Report — From the April 2016 issue

Legalize It All

How to win the war on drugs

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Let’s start with a question that is too seldom asked: What exactly is our drug problem? It isn’t simply drug use. Lots of Americans drink, but relatively few become alcoholics. It’s hard to imagine people enjoying a little heroin now and then, or a hit of methamphetamine, without going off the deep end, but they do it all the time. The government’s own data, from the Substance Abuse and Mental Health Services Administration, shatters the myth of “instantly addictive” drugs. Although about half of all Americans older than twelve have tried an illegal drug, only 20 percent of those have used one in the past month. In the majority of those monthly-use cases, the drug was cannabis. Only tiny percentages of people who have sampled one of the Big Four — heroin, cocaine, crack, and methamphetamine — have used that drug in the past month. (For heroin, the number is 8 percent; for cocaine, 4 percent; for crack, 3 percent; for meth, 4 percent.) It isn’t even clear that using a drug once a month amounts to having a drug problem. The portion of lifetime alcohol drinkers who become alcoholics is about 8 percent, and we don’t think of someone who drinks alcohol monthly as an alcoholic.

In other words, our real drug problem — debilitating addiction — is relatively small. One longtime drug-policy researcher, Peter Reuter of the University of Maryland, puts the number of people addicted to hard drugs at fewer than 4 million, out of a population of 319 million. Addiction is a chronic illness during which relapses or flare-ups can occur, as with diabetes, gout, and high blood pressure. And drug dependence can be as hard on friends and family as it is on the afflicted. But dealing with addiction shouldn’t require spending $40 billion a year on enforcement, incarcerating half a million, and quashing the civil liberties of everybody, whether drug user or not.

It’s possible, of course, that one reason we have a relatively small number of drug addicts is precisely that the most addictive drugs are illegal. If cocaine were to be legalized, says Mark Kleiman, a professor of public policy at New York University who has been a critic of the war on drugs since the 1970s, there’s no evidence indicating that the number of cocaine abusers would be less than the number of alcoholics, or about 17.6 million. Moreover, legalizing cocaine might worsen both cocaine addiction and alcoholism, Kleiman adds. “A limit to alcoholism is you fall asleep. Cocaine fixes that. And a limit to cocaine addiction is you can’t sleep. Alcohol fixes that.”

Kleiman’s prediction of a big increase in post-legalization addiction rates seems intuitively correct. Common sense and decency dictate that any plan for legalizing drugs ought to make provisions for a rise in dependence. Millions of addicts already go untreated in the United States. Although treatment is a bargain — the government estimates that for every dollar spent on drug treatment, seven are saved — treatment and prevention get only 45 percent of the federal drug budget while enforcement and interdiction get 55 percent, and that’s not including the stupendous cost of incarcerating drug offenders. Treatment may become more available now that the Affordable Care Act requires many insurers to pay for mental-health services, including drug addiction, at parity with physical illnesses. Training effective treatment providers is time-consuming and expensive, but the billions freed up by the end of enforcement and mass incarceration could be used to help address that need.

It is also not a certainty that legalizing drugs would result in the huge spike in addiction that Kleiman predicts. In fact, some data argue against it. The Netherlands effectively decriminalized marijuana use and possession in 1976, and Australia, the Czech Republic, Italy, Germany, and New York State all followed suit. In none of these jurisdictions did marijuana then become a significant health or public-order problem. But marijuana’s easy; it isn’t physically addictive. So consider Portugal, which in 2001 took the radical step of decriminalizing not only pot but cocaine, heroin, and the rest of the drug spectrum. Decriminalization in Portugal means that the drugs remain technically prohibited — selling them is a major crime — but the purchase, use, and possession of up to ten days’ supply are administrative offenses. No other country has gone so far, and the results have been astounding. The expected wave of drug tourists never materialized. Teenage use went up shortly before and after decriminalization, but then it settled down, perhaps as the novelty wore off. (Teenagers — particularly eighth graders — are considered harbingers of future societal drug use.)

The lifetime prevalence of adult drug use in Portugal rose slightly, but problem drug use — that is, habitual use of hard drugs — declined after Portugal decriminalized, from 7.6 to 6.8 per 1,000 people. Compare that with nearby Italy, which didn’t decriminalize, where the rates rose from 6.0 to 8.6 per 1,000 people over the same time span. Because addicts can now legally obtain sterile syringes in Portugal, decriminalization seems to have cut radically the number of addicts infected with H.I.V., from 907 in 2000 to 267 in 2008, while cases of full-blown AIDS among addicts fell from 506 to 108 during the same period.

The new Portuguese law has also had a striking effect on the size of the country’s prison population. The number of inmates serving time for drug offenses fell by more than half, and today they make up only 21 percent of those incarcerated. A similar reduction in the United States would free 260,000 people — the equivalent of letting the entire population of Buffalo out of jail.

When applying the lessons of Portugal to the United States, it’s important to note that the Portuguese didn’t just throw open access to dangerous drugs without planning for people who couldn’t handle them. Portugal poured money into drug treatment, expanding the number of addicts served by more than 50 percent. It established Commissions for the Dissuasion of Drug Addiction, each of which is composed of three people — often a doctor, a social worker, and an attorney — who are authorized to refer a drug user to treatment and in some cases impose a relatively small fine. Nor did Portugal’s decriminalization experiment happen in a vacuum. The country has been increasing its spending on social services since the 1970s, and even instituted a guaranteed minimum income in the late 1990s. The rapid expansion of the welfare state may have contributed to Portugal’s well-publicized economic troubles, but it can probably also share credit for the drop in problem drug use.

Decriminalization has been a success in Portugal. Nobody there argues seriously for abandoning the policy, and being identified with the law is good politics: during his successful 2009 reelection campaign, former prime minister José Sócrates boasted of his role in establishing it.

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is the author of four books, most recently Gun Guys (2013). His most recent article for Harper’s Magazine, “How to Make Your Own AR-15,” appeared in the June 2013 issue.

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