as tobacco cigarettes? No. The addiction rate for tobacco is about 1 in 3; for heroin it is lower, about 1 in 4. Users who try to quit experience withdrawal symptoms that include irritability, anxiety, insomnia, appetite disturbance, and depression.

A United States study that dissected the National Longitudinal Alcohol Epidemiologic Survey (conducted from 1991 to 1992 with 42,862 participants) and the National Epidemiologic Survey on Alcohol and Related Conditions (conducted from 2001 through 2002 with more than 43,000 participants) found that the number of cannabis users stayed the same while the number dependent on the drug rose 20 percent ­ from 2.2 million to 3 million.[5]Authors speculated that higher potency marijuana may have been to blame for this increase. As I've heard said many times by experienced tokers, "this isn't your Grandfather's Woodstock Weed."

[1] “Substance Abuse and Treatment, State and Federal Prisoners, 1997.” BJS Special Report, January 1999, NCJ 172871. http://www.ojp.usdoj.gov/bjs/pub/pdf/satsfp97.pdf

[2] Beau Kilmer, Jonathan P. Caulkins, Rosalie Liccardo Pacula, Robert J. MacCoun, Peter H. Reuter, Altered State? Assessing How Cannabis Legalization in California Could Influence Cannabis Consumption and Public Budgets, RAND, 2010.

[3] For a discussion see MacCoun, R., Pacula, R. L., Reuter, P., Chriqui, J., Harris, K. (2009). Do citizens know whether they live in a decriminalization state? State cannabis laws and perceptions. Review of Law & Economics, 5(1), 347-371.

[4] Beau Kilmer, Jonathan P. Caulkins, Rosalie Liccardo Pacula, Robert J. MacCoun, Peter H. Reuter, Altered State? Assessing How Cannabis Legalization in California Could Influence Cannabis Consumption and Public Budgets, RAND, 2010. And see Kilmer, Beau , Jonathan P. Caulkins, Brittany M. Bond and Peter H. Reuter. Reducing Drug Trafficking Revenues and Violence in Mexico: Would Legalizing Cannabis in California Help?.Santa Monica, CA: RAND Corporation, 2010. http://www.rand.org/pubs/occasional_papers/OP325. Also available in print form.

[5] ]Compton, W., Grant, B., Colliver, J., Glantz, M., Stinson, F. Prevalence of Cannabis Use Disorders in the United States: 1991-1992 and 2001-2002Journal of the American Medical Association.. 291:2114-2121.

Photo Credit:http://article.wn.com/

White House Releases New National Drug Strategy

The official press statement.


The White House
Office of the Press Secretary
For Immediate Release
May 11, 2010

WASHINGTON, DC – Today, President Obama released the Administration’s inaugural National Drug Control Strategy, which establishes five-year goals for reducing drug use and its consequences through a balanced policy of prevention, treatment, enforcement, and international cooperation.   The Strategy was developed by the Office of National Drug Control Policy (ONDCP) with input from a variety of Federal, State, and local partners.

“This Strategy calls for a balanced approach to confronting the complex challenge of drug use and its consequences,” said President Obama. “By boosting community-based prevention, expanding treatment, strengthening law enforcement, and working collaboratively with our global partners, we will reduce drug use and the great damage it causes in our communities.  I am confident that when we take the steps outlined in this Strategy, we will make our country stronger and our people healthier and safer.”

The 2010 Strategy highlights a collaborative and balanced approach that emphasizes community-based prevention, integration of evidence-based treatment into the mainstream health care system, innovations in the criminal justice system to break the cycle of drug use and crime, and international partnerships to disrupt transnational drug trafficking organizations.  

During a nationwide listening tour soliciting input for the development of the Strategy, National Drug Policy Director Gil Kerlikowske met with police and medical professionals, drug treatment providers and people in recovery, elected officials, corrections officials, academics, parents groups, faith leaders, and others.  Throughout the consultation process, significant themes emerged which connect the drug issue to major Administration policy priorities, including the economy, health care reform, youth development, public safety, military and veterans’ issues, and foreign relations.

“In following President Obama’s charge to seek a broad range of input in the Strategy, I gained a renewed appreciation of how deeply concerned Americans are about drug use,” said Director Kerlikowske. “It touches virtually all of us, whether we know a family member, a friend, or a colleague who suffers from addiction or is in recovery, a police officer working to protect the community, or a parent striving to keep a child drug free,” said Director Kerlikowske.

