The elephant in the room

Presidential candidates are silent on the failure of the U.S. war on drugs.

Published February 22, 2000 5:00PM (EST)

With little fuss or fanfare, the United States is preparing to sharply escalate the war on drugs. Over the next two years, the Clinton administration is planning to spend a whopping $1.3 billion in Colombia to disrupt the production and export of drugs to the United States. Most of that money will go for military purposes, including 30 Blackhawk helicopters and training for two rapid-deployment battalions. Given that Colombia is embroiled in a bitter civil war involving leftist guerrillas linked to the drug trade, American lives will clearly be at stake.

One would expect such a risky venture to spark some debate. It hasn't. Few members of Congress have raised questions about the new aid package. The press has greeted it with a yawn. And the presidential candidates have all but ignored it.

On the campaign trail, the overwhelming concern regarding drugs has been who used what when. And no one can qualify for the label drug-free. George W. Bush drank heavily until he was 40, when he found Jesus, and he continues to be dogged by rumors of cocaine use. John McCain's wife, Cindy, was once addicted to prescription drugs and was even caught trying to steal some. Bill Bradley has acknowledged experimenting with marijuana as a youth, and Al Gore has admitted to even more.

This is progress of a sort. Eight years ago, Bill Clinton felt compelled to maintain that he didn't inhale. Now we've learned that Gore was nearly a pothead. And it hasn't damaged his political prospects. Actually, the fact that he served capably as vice president for eight years would seem to show that smoking marijuana does not necessarily fry the brain.

Yet anyone looking for a reasoned discussion of marijuana on the campaign would be disappointed. Asked about marijuana last October, for instance, McCain, citing "scientific evidence," said that "the moment it enters your body, it does damage" and "can become addictive." McCain also embraced the view that marijuana is a "gateway drug" leading inexorably to harder stuff, despite the fact that more than 50 million Americans have tried it without moving on to heroin or cocaine. This darling of the liberal media supports tougher penalties for selling drugs (including the death penalty for drug kingpins), increased funding for border interdiction and restricted availability of methadone. In short, McCain would clearly intensify the drug war. Bush has had less to say on the matter, but it's apparent from his record as the governor of Texas that he supports severe penalties for even minor drug offenses.

The Democrats have struck a more moderate note. Bradley has come out against mandatory sentences for first-time, nonviolent drug offenders, and Gore has criticized the federal statutes that punish crack offenses far more severely than they do those for powdered cocaine. Bradley has said he would spend more money on drug treatment and Gore has expressed support for more after-school programs.

Beyond that, though, the candidates have been mute. The unrelenting violations of civil liberties in the name of drug enforcement, the noxious spread of intrusive drug-testing programs, the government's continuing refusal to fund needle exchanges -- on all these crucial matters, silence has resounded. Over the last 10 years, the federal government has spent more than $150 billion to fight drugs, yet no one seems to care what we've gotten for our investment.

A closer look would reveal it's not much. In the name of fighting drugs, the United States has dispatched troops to Bolivia, built a paramilitary base in Peru, eradicated crops in Colombia, sent AWACS spy planes over the Caribbean, installed X-ray machines along the Mexican border, erected an electronic curtain around South Florida and invaded Panama. It has dismantled the Medellmn and Cali cartels, the two great Colombian cocaine syndicates said to control the flow of drugs into the United States. Despite it all, the cocaine market is glutted as always, and heroin is readily available at record high rates of purity. And, while the number of casual drug users has decreased, the number of hardcore, addicted users hasn't. In the face of such futility, the Clinton administration, led by drug czar Barry McCaffrey, is set to embark on the most ambitious, and dangerous, operation in the history of U.S. drug enforcement. And no one's issued a peep.

The political timidity surrounding the drug issue is breathtaking. It has been 15 years since Nancy Reagan first admonished Americans to "Just say no." In that period, the nation has grown markedly more tolerant on subjects ranging from gay rights and abortion to cohabitation, interracial dating and oral sex in the Oval Office. On drugs, however, the reign of terror prevails. When New York Gov. George Pataki proposed a modest revision of the state's notoriously strict Rockefeller drug laws, it was the Democrats -- possibly fearful of appearing weak-kneed -- who objected. Just as the charge of being "soft on communism" helped keep pols in line during the Cold War, the label "soft on drugs" enforces support for the drug war today.

