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Drug Policy, Featured

Drug Policy Reform

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By  Robert L. DuPont, MD,President, Institute of Behavior and Health, a  501(c)3 non-profit organization working to reduce illegal drug use through the power of good ideas.

Often overlooked in discussions of drug policy today is the nature of the drug problem. The global drug problem can be traced to the innate nature of the human brain. The mammalian brain is extremely vulnerable to chemicals that stimulate brain reward. These chemicals are drugs of abuse. They produce far more intense brain reward than any natural reward, even sex and food. The repeated use of drugs of abuse leads to addiction. In its definition of addiction, the American Society of Addiction Medicine notes that it is “characterized by inability to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems with one’s behaviors and interpersonal relationships, and a dysfunctional emotional response.”

Addiction is a chronic, often fatal, illness that typically begins in adolescence. The earlier an individual uses drugs of abuse, including alcohol and marijuana, the more likely it is that the person will develop a substance use disorder later in life. The best way to prevent addiction is to prevent the use of these substances. As a 13-year-old said to me years ago, “I don’t want to try cigarettes because I might like them.”

Modern Drug Use Epidemic

While the biology of addiction has not changed for millions of years, over the past half century drug use has changed dramatically. In the modern drug abuse epidemic, whole populations are exposed to a mind-bending array of drugs of abuse by powerful routes of administration. This has never happened before in human history.

Marijuana, the most widely used illegal drug, has been transformed in the time since the peak of its use in the United States in 1978. The potency of marijuana, as measured by the level of THC (the primary active cannabinoid in marijuana), has tripled over this time. New modes of marijuana consumption have increased the potency of marijuana delivery. For example, butane hash oil contains dramatically higher levels of THC, with concentrations up to 90 percent.

The addiction landscape also has changed as a result of the non-medical use of legal prescription drugs. Eighty percent of the global opioid supply is consumed by Americans who constitute less than five percent of the world’s population. With widespread medical use of opioid analgesics has come an epidemic of opiate dependence. The number of drug overdose deaths in the US has surpassed highway fatalities. The widespread use of prescription drugs has led to changes in the demographics of heroin use and subsequent heroin overdoses. Forty years ago heroin addiction was mostly confined to young inner-city men who often were involved in criminal activities. The new demography of heroin is the result of the demography of those that use pain medications non-medically. An estimated half of young heroin users previously abused prescription opioids prior to their heroin use. Heroin addiction has reached all parts of the country, especially small towns and rural areas, and is no longer limited to minority, male or lower income populations.

The drug epidemic continues to evolve in complex ways even as the public attitudes toward the use of drugs are shifting. Attitudes today are far more permissive toward the “recreational” use of drugs, especially marijuana. National polls indicate that a growing majority of Americans now favor legalization of marijuana for “recreational” use by adults.

Well-Funded Lobby Pushes for Marijuana Normalization

The well-funded lobby promoting the normalization of the use of marijuana (and other drugs) is based on the erroneous premise that marijuana is not only safe but also beneficial. (Ed. note: Three billionaires have spent an estimated $200,000,000 to legalize marijuana.) In contrast to this view, the science is clear that marijuana use is a serious threat to health, safety and productivity. As the negative impact of legal marijuana in the states of Colorado and Washington – and in the states that permit “medical” marijuana – is more widely understood, attitudes toward permissive drug use will shift once again.

The US, and the entire world, is at a crossroads in drug policy today with two oppositional perspectives on the future of drug policy. On the one hand is the vision on which current global drug policy was established in the first decades of the 20th century with the US in the lead which separates medical use from non-medical use of drugs with abuse potential. Under this framework, the goal of drug policy is to limit the use of drugs of abuse to medical uses only. Drugs of abuse are provided only through the process of physicians’ prescriptions and dispensed at pharmacies in a closed system and only for the treatment of diseases. The use of drugs of abuse outside of this very limited medical practice and their sale is illegal, punishable by the criminal law.

This well-established formulation of drug policy now is threatened by an alternative vision that treats drugs of abuse the way alcohol and tobacco are treated: through regulated production and sale to adults for legal use for any purpose. The campaign for this alternative drug policy begins with the legalization of marijuana but the stakes are far greater because it applies to all drugs of abuse and because there are enormous potential profits to be earned in this new marketplace. This move erases the sharp line between legal and illegal drugs. Erasing this line frustrates prevention and it opens the floodgates to widespread drug use.

