Drug War Heresies
Robert J. MacCoun, Peter Reuter
This book provides the first multidisciplinary and nonpartisan analysis
of how the United States should decide on the legal status of cocaine,
heroin and marijuana. It draws on data about the experiences of Western
European nations with less punitive drug policies as well as new analyses
of America’s experience with legal cocaine and heroin a century ago, and
of America’s efforts to regulate gambling, prostitution, alcohol and cigarettes.
It offers projections on the likely consequences of a number of different
legalization regimes and shows that the choice about how to regulate drugs
involves complicated tradeoffs among goals and conflict among social groups.
The book presents a sophisticated discussion of how society should deal
with the uncertainty about the consequences of legal change. Finally, it
explains, in terms of individual attitudes toward risk, why it is so difficult
to accomplish substantial reform of drug policy in America.
September 2001
ISBN: 0-521-57263-0 (Hardback) and 0-521-79997-X (Paperback)
488 pages with 26
line diagrams, 22 tables
TABLE OF CONTENTS
ACKNOWLEDGEMENTS
CHAPTER 1. PREFACE AND OVERVIEW
SECTION I: THE ARGUMENTS
SECTION II. THE EVIDENCE
Other vices
History
Western Europe
SECTION III: ASSESSING THE ALTERNATIVES
Projecting changes in total drug-related
harm
Cocaine or heroin adult legal
market
Heroin maintenance
Cannabis
Weighing the alternatives
Prospects for change
CHAPTER 2. DRUG PROHIBITION: AMERICAN STYLE
PATTERNS OF DRUG USE
Occasional drug use
Frequent use
DRUG RELATED PROBLEMS
ENFORCEMENT
Stringency
Divisiveness
Intrusiveness
The punitive cycle
How successful has enforcement
been?
DEMAND SIDE PROGRAMS
Treatment
Prevention
CONCLUSION
CHAPTER 3. THE DEBATE
ELITE OPINION
Shifts in advocacy and emphasis
Shifts in the content of the debate
PUBLIC OPINION
WHY HAVE LEGALIZERS HAD SO LITTLE IMPACT?
CONCLUSION
CHAPTER 4. PHILOSOPHICAL UNDERPINNINGS
CONSEQUENTIALIST VS. DEONTOLOGICAL ARGUMENTS
THE LIBERAL TRADITION
John Stuart Mill
Joel Feinberg
Drug laws
ALTERNATIVES TO LIBERALISM
Legal paternalism
Legal moralism
Effects of laws on cohesion and
legitimacy
The benefits of drug use
IMPLICATIONS
CHAPTER 5. HOW DOES PROHIBITION AFFECT DRUG USE?
THE ECONOMICS OF DRUG DEMAND
DETERRENCE: THE FEAR OF LEGAL SANCTIONS
Effects of penalties and their
enforcement on crime rates
Perceptual deterrence research
Limited rationality and deterrence
INFORMAL SELF AND SOCIAL CONTROLS
Morality and legitimacy
'Forbidden fruit' effects
Informal social controls
SUMMARY OF MECHANISMS
IMPLICATIONS FOR POLICY
Effects of depenalization on drug
use
Effects of legalization on drug
use
CHAPTER 6. HOW DOES PROHIBITION AFFECT DRUG HARMS?