The 2010 Strategy establishes five-year goals to reduce drug use and its consequences, including:

• Reduce the rate of youth drug use by 15 percent;
• Decrease drug use among young adults by 10 percent;
• Reduce the number of chronic drug users by 15 percent;
• Reduce the incidence of drug-induced deaths by 15 percent; and
• Reduce the prevalence of drugged driving by 10 percent.

In addition, the Strategy outlines three significant drug challenges on which the Administration will specifically focus this year: prescription drug abuse, drugged driving, and preventing drug use.  Prescription drug abuse is the Nation’s fastest growing drug problem, driving significant increases of drug overdoses in recent years.   Drugged driving poses threats to public safety, as evidenced by a recent roadside survey which found that one in six drivers on weekend nights tested positive for the presence of drugs.  Preventing drug use before it starts is the best way to keep America’s youth drug-free.  In addressing each of these issues, the Strategy outlines a research-driven, evidence-based, and collaborative approach.

New Strategy elements also include a focus on making recovery possible for every American addicted to drugs through an expansion of community addiction centers and the development of new medications and evidence-based treatments for addiction.  Continued support for law enforcement, the criminal justice system, disrupting domestic drug traffic and production, working with partners to reduce global drug trade, and innovative community-based programs, such as drug courts, play a critical role in reducing American drug use and its effects.

For more information about the 2010 National Drug Control Strategy visit www.whitehousedrugpolicy.gov.

Photo Credit: http://www.whitehouse.gov

Obama Set to Name New Drug Czar

Seattle police chief gets the nod.

Drug reformers, hoping for the appointment of a public health official, expressed initial dismay at the news that President Barack Obama will nominate Seattle Police Chief Gil Kerlikowske as the nation’s new “drug czar.”

As the president’s evident choice to head up the White House Office of National Drug Control Policy (ONDCP), Kerlikowske is not known for highlighting drug issues in national law enforcement circles, notes the Drug War Chronicle. “While we’re disappointed that President Obama seems poised to nominate a police chief instead of a major public heath advocate as drug czar,” said Drug Policy Alliance’s Ethan Nadelmann, “we’re cautiously optimistic that Seattle Police Chief Gil Kerlikowske will support Obama’s drug policy reform agenda.”

According to the Seattle Post-Intelligencer, “He’s likely to be the best drug czar we’ve seen, but that’s not saying much,” Nadelmann said. “At least we know that when talk about needle exchanges and decriminalizing marijuana arrests, it’s not going to be the first time he’s heard about them.”

For those worried about a radical change in the nation’s drug policy, Seattle City Councilman Nick Licata sought to assure citizens that Kerlikowske is “not on a platform arguing for decriminalization of drugs or radical drug reform measures.”

A spokesperson for the American Civil Liberties Union (ACLU) told the Post-Intelligencer: “I would imagine that being a chief law-enforcement officer makes it very difficult for someone to speak out in favor of more progressive drug laws and drug policies.” However, former Seattle Police Chief and drug reform advocate Norm Stamper insisted that Kerlikowske was more inclined to support “research-driven and evidence-based conclusions about public policy.”

In “Advice for the New Drug Czar,” an article for the online edition of The American Prospect, drug policy experts Mark Kleiman of UCLA and Harold Pollack of the University of Chicago laid out their recommendations for Kerlikowske. Here is an example of their thinking:

--“You’ll be told that we have a national strategy resting on three legs: enforcement, prevention, and treatment. Don’t believe it. There is no coherent strategy. Enforcement, prevention and treatment are the names of three quarrelling constituency groups whose pressures you will sometimes need to resist....”

--“There are some real ‘drug wars’ raging: in Afghanistan, in Columbia, and in northern Mexico. Those wars matter terribly to the countries involved, but no outcome of those wars is likely to make the drug situation in the United States noticeably better or worse.”

--“Treatment needs to be more accessible and more accountable. Good news: even lousy treatment has benefits greater than its costs. Bad news: much of the treatment actually delivered is, in fact, pretty lousy. Demand to see results, and insist on rigorous evaluations. Focus resources on effective programs. It’s an outrage to have addicts dying of overdoses while on waiting lists for methadone treatment.”

--“Most primary care providers never perform highly cost-effective screening and brief intervention, because they’re neither trained for it nor paid for it. Many don’t think that dealing with drug abuse is in their job description; it needs to be.”