Addiction Goes Up When Percent Usage Increases

When considering the potential public health impact of the legalization of drugs of abuse, including marijuana, it is helpful to consider the rates of use of the two legal drugs. Among Americans age 12 and older, 52 percent used alcohol and 27 percent used tobacco in the past month whereas 9 percent used any illegal drug. Only 7 percent of Americans used marijuana. Treating marijuana – to say nothing of other drugs of abuse – the way alcohol and tobacco are treated most certainly will increase availability and with it dramatically increase the level of marijuana use to a level that is similar to the use of the two currently legal drugs.

Is increased marijuana use and subsequent proportional increases in marijuana addiction in the interest of the nation’s public health? I don’t think so. The use of alcohol and tobacco are the two leading causes of preventable illness and death in the United States. Adding a third legal drug will add to the devastation that these legal drugs already generate.

NFIAAmericaondrugs
Usage can only go up if legalized.      Graphic Source: National Families in Action

What is the better answer for the future of drug policy, if it is not the legalization and regulation of drugs of abuse? The future of an effective drug policy lies in finding ways to reduce the use of drugs of abuse that are compatible with modern values and laws. This search for better ways to reduce illegal drug use is the focus and the agenda of the Institute for Behavior and Heath, Inc. (www.ibhinc.org). There are many good new ideas for drug policy, all based on the recognition of the vulnerability of the brain to the excessive, unnatural stimulation of brain reward mechanism by drugs of abuse which leads to addiction for millions of people and the resulting devastation suffered by these individuals, their families and their communities.

Rather than embrace drug legalization, we must develop innovative policies and programs that reduce the use of drugs of abuse and we must provide assistance, including quality treatment that achieves long-term recovery, to those with substance use disorders.

Robert L. DuPont, M.D.
President, Institute for Behavior and Health, Inc.
Former Director, National Institute on Drug Abuse (1973-1978)
Former White House Drug Chief (1973-1977)

(Editor’s Note–Original article, “The Changing State of Drug Policy,” is reprinted with permission from the Institute of Behavior and Health website, where footnotes align exactly with text.  It publishes several excellent articles about the influence of drug policy on addiction, drugged driving,etc.)

 

American Society of Addiction Medicine. (2011). Public Policy Statement: Definition of Addiction. Chevy Chase, MD: American Society of Addiction Medicine. Available: http://www.asam.org/advocacy/find-a-policy-statement/view-policy-statement/public-policy-statements/2011/12/15/the-definition-of-addiction
National Institute on Drug Abuse. (2010). Drugs, Brains and Behavior: The Science of Addiction. NIH Pub No. 10-5606. Rockville, MD: National Institute on Drug Abuse, National Institutes of Health, US Department of Health and Human Services. Available: http://www.drugabuse.gov/sites/default/files/sciofaddiction.pdf
Drug Enforcement Administration. (2014). The Dangers and Consequences of Marijuana Abuse. Washington, DC: Drug Enforcement Administration Demand Reduction Section, US Department of Justice. Available: http://www.justice.gov/dea/docs/dangers-consequences-marijuana-abuse.pdf
Manchikanti, L., Fellows, B., Ailinani, H., & Pampati, V. (2010). Therapeutic use, abuse, and nonmedical use of opioids: a ten-year perspective. Pain Physician, 13(5), 401-435. Available: http://www.painphysicianjournal.com/2010/september/2010;13;401-435.pdf
Centers for Disease Control and Prevention. (2014). Prescription Drug Overdose in the United States: Fact Sheet. Atlanta, GA: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Unintentional Injury Prevention. Available: http://www.cdc.gov/homeandrecreationalsafety/overdose/facts.html
Kuehn, B. M. (2014). Driven by prescription drug abuse, heroin use increases among suburban and rural whites. JAMA, 312(2), 118-119.
Johnson, K. (2014, April 17). Heroin is a growing threat across USA, police say. USA Today. Available: http://www.usatoday.com/story/news/nation/2014/04/16/heroin-overdose-addiction-threat/7785549/
National Institute on Drug Abuse. (2013, April). Heroin. DrugFacts. Rockville, MD: National Institute on Drug Abuse, National Institutes of Health, US Department of Health and Human Services. Available: http://www.drugabuse.gov/sites/default/files/drugfacts_heroin_final_0.pdf
Cicero, T. J., Ellis, M. S., Surratt, H. L., & Kurtz, S. P. (2014). The changing face of heroin use in the United States: a retrospective analysis of the past 50 years. JAMA Psychiatry, 71(7), 821-826.
Pew Research Center. (2014, April 2). America’s New Drug Policy Landscape. Washington, DC: Pew Research Center. Available: http://www.people-press.org/files/legacy-pdf/04-02-14%20Drug%20Policy%20Release.pdf
Volkow, N.D., Baler, R.D., Compton, W.M., & Weiss, S.R.B. (2014). Adverse health effects of marijuana use. The New England Journal of Medicine, 370(23), 2219-2227.
Richter, K. P., & Levy, S. (2014, June 11). Big marijuana—lessons from big tobacco [Perspective]. The New England Journal of Medicine. Available: http://www.nejm.org/doi/full/10.1056/NEJMp1406074
Substance Abuse and Mental Health Services Administration. (2013). Results from the 2012 National Survey on Drug Use and Health: Summary of National Findings, NSDUH Series H-46, HHS Publication No. (SMA) 13-4795. Rockville, MD: Substance Abuse and Mental Health Services Administration.