Happily, there are some signs of change. Voters in more than a half-dozen states have approved ballot measures to allow the use of marijuana for medical purposes -- a clear sign of rebellion against the regime of Reefer Madness. In Arizona, a referendum to mandate low-level drug offenders to treatment instead of prison carried by a decisive margin, and the program has been so successful that even some law-enforcement officials have endorsed it. And Gary Johnson, the governor of New Mexico, has urged a radical overhaul of the nation's drug laws. So, even as national politicians fiddle in Washington, the fires of rebellion are beginning to burn at the grass roots.

Progress toward ending the drug war, however, continues to run into one major obstacle: the lack of a clear alternative. If we are to end the war on drugs, what should take its place? The most frequent answer is legalization. If the drug war is failing, as it's commonly asserted, then legalizing drugs is the only alternative. On the surface, the idea of legalization has much appeal. If drugs were legalized, the whole noxious network of drug traffickers, smugglers, and money launderers stretching from the jungles of South America to the streets of our inner cities would suddenly disappear. Drug agents would no longer barge unannounced into apartments, teenagers would no longer be busted for smoking pot and black motorists would no longer be stopped on the New Jersey Turnpike.

Yet legalization entails some real risks. If hard drugs like heroin or crack were suddenly sold in state stores or made available through prescription, use -- and abuse -- could increase. The end of Prohibition, for instance, resulted in a sharp rise in alcohol consumption, along with many unfortunate side effects. And, while no one wants to revive that disastrous experiment, it does suggest that the sudden legalization of an intoxicant can lead to a spurt in consumption. It is this prospect that makes many Americans recoil from the idea of legalizing drugs -- or at least hard ones. (A far more convincing case can be made for legalizing, or at least decriminalizing, marijuana, a much less toxic substance.) As long as legalization is seen as the main alternative to the drug war, the movement toward reform will stall.

Fortunately, there is another way. It consists of viewing drugs as not a law-enforcement issue but a public-health one. Under such an approach, hard drugs would remain illegal, but, rather than make punishment our main weapon against them, we would rely on treatment, rehabilitation and prevention.

Under a public-health approach, we would recognize that the main threat from drugs comes not from teenage pot smokers or adult casual users but from chronic, addicted users. Nationally, there are an estimated 4 million hardcore users of heroin, cocaine, crack and methamphetamine. While making up only 20 percent of all drug users in the country (the rest being occasional users), these hardcore users account for two-thirds to three-quarters of all the drugs consumed in the United States. They also account for most of the crime, medical emergencies, HIV transmission and child neglect associated with drugs.

Currently, our main strategy for dealing with such users is arrest, prosecution and incarceration. A public-health approach would instead offer a network of services to help these addicts lick or control their habits. In particular, it would provide ready access to an array of treatment programs -- methadone clinics, residential centers, outpatient programs, detox units and short-term sobering-up stations.

Many Americans are skeptical about the value of drug treatment. This is understandable, given the frequency of relapse. Relapse is so common that the idea has been incorporated into the very definition of addiction: a "chronically relapsing disorder," it's called. Even so, a vast literature has accumulated showing that, dollar for dollar, treatment is the most effective means of reducing drug use. A 1994 study by the RAND Corporation, for instance, estimated that, for reducing cocaine consumption, treatment is seven times more cost-effective than domestic law enforcement, 10 times more effective than border interdiction and 23 times more effective than counter-narcotics programs in Latin America. Even if someone relapses immediately upon leaving a program, RAND found, treatment is a good bargain, since the savings from reduced crime, medical problems and other harmful effects far outweigh the cost of the program. (Studies show that no one form of drug treatment is superior to the rest; addicts differ widely in their needs, so it's important to offer a wide range of programs.)

