Is Responsible Drug Use Possible?

The Erowids assert that “Modern humans must learn how to relate to psychoactives responsibly, treating them with respect and awareness, working to minimize harms and maximize benefits, and integrating use into a healthy, enjoyable, and productive life.” Most of that assertion is innocuous. Psychoactives are ubiquitous when the term is used so broadly as to include even caffeine. However some are quite dangerous, so as a class they should certainly be treated with respect. And working to minimize harms and maximize benefits is unobjectionable in most endeavors.

What distinguishes the Erowids is their assertion that modern humans must integrate psychoactive use into life. Apparently from their perspective, choosing abstinence, at either the individual or societal level, is inherently inconsistent with being modern.

Denying or denigrating an individual’s right to choose temperance is an extreme position not worth engaging. The more familiar terrain of debate is whether the majority in a democratic society have the right to choose temperance for society as a whole.

While avoiding a full rehash of the by-now dull legalization debate, two points bear mention. First, American drug policy is easy to criticize as intrusive, ineffective, and mean-spirited. However, it does not follow that prohibition is necessarily a bad policy. Essentially every country in the world prohibits production and distribution of cocaine, crack, heroin, and methamphetamines for recreational use, even legalizers’ poster child, the Netherlands. Most affluent industrialized countries take a far less aggressive approach to their prohibitions than the United States does, yet they maintain prohibitions nonetheless. The problems with America’s prohibition stem primarily from particulars of its implementation, not from prohibition per se.

Second, the challenge is not in criticizing prohibition, but designing something better. To their credit, the Erowids offer specific suggestions in their “Fundamentals of Responsible Psychoactive Use.” I am skeptical that they constitute a practical framework for social policy, as distinct from being useful guidelines for individuals who choose to use psychoactive drugs. Note, though, that nothing about American alcohol policy precludes application of these principles. So if their advocates are successful in taming the rather considerable problems with legal alcohol, then I would take more seriously claims about the Principles’ universal efficacy with respect to all psychoactives, including, say, methamphetamine.

Even at the individual level, I wonder whether these Principles are universal. They strike me as overkill for caffeine and thin protection for the average person contemplating daily crack use. However, just as I would not want the Erowids to denigrate someone’s choice to pursue a drug-free life, I would never deny someone who opts for a drug-related life the chance to try following the Erowids’ Principles.

In practice, how responsible is use of drugs that are now prohibited? Most people who try an illegal drug do not harm themselves or anyone else. However, it is also true that most instances of drunk driving and speeding do not result in accidents, yet this does not mean that driving under the influence or speeding is a responsible way to drive. Ex post success does not imply ex ante risk taking is responsible. A prospective user’s ex ante claims to know he or she will not be among those whose use gets out of control should be met with the skepticism appropriate for rooms full of people all describing themselves as above average drivers. Teenage smokers often report knowing that tobacco is addictive but still wrongly believe that they will be able to quit whenever they want.

What are the risks of trying the big four illegal drugs (marijuana, methamphetamine, cocaine—including crack—and heroin)? Statistics vary by drug, age of first use, and other variables, but among the myriad patterns of drug use, four are common: (1) limited experimentation, (2) ongoing controlled use, (3) ongoing use that is mostly controlled but punctuated by occasional abuse, and (4) escalation to dependent use.

Limited experimentation is the most common. Roughly 20-25% of household survey respondents who report using one of these drugs say they used it only once or twice, and another 20-25% report using just 3-11 times in their life. Most people do not find the drug sufficiently appealing to incur the cost, enforcement risk, health risk, and/or social approbation of continued use. (There are exceptions. One person I know said she liked cocaine so much the first time that she knew she shouldn’t try it again.)

Ongoing controlled users can be ex post claimants to the title of fully responsible users. They might use the drug over many years, but within prescribed limits. For example, they might only use while with friends on weekends and never before driving.

The third category is like the second, but with occasional slips. Such people might sometimes believe they are competent to drive when they are not. They might occasionally binge and spend money reserved for another purpose. Or they might require a trip to the emergency room or use in ways that adversely affect their productivity the next day at work. Such people are not dependent. In between slips they can exercise control over their consumption. For example, they could decide not to go to a party where they know drugs will be used. However, once in the drug milieu, there is some risk their use will harm themselves or someone else.

The fourth category consists of people who have developed a clinically diagnosable medical condition, and have more or less permanently changed how their brain responds to certain chemicals. The resulting costs can vary from drug to drug and from case to case. Opiate dependence is much less problematic with a legally prescribed opiate, such as methadone, than when the opiate is illegal street heroin. Cannabis dependence is not uncommon, but as a functional matter, on average it is nowhere near as debilitating as dependence on crack.

To grossly simplify, about half of people who try illegal drugs stop with experimentation, and one in six end up in each of the other three categories (controlled use without and with occasional abuse and dependence). The proportions are slightly more favorable for those who only try cannabis, but less dramatically so than one might expect. At any given time, five times more people are dependent on marijuana than are incarcerated for drug-law violations, and the lifetime risk of abuse or dependence for cannabis use is on the order of one in ten.[1]

No one knows how legalization would change these probabilities. The Erowids might argue the risks would go down, particularly if their principles were applied. I would argue the opposite. The drugs would be cheaper, more easily available, and (likely) marketed aggressively; and their use would be less costly in terms of risk of arrest, loss of employment, and social approbation. In short, there would be fewer external constraints on use, and more frequent and heavier use increases the risk of dependence. For the sake of argument, let’s stick with the figure of a one-in-six risk that trying a drug will lead to dependence and associated harms.

Does society have a right to “protect” its citizens from a one-in-six risk of dependence, even though that “protection” denies five times as many people legal access to something pleasurable? The question is parallel to asking whether society has a right to pass a law against riding a motorcycle without a helmet, driving without a seatbelt, or swimming when there is no lifeguard. Note: the issue is not, “If the question were put to a referendum, would you vote yes or no?” Rather, the question is, “If the majority wanted such a law, would it be unconstitutional?” I am no constitutional scholar, but I do not believe access to a recreational activity or substance is a constitutionally protected right that forbids passage of laws designed to protect people from their own poor choices, particularly when sometimes the choices can harm others. (Granted, U.S. sanctions for violating drug laws are much more severe than in these other examples. Some of that greater severity is appropriate—even for users—given the risks, and other countries’ policies demonstrate that the unproductively excessive severity of current U.S. drug policies is not intrinsic to prohibition per se.)

American voters appear to have decided that even though responsible drug use is possible ex post, society is better off if the ex ante gamble is prohibited. Given that reality, is it responsible to willfully flout laws that are constitutional and produced by a generally fair and open democratic process? I would argue no. Civil disobedience has its place as a form of political expression, but stealthily using drugs with the objective of getting away with breaking the law is an act of selfishness, not civil disobedience. The responsible decision is to obey the law, even if doing so forecloses some pleasures, and in that respect responsible drug use is not possible in today’s society, even ex post.

Jonathan Caulkins is is Professor of Operations Research and Public Policy at Carnegie Mellon University’s Qatar Campus and Heinz School of Public Policy; he is a former director of the RAND Corporation’s Drug Policy Research Center.

[1] Anthony