--“’Drug Czar’ is a silly title.”


Photo Credit: www.pbs.org

medical marijuana

A Dubious Choice for Drug Czar

Obama should just say no to Congressman Ramstad.

At the Huffington Post, Maia Szalavitz deconstructs the exaggerated outcome data being used by Minnesota Teen Challenge (MNTC) to document the supposed effectiveness of their addiction treatment program. Plenty of treatment programs inflate their success numbers, knowingly or unknowingly, by using flawed statistics to support their arguments. Often--as in this case--there is no control group, thereby making firm statements about the “success” of a treatment all but impossible to prove.

So why bother pointing out such obvious problems in the case of Minnesota Teen Challenge? Primarily, Szalavitz writes, because “the sole sponsor of an earmark providing $235,000 to Minnesota Teen Challenge, a branch of a national anti-addiction group which believes that recruiting people into the Assemblies of God ministry will cure their addiction,” was none other than Jim Ramstad (R-Minnesota) a populist conservative Obama is considering as the nation’s new “Drug Czar.”

(Earlier this year, Congressman Ramstad came out in opposition to plans for the crescent-shaped Flight 93 Memorial Project, arguing that the design had “Islamic features.”)

NORML, the National Organization for the Reform of Marijuana Laws, gives Ramstad a grade of 30, indicating a “hard-on-drugs” stance. Ramstad, an alcoholic in recovery, backs expanded drug testing for federal employees, and beefed-up military patrols along the Mexican border in order to battle “drugs and terrorism.”

Unfortunately for the country’s hard drug addicts, Ramstad is also adamantly opposed to such things as needle exchange programs and medical marijuana.

No word yet from Ramstad on sentencing issues or the matter of addiction treatment rather than incarceration.

medical marijuana

Obama on Drugs

Will he do anything about the Drug War?

One issue largely missing in action during the presidential campaign has been the Drug War, and all the policy implications for addiction treatment that go with it. Our thanks go out to OnTheIssues blog for compiling the admittedly skimpy record of public statements about drug policy by both candidates. In this post, we examine the on-the-record views of Democratic candidate Barack Obama.

The official Obama plan, as outlined in his campaign booklet, Blueprint for Change, calls for greater use of drug courts, job training for ex-offenders, and the elimination of sentencing disparities like the crack/powdered cocaine inequities. He does not favor lowering the current drinking age from 21 to 18, despite a collective push to do so by dozens of university presidents.

In an AP report posted at Drug WarRant, Obama said, “I’m not interested in legalizing drugs.” His focus, he said, was on emphasizing the public health approach to drugs over the prison approach. “All we do is give them a master’s degree in criminology.”

In a speech at Howard University, he told the crowd that “it’s time to take a hard look at the wisdom of locking up some first-time, non-violent drug users for decades.... We will review these sentences to see where we can be smarter on crime and reduce the blind and counterproductive warehousing of non-violent offenders.... So let’s reform this system. Let’s do what’s smart. Let’s do what’s just.”

In reference to the HIV/AIDS crisis, Obama has said that “we have to look at drastic measures, potentially like needle exchange in order to insure that drug users are not transmitting the disease to each other. And we’ve got to expand on treatment.”

Obama himself--a former cigarette smoker--is no complete stranger to drugs, having admitted to high school and college drug use in his book, Dreams from My Father. On page 87, he writes that he used to get high as a way to “push questions of who I was out of my mind, something that could flatten out the landscape of my heart, blur the edges of my memory.... Everybody was welcome into the club of disaffection. And if the high didn’t solve whatever it was that was getting you down, it could at least help you laugh at the world’s ongoing folly and see through all the hypocrisy and bullshit and cheap moralism.”

On a Tonight Show appearance with Jay Leno, when reference was made to President Bill Clinton’s famous claim that he “didn’t inhale,” Obama responded, “That was the point.”

As Kurt Schmoke, the former mayor of Baltimore, wrote: “The relative silence by presidential candidates about the War on Drugs has been disappointing but not surprising. The next president will be in office when we commemorate the one hundredth anniversary of the Harrison Narcotics Act, which many consider to the beginning of the war on drugs. Hopefully, the new president will listen to the voices of reform....”

It appears that Senator Obama is at least partially receptive to the goal of changing national drug policy “to make the war on drugs a public health battle rather than a criminal justice war,” as Schmoke wrote.