A TAXONOMY OF DRUG-RELATED HARMS
The dimensions of drug-related
harm
THE IMPLEMENTATION OF PROHIBITION AND SPECIFIC HARMS
The economics of black markets
Ubiquity of drug selling in inner
city communities
Corruption
Violence and other crime
Health consequences
CONCLUSIONS
CHAPTER 7. OTHER VICES: PROSTITUTION AND GAMBLING
GAMBLING
Gambling as behavior
History of control
The current regime
Assessing the current regime
Conclusion
PROSTITUTION
Characterizing the prostitution
problem
History and regulation
Reform models
Attitudes and politics
An assessment
CHAPTER 8. OTHER SUBSTANCES: ALCOHOL AND CIGARETTES
ALCOHOL
Prohibition
Repeal
Assessment
Current policy
CIGARETTES
Cigarette consumption and its
problems
Policy
Smoking promotion and politics
Smoking and the future
CONCLUSION
CHAPTER 9. U.S. EXPERIENCE WITH LEGAL COCAINE AND HEROIN
COCAINE
The medical phase
Patent medicine and the promotion
of cocaine
Recreational use
Legal but unrespectable
Prevalence and problems
Responses
Post-Harrison Act
THE OPIATES
Controls
CONCLUSIONS
CHAPTER 10. LEARNING FROM EUROPEAN EXPERIENCES
CHARACTERIZING DRUG POLICY
ANALYTIC FRAMEWORK
LAWS AND THEIR ENFORCEMENT
Drug seizures
Arrests and imprisonment
THE PREVALENCE OF DRUG USE
Interpreting the prevalence estimates
ITALY’S "NATURAL EXPERIMENT" WITH DEPENALIZATION
A brief history
Effects of legal change on drug
problems
CONCLUSIONS
CHAPTER 11. CANNABIS POLICIES IN THE NETHERLANDS
CHARACTERIZING DUTCH CANNABIS POLICY
History
The problems of regulation when
a drug is only “de facto” legal
OUTCOMES
Prevalence of cannabis use in
the Netherlands, U.S., Denmark, and Germany
Trends in the prevalence of cannabis
use
Other effects
INTERPRETING THE DUTCH EXPERIENCE AND OTHER ANALOGIES
CHAPTER 12. HARM REDUCTION IN EUROPE
NEEDLE EXCHANGE AND TREATMENT PROGRAMS IN EUROPE
HIV and drug use
Needle exchange
Methadone treatment
EVALUATING THE HARM REDUCTION APPROACH: THE NETHERLANDS
Evaluating the success of Dutch
drug policy
SWISS EXPERIMENTATION
Background
Zones of tolerance: The Platzspitz
HEROIN MAINTENANCE
The British experience
The Swiss heroin maintenance trials
LEARNING FROM EUROPE
The values that inform drug policy
CHAPTER 13. SUMMARY OF THE EVIDENCE AND A FRAMEWORK FOR ASSESSMENT
INTERPRETING THE ANALOGIES
Relaxations
Tightenings
Other relevant analogies
THE SPECTRUM OF REGIMES
Prohibition regimes
Prescription regimes
Regulatory regimes
OUTCOMES: TOTAL HARM AND ITS COMPONENTS
THE NECESSITY OF VALUE JUDGMENTS
The identification of harms (and
benefits)
Weighing the harms
Burdens and standards of proof
SUMMARY PROPOSITIONS
CHAPTER 14. PROJECTING THE CONSEQUENCES OF ALTERNATIVE REGIMES
PROJECTIONS FOR COCAINE AND HEROIN
Regulated adult market for cocaine
and heroin
Depenalization of cocaine and/or
heroin
Heroin maintenance regime
CANNABIS: BACKGROUND
Current usage patterns and policy
The gateway mechanism
Health consequences of cannabis
Cannabis intoxication
Cannabis dependence
The basis for continued cannabis
prohibition
Can cannabis prohibition be reconciled
with legal alcohol and tobacco?
Cannabis depenalization
Cannabis legalization
The Alaska model
APPENDIX
CHAPTER 15. OBSTACLES TO MOVING BEYOND THE DRUG WAR
UNCERTAINTY AND THE LEGALIZATION DEBATE
POLITICS
Marijuana reform
Medical marijuana
Needle exchange
Heroin maintenance
THE STRICT ALLEGIANCE TO USE REDUCTION
Harm reduction and use reduction
Does harm reduction "send the
wrong message"?
Quantity reduction as a middle
ground
Psychological foundations of the
strict allegiance to prevalence reduction
HOW FIRM IS THE RESISTANCE TO CHANGE?
CAN AMERICA TREAT AND PREVENT ITS WAY OUT OF DRUG
PROBLEMS?
ON DOING LESS: DRUG POLICY IN MODERATION AND SOME
NON-ZERO TOLERANCE
BIBLIOGRAPHY