Rethinking the Global War on Drugs

Reflections on a talk given by Ethan Nadelmann at University of Miami Miller School of Medicine
March 20, 2007

Legalizing marijuana? Government-endorsed use of heroin? As a child of parents who attended art school in the late 1960s and compensated for their youthful drug excesses by instilling a strict anti-drug rhetoric in their progeny, and figurative child of the “Say No to Drugs” campaign, these ideas seem almost sacrilegious. Before going into Dr. Nadelmann’s presentation, I admit that I thought he was an entertaining leftist with unrealistic goals. But what was conveyed through Nadelmann’s live talk, which did not come through in his myriad newspaper publications nor his appearance on “The Daily Show”, is the absurdity of some of the origins of American policy, particularly in the realm of healthcare.

Why is marijuana illegal? And heroin? Really why? As a child and teenager I believed that these drugs are “bad” and did not question further. I subsequently went off to New York University, then ranked #1 for weed smoking in the country and full of privileged prep-school students able to afford not only Marc Jacobs shoes (my particular point of jealousy) but experimentation with a cornucopia of drugs. The vast majority of my peers did not become consumed with “sin, degradation, vice, insanity and debauchery”, as a 1950s-era anti-marijuana poster in my roommate’s bedroom claims. This is a point that Dr. Nadelmann made, with more solid evidence, not only as pertains to marijuana but even heroin, hence the concept of methadone clinics. This leads me to question how our drug policy did evolve, if it was not a direct result of public health concern.

The story of cocaine is eye-opening. The first anti-cocaine laws were passed in the Southeast, particularly directed at blacks working on the docks because whites feared the unpredictable “negro fiends”, stories of whom stem from yellow journalism.[i] The first anti-heroin laws were passed in California directed against Chinese immigrants. Drug policy is therefore historically tainted by racism, not so much scientific proof. What should save current policy, however, is that there is a close relationship between crime and drugs, so campaigning for fewer drugs and arrests of people with drug possession will lower crime. What did not occur to me is that the deviant culture surrounding these drugs is propagated and upheld, at least partially, by their very illegality and lack of government control. Indeed, 18% of Federal inmates commit their crimes to obtain money for drugs.[ii] Dr. Nadelmann’s ideas for cleaning up crack neighborhoods, i.e. controlling drug use and purging the powerful drug dealers and black market drug economy, does make sense. This is akin to current HIV/AIDS prevention issues in Africa, where the U.S.A. has allocated $15 billion but with certain restrictions, such as mandating that 33% of prevention funds be used for abstinence-until-marriage-only programs and deemphasizing the importance of condoms in HIV/AIDS prevention in all but the highest-risk groups.[iii] All this in the face of clear, sound global health tactics showing that condoms are the most effective preventive tool and that marriage does not necessarily protect from transmission.[iv] Yes - in a perfect world no one would have sex outside of disease-free, monogamous relationships, just as no one would even try drugs much less become addicted, but to ignore reality for idealism is lunacy. It just doesn’t make sense, and the losers are the poor.

The crux of my ruminations on this subject tend toward the following: in a time of growing mistrust of our government, eroding domestic social programs, and lessening sense of security, I am questioning the way America does business. I am questioning to what extent our laws, supposedly set in place to promote a civilized and democratic society, in fact serve to keep certain groups of people down. While I cannot predict what the American people will do about disparities in drug or HIV/AIDs policy, I can predict what my actions in my medical career will be. What Dr. Nadelmann’s talk underscored, more than the specific challenges facing new approaches to drug policy, is that there exists a context for medicine and it should not be forgotten. Just because particular laws and procedures are in place does not mean that they are the best nor even helpful ( our current health insurance system may be a case in point). The genesis of drug policy may have been derived along racial lines, but what may be a bigger problem, particularly in Miami, is the all-too-easy stigmatization of drug addicts seeking help, as well as their limited options.

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[i] Williams, Edward H., “Negro Cocaine ‘Fiends’ New Southern Menace,” New York Times, February 8 1914. http://www.druglibrary.org/schaffer/History/negro_cocaine_fiends.htm

[ii] Bureau of Justice Statistics, “Veterans in State and Federal Prison”, NCJ 217199, May 2004.

[iii] UNAIDS. (2005a, accessed 2007, June 30). AIDS Epidemic Update, 2005. [Online]. http://www.npr.org/documents/2005/nov/unaids/2005_update_full.pdf

[iv] Engender Health. (2005, accessed 2007, June 30). Women's Health in Jeopardy: Women and HIV. [Online]. http://www.engenderhealth.org/ia/swh/pwomenandhiv.html