Drug War Heresies: Learning from Other Vices, Times & Places, by Robert J. MacCoun and Peter Reuter. Cambridge, U.K.: Cambridge University Press. 2001. 479 pp. ISBN: 0-521-79997-X.

Social Control, Deviance, and Law

What would happen if the United States were to reform its drug policy? This is the central question Robert MacCoun and Peter Reuter ponder in Drug War Heresies as they present a rational analysis of American drug policy. True to rationalism, the analysis endeavors to comprehensively examine the relevant information in an even-handed manner. In this regard, the book provides an important critical synthesis of a great wealth of information.

Drug War Heresies’ careful prognostications derive from analogies to different vices (prostitution, gambling, alcohol, and cigarettes), different times (American drug use prior to the Harrison Act of 1914), and different places (drug use in Europe). For each analogy, the book provides a narrative description of the impact from policy changes and reviews the available data. Gambling proves to be a particularly important analogy. Their history of U.S. gambling legalization suggests it reduced corruption and provided revenue to the states. Still, MacCoun and Reuter rue the commercialization of vice as, "State governments have become greedy boosters of a behavior that clearly causes problems."

One of the most important precedents is the Netherlands where cannabis policy was reformed in 1976. The weight of twenty-eight published international comparisons strongly suggests that cannabis use is less common in the Netherlands than in the U.S. but slightly higher than in other European countries. A time trend analysis indicates Dutch cannabis use actually declined following reform and started increasing after 1984. MacCoun and Reuter suggest that part of this increase was due to commercialization of cannabis use as the coffee shop industry took root, which was only made possible by policy reform. In this tentative, lagged, partial manner, they find limited support for the suggestion that marijuana policy reform ultimately led to increased marijuana use. They partially dismiss concerns stemming from the "gateway hypothesis" that increased cannabis use leads to increased use of hard drugs because fewer Dutch than American cannabis users report having used cocaine. This may have been the result of Dutch efforts to separate the markets for hard and soft drugs.

Turning to the task of evaluating the desirability of various potential drug policy regimes, the authors introduce the formula:

macro harm = number of users ´ average units used per user ´ average harm per unit

I find this formula potentially misleading. The most naïve interpretation leads to the inappropriate conclusions that all drug use is harmful and that the dose-response function is linear. Fortunately, at other moments the authors identify how the components of harm are interrelated, non-linear and affected by numerous other factors; how there are multiple far-ranging harms to consider including devaluation of arrest as a moral sanction; and how the available data is insufficient for development of plausible estimates of total macro-harm. In the end, they abandon the quest for quantification and instead provide narratives of what might happen under a variety of drug policy reforms based on their analogies.

There are several important topics not covered in this book including the psychopharmacology of drug use, the context of use, the operation of illegal drug markets and the health consequences of extended use. Surveying these topics would have lengthened the book tremendously. However, these factors are still considered in the analysis. In the end, it is the danger associated with cocaine and heroin that lead MacCoun and Reuter to personally reject legalizing or even depenalizing use of these drugs. To reduce harm, they support methadone maintenance and needle exchange and express mixed feelings about heroin maintenance. They are more sanguine about the prospects for marijuana policy reform although stop short of advocating legalization because of concern about the impact of "commercialization, American style." Instead, they lean towards depenalization.

I greatly appreciate their deliberate use of the first person in presenting their assessments. Doing so emphasizes the incompleteness of the data, the value judgments involved and that others will draw very different conclusions even after carefully evaluating the same evidence. An important use for rational analysis is that it can highlight where individuals disagree, why they disagree, and sometimes where compromise might be achieved by collecting further data that puts policy advocates’ key claims to the test.

A steady undercurrent of disdain runs through the book. In the final chapter, the authors let go of their academic reserve and proclaim, "The pursuit of a drug-free society seems quixotic, and its nobility is tarnished by the associated hatred and contempt for drug users. Defenders of the current regime deliberately avert their eyes from an honest assessment…" In a society where most politicians and the drug warriors they empower pay unflinching allegiance to irrational goals, it would seem that rational policy analysis is heresy. This book will make you think.