Proposals for drug legalization are rooted in the belief that drug prohibition does not work. Legalization advocates point out that the prohibition of alcohol failed in the United States two generations ago. They argue that the use of illicit drugs is widespread despite prohibition and that the high costs and negative consequences of that prohibition ranging from costs for police and prisons to the loss of privacy caused by drug testing in many settings, notably the workplace are unreasonably high prices to pay for an ineffective policy. But while prohibition has not been the perfect solution to the drug problem, legalization will likely lead to increases in drug use, addiction and drug-related death.
The range of available options within both general categories, drug legalization and drug prohibition, is wide. It is useful to look at the big picture to examine (and question) the whole spectrum of options. In general, we can ask: Is prohibition working? Is it cost effective? Does legalization offer a reasonable alternative to prohibition?
There are three models for legalization that can help us sketch an answer to these fundamental questions. The first is a look back at life in the United States a hundred years ago, when addicting drugs were sold like toothpaste and candy. The second is derived from observing the recent trends in the rates of the use of both legal and illegal drugs in the United States and comparing the costs generated by the drugs that now are legal for adults tobacco and alcohol and those that are not marijuana, cocaine, heroin and others. The third is a look at the experiences of other countries that have experimented with legalization. Examining these models gives us valuable perspective as we consider the possibility of lifting prohibition and replacing it with one of the many options for drug legalization.
A Look at the American Experience
The American experience with drugs at the end of the 19th century demonstrated the serious problems that can be caused by the general use of a wide range of legally available drugs. These problems were, finally, judged unacceptable by Americans of that day. Prohibition was the result of a nonpartisan public outcry over the negative effects of unrestricted drug use. Thus, the prohibition of heroin and cocaine did not cause widespread drug use; widespread drug use caused prohibition.
Furthermore, the prohibition of drugs has been almost universally supported politically, in the United States and throughout the world, for more than half a century. The single exception was, of course, the prohibition of alcohol.
A Comparison of Costs
The goal of a drug policy is to reduce harm. Alcohol and tobacco cause far more harm in the U.S. than all illegal drugs combined. Deaths in the United States from alcohol are estimated at about 125,000 per year. Tobacco use causes about 420,000 deaths a year. Deaths resulting from all illicit drugs combined are fewer than 10,000 per year.
Similarly, the costs to society of alcohol use in the United States in 1990 were estimated at $98.6 billion a year; the costs of tobacco smoking were estimated to be $72 billion; and the 1990 estimated costs of all illicit drugs including the costs of prohibition were $66.9 billion.
To put these statistics another way: Whether the standard is drug-caused deaths or drug-related economic costs, the drugs that are legal for adults (alcohol and tobacco) cause far more harm than do all currently illegal drugs combined (see Table 1).
Table 2 shows figures for 1985 and 1993 of the number of people in the United States who said they had used legal and/or illegal drugs in the previous 30 days. The table also shows the decline in the rates of use of all these substances in the years from 1985 to 1993. The prohibited drugs were used at lower levels and showed greater reductions in use over that time span than either cigarettes or alcohol.
Note, in Table 1, that the economic cost of illicit drugs is primarily related to crime: Almost 70 percent of the $66.9 billion total cost of illicit drugs in 1990 was the cost of prohibition. At the same time, crime produced only 16 percent of the cost to society of alcohol and zero percent of the cost generated by tobacco use.
The costs of medical care, lost productivity and death stand in dramatic contrast to the crime costs, however. Those costs taken together totaled $14.6 billion for all illegal drugs, $80.7 billion for alcohol and $72 billion for tobacco. These figures show clearly that when drugs are legalized, they are used more widely and the total costs of their use go up when compared to the costs of drugs still under prohibition. The costs of legal drugs are primarily costs related to medical care, lost productivity and death.
Table 1 also breaks out AIDS as a separate factor in the total costs of both legal and illegal drugs. But even when AIDS-related costs are added to the non- crime-related costs (medical care, lost productivity and death) for all illicit drugs, the total is $20.9 billion; the equivalent totals are $82.8 billion for alcohol and $72 billion for tobacco.
Some advocates of the legalization of now-illegal drugs claim that those drugs do not produce health costs on the scale of those produced by alcohol and tobacco, but the data show that illicit drugs produce higher levels of health and productivity costs per user than do legal drugs.
The United States has about 103 million current users of alcohol, 50 million current users of tobacco and 12 million current users of illicit drugs. The health-related costs per user per year, exclusive of crime costs, are $798 for users of alcohol, $1,440 for users of tobacco and $1,742 for users of illicit drugs.
Under prohibition, the costs to society of illegal drugs are lower, overall, than the costs of legal drugs; and the costs of illicit drugs show up primarily in police and corrections budgets. Prohibition is currently reducing the total costs generated by drugs such as marijuana, cocaine and heroin. But human suffering and health-care costs would rise dramatically if those drugs were as readily and legally available as alcohol and tobacco are now.