Despite the effectiveness of treatment, it is often hard to get. In cities across the country, it can take weeks or even months to find a bed. In Baltimore, one of the nation's most afflicted cities, long-term residential treatment is virtually unavailable. In Washington, hundreds of drug offenders whom judges have mandated to treatment are forced to remain in prison due to the lack of beds. In several states, methadone is completely unavailable, forcing people to drive hours to get it. Even in cities that do have many beds, like New York, the red tape, lack of coordination and insurance requirements can discourage even the most determined addicts.

The unavailability of treatment reflects the government's spending priorities. Fully two-thirds of the $18 billion federal drug budget goes for law enforcement, criminal justice and international intervention. Just one-third goes for treatment and prevention. At the state and local levels, the imbalance is even greater. If the government changed its priorities and redirected money from law enforcement and interdiction into rehabilitation, treatment could be made available to all addicts who want it. Cities could also set up "central intake units" offering immediate attention to addicts and quick referral to programs. And more could be done to find addicts jobs after they complete their programs -- a key point on the road to recovery.

In a public-health model, more attention would also be paid to prevention. At the moment, drug prevention consists mainly of "This is your brain on drugs"-type messages aired on television or taught in classrooms. Research shows, however, that such messages by themselves rarely work. To be effective, prevention must provide alternatives to at-risk kids, such as after-school programs. Rather than busting kids for smoking pot, as Mayor Rudy Giuliani is now doing in New York, we should convert our schools into around-the-clock community centers offering youths a refuge from the troubled streets around them.

Finally, under a public-health model, we would have as our drug czar somebody who actually knows something about drugs. Since the Office of National Drug Control Policy was created in 1989, it has been headed by a moralist (William Bennett), an ex-governor of Florida (Bob Martinez), a police chief (Lee Brown) and a four-star general (Barry McCaffrey). Certainly it's time we had a drug czar who has a background in drug addiction, psychopharmacology or, at the very least, medicine.

Once, we did actually have such a drug czar. And the results were remarkable. This occurred during the presidency of Richard Nixon, of all people. Personally, Nixon detested drugs, especially marijuana, which he felt was poisoning the nation's youth. It was Nixon who actually launched the war on drugs. But Nixon was also a pragmatist. During the 1968 presidential campaign, he promised to reduce the nation's crime rate and, once in office, he ordered his domestic policy staff to find a way to do that. Studying the issue, his advisors found that heroin addicts were committing much street crime and that the fastest, most effective way of getting them to stop was to get them into methadone programs or other forms of drug treatment. In 1971, the Nixon White House set up a special-action office to prevent drug abuse and, to head it, named Dr. Jerome Jaffe, a psychopharmacologist widely recognized as the nation's leading expert on drug addiction.

Jaffe was given hundreds of millions of dollars to open up treatment facilities around the country, and by the summer of 1972 treatment was available on request. Almost immediately, crime, heroin overdose deaths and hepatitis transmission rates declined. And the treatment network Jaffe had set up was given much of the credit.

That network remained intact throughout the 1970s, and the nation's drug problem remained largely under control. In the 1980s, however, the Reagan administration -- believing that the government had no obligation to help addicts -- gutted the federal treatment budget. By the time crack hit, in the mid-1980s, treatment facilities were completely overwhelmed, and the many new addicts who wanted help were turned back onto the street, there to commit more crime and cause more mayhem.

While federal spending on treatment has increased some over the last 10 years, it remains entirely inadequate. Nothing could do more to reduce the harm that drugs cause society than to make treatment available on request. That $1.3 billion being proposed for Colombia could fund the creation of many more treatment beds in our nation's cities. Surely it's time to call a halt in the drug war and pursue a strategy that attacks the real source of the problem -- our nation's inexhaustible appetite for drugs. At the very least, it's time for a rousing national debate on the issue. Rather than pester presidential candidates about their past drug use, journalists should begin posing the really important questions about drugs: "Do you think the war on drugs has been a success? If elected president, what would you do differently?"

By Michael Massing

Michael Massing is a contributing editor of the Columbia Journalism Review. A frequent contributor to the New York Review of Books, he is the author of Now They Tell Us: The American Press in Iraq. He lives in New York City.

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Al Gore Bill Clinton Drugs George W. Bush John Mccain R-ariz.