Established in 1978, the Institute for Behavior and Health, Inc. (IBH) is a 501(c)3 non-profit organization working to reduce illegal drug use through the power of good ideas. IBH websites include: www.ibhinc.org, www.StopDruggedDriving.org, www.PreventTeenDrugUse.org, and www.PreventionNotPunishment.org.

District of Columbia, Featured, News Articles

Two.Is.Enough.D.C. Fights Washington Going to Pot

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Two Is Enough D. C. has formed to fight off marijuana legalization in the  District of Columbia this fall.  Although it has taken years to reduce the smell and litter of cigarettes, the public health benefit could be erased and replaced with the widespread infiltration of marijuana smoke.

Polls show that DC voters favor legalization, but they need to look at what has happened in Colorado and Washington state.   One wonders how, after seeing what alcohol and tobacco do to health, voters can want a third vice.   The answer appears to be the huge amount of money backing full legalization.

The Money Behind Marijuana

The change of public opinion has gone hand-in-hand with the large influx of money to fund marijuana legalization.  Since the early 1990s, money-fund manager George Soros has been providing  financial backing to groups such as the Marijuana Policy Project.   Together Soros and the late Peter Lewis donated approximately 100 million dollars to legalization and medical marijuana campaigns.  The well-organized marijuana lobby has gained some backers in Congress: Dana Rohrabacher of California, Jared Polis of Colorado, Earl Blumenauer of Oregon and Stephen Cohen of Tennessee.

Laws revolving around marijuana have gradually changed.  Support is especially strong in the western states, where politics involves personal freedom and individual rights.  A movie released in 2011, Guns and Weed, reflects the views of many who have advocated for this freedom.  Unfortunately, the freedom issue has become stronger than protecting children.  Legalization legitimizes a vice and promotes the greed of both dealers and governments, at the expense of future generations.

The  normal course for changing marijuana laws has been decriminalization, followed by introducing medical marijuana and finally allowing voters to tax and regulate.  About a year ago, medical marijuana was implemented in the district.  This spring the city council voted to decriminalize pot, with a $25 fine.

Only one city council member in Washington, DC, Yvette Alexander, stood firm against the measure.  The fine for kids smoking marijuana in public is now less than the fine for smoking cigarettes. It is likely that the marijuana lobbyists, such as NORML and Drug Policy Action Committee, have worked long and hard to gain the support of politicians in Washington, DC.

Typically voters don’t even notice what is happening because these lobbying groups talk only from the side people going to jail or the inefficiency of drug wars and suggest that drug money could go to governments instead of criminals.  The first medical marijuana initiative passed in California back in 1996.  California voters rejected full legalization in 2010, despite being outspent 10 to 1.