The Dutch Example
Those who support legalization widely praise the Dutch for permitting the purchase of marijuana for use by those over age 15. But the Dutch saw a 250 percent increase in adolescent marijuana use between 1984 and 1992. During the same period, American youth reduced their marijuana use by two thirds. Furthermore, between 1991 and 1993 the Dutch saw a 30 percent increase in registered marijuana addicts.
The evidence from the Netherlands suggests that if the United States were to legalize currently illicit drugs, the number of users would likely increase from the present 12 million to something like the 50 million who use tobacco or even the 103 million who use alcohol. The current prohibition in the United States works reasonably well in reducing both the amount and the costs of addictive drug use. Legalization would result both in the increased use of no-longer-illegal drugs and in more harm, which would be expressed in greater social costs.
Wider Use Equals Wider Harm
Those who would reform drug laws who also support harm-reduction objectives should focus their efforts on alcohol and tobacco the two drugs responsible for the major part of the drug-caused harm now taking place in the United States and throughout the world. Those two substances are not causing the most harm because they are more dangerous or more attractive than marijuana, cocaine or heroin. Alcohol and tobacco are, in fact, less attractive to many experienced drug users; and they are much less dangerous than marijuana, cocaine and heroin. Alcohol and tobacco produce more harm than all of the illegal drugs combined even when you include the costs of prohibition simply because alcohol and tobacco are so much more widely used. Furthermore, alcohol and tobacco are more widely used by children because their use is legal for adults.
If all drugs were declared completely legal, many people would still choose not to use them, just as many adults choose not to use alcohol and tobacco today. And even under the most severe prohibition, some people still choose to use prohibited drugs. The question, however, is this: Would legalization, when compared to prohibition, increase both the number of drug users and the social harm produced by the use of these substances? The answer is yes.
The Costs of Prohibition
Those who support legalization correctly point out that prohibition is an expensive strategy. Making the consumption of marijuana, cocaine, heroin and other drugs illegal costs society large sums of money for everything from police and prisons to the incentives that prohibition-inflated drug prices provide to illicit drug traffickers. There are costs, too, in the loss of privacy: Drug tests are widely used in the criminal-justice system, the workplace and elsewhere.
Those who support prohibition do not help their case by denying the magnitude of these costs. The question to ask is this: Are the high costs of prohibition justified in terms of reduced harm and an improved quality of life for most citizens? The evidence is clear; the answer is yes. Prohibition is worth its high costs.
The Views of Drug-Treatment Professionals
One curious aspect of the legalization controversy is that people who are involved in drug treatment almost all oppose legalization. One would think that if they were operating in their own self interest, these people would welcome legalization; after all, it would substantially increase the need for the treatment of addiction. However, drug-treatment professionals generally oppose drug legalization because their dedication to the welfare of drug users is more powerful than their dedication to their own narrow economic interests.
Talk, too, to drug abusers in treatment or to those who have successfully developed solid, personal recovery programs. Few of them support legalization; they know that such an approach would make life harder for them and for all other recovering former users.
Life After Legalization: A Projection
Since many thoughtful people have proposed the legalization of drugs as a solution to the war we are waging against the financial, social, medical and political ravages of drug abuse, I would like to share my own projection of the results of such a decision. Here is my fantasy of life after drug legalization:
Let's say some community or nation were to give it a try, putting heroin, cocaine, LSD and the whole modern menu of addicting drugs on sale in local markets. The results of the experiment would not be long in coming, and they wouldn't be hard to predict.
First the good news: As a result of drug legalization, crime costs for prisons, courts and police would fall. Tax revenues would rise, and the illegal market for the newly legal drugs would be reduced.
Then the bad news: Health and productivity costs would increase dramatically, and the net costs to society would rise substantially. Worse, the human costs from drug use would rise over time as more people who tried the drugs used them and became addicted. And the highest costs of legalization would be paid by those most vulnerable to addiction: the young and the disadvantaged.
If any community in the world would be so foolish as to try the outright legalization of marijuana, cocaine, heroin and LSD, we might have less discussion of this thoroughly unworkable and dangerous but endlessly seductive idea.
But this fantasy of drug legalization is not merely speculative. The scenario has already been played out in the real world. In 1987 the Swiss opened a drug bazaar, called "Needle Park," for a few hundred addicts. By 1992, 20,000 addicts had swarmed to Switzerland, and that nation's heroin death rate had become Europe's highest. That same year, in the face of public outrage, the Swiss police closed Needle Park.
The Better Way
It has often been said that democracy although a messy, expensive and flawed system of government is better than any of the alternatives. The prohibition of currently illegal drugs is also a messy, expensive and flawed system; but, like democracy, it is better than the alternatives. This is not to say that drug-prohibition strategies cannot be improved; they almost certainly can be. But abundant evidence gathered from many societies over many years has shown that, in general, the prohibition of drugs such as marijuana, cocaine and heroin is a reasonable and generally effective way to deal with a difficult human problem.
Robert L. DuPont, M.D., is a former director of the National Institute on Drug Abuse and the second White House "drug czar." He currently serves as president of the Institute for Behavior and Health, Inc., a nonprofit research and policy organization, and is Clinical Professor of Psychiatry at the Georgetown University School of Medicine.
(From Priorities Vol. 7, No. 2, 1995)