How Congress Can Respond

One member of Congress, Andy Harris of Maryland, a physician, has tried to stall the implementation of decriminalized marijuana in Washington, citing the negative effects it has on children.   The marijuana lobby waged an expensive, negative advertising campaign against Harris and Rep. Debbie Wasserman Schultz of Florida, who has also stood firm against the pot lobby.

Congress has the ability to slow legislation in the district.  A House budget bill passed last month included a provision to block not only a legalization effort but the decriminalization bill  that is now in effect.   Rep. Harris argued that the law has no drug-treatment component, even for minors, and that the fine for a young teen who is caught with a joint would be half that of the city’s $50 ticket for underage smoking of a cigarette.

A three-member D.C. Board of Elections voted unanimously today to approve the ballot initiative.  Malik Burnett, leader of the D.C. Cannabis Coalition, turned in more than 57,000 signatures to get the referendum on the November ballot.   However, he was not sure how Congress would ultimately react to this legalization effort, but he said that the vote “will send a message that D.C. is serious about reforming its marijuana laws.”

Editorial, Featured

Marijuana Vs. Alcohol

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The marijuana lobbyists want to “mainstream” marijuana and call for its regulation to be like alcohol.  Let’s make it equal to alcohol, they say.   Why are they asking for addiction equality?

When they compare its illegal status to alcohol, they don’t mention that Alcoholics Anonymous was founded in 1935, the year after a 13-year Prohibition era ended.  When the marijuana community decries the nationwide prohibition of marijuana in 1937, they forget to mention that it happened much earlier, state-by-state, 1911 in MA, 1913 in CA, 1914 in NY, etc.

These same marijuana lobbyists keep suggesting that people who drink too much booze or take pain pills should switch to marijuana.   As much as addiction is hard to overcome, the suggestion of substituting one addiction or bad habit for another can just get you back to square one.

Why are we making a second vice, pot, totally legit for those 21 and over while keeping it illegal for those under 21? The minimum age for alcohol purchase is 21, yet the US already has a problem with underage drinking. Why duplicate this problem with marijuana?

The only obvious reason is that there is a business and a marijuana industry that wants to make profits.  Like with alcohol and tobacco, 80% of those profits will come from those who are addicted or over-indulgent.  The growing industry wants and needs to get young users to keep a steady stream of buyers; the younger they start, the greater likelihood of getting hooked.

An experiment with lowering the beer and wine age to 18 in much of the US in the 1970s did not work.  The national law needed to be changed back to age 21.  Elsewhere teens do not go to the extremes that are common to American culture.  We simply are not a modest or temperate culture, like the Netherlands.

The sales pitch of the marijuana lobby:

“Wouldn’t you rather have your teenage son driving stoned, rather than drunk?”  Both practices are very dangerous, and even more dangerous when stoned and drunk at the same time.

“I support legalization so marijuana can be on equal footing with alcohol.”   Pot users don’t have addiction equality yet, but statistics and studies show that 9% of marijuana users will be come addicted (approximately same rate as drinkers) and that rate jumps to 17% if they begin before age 17.

“No one has ever died from marijuana.”  The advocates claimed in the campaign for legalization in Colorado and Washington.  There have since been 2 deaths in Colorado this year directly attributed edible marijuana and many child-abuse deaths caused by the parents’ usage of marijuana.

Simplistic soundbites don’t tell the whole story.   Marijuana is not safer than alcohol, but it is used less frequently by Americans than pot.   Leah Allen’s account of growing up with a marijuana-addicted father is similar to what it would be like having a chronic alcoholic dad: negligent, irresponsible, violent to the mom and prone to anger when he could not have it.

Pot users could be 7% of adult Americans, vs. at about 66% who drink.  They’re asking us to change a law for the 7%, and Parents Opposed to Pot disagrees.  More people die from alcohol because it is and has been a larger part in society.

We’re better at recognizing who might be  susceptible to alcoholism.  We have little idea who is most at risk for mental illness and other negative effects from marijuana.   Certain teens haven’t thought about it, either.  Tobacco cannot affect brain function, memory and mental health the same way marijuana can.

The risk for mental illness caused by marijuana alone is too great not to be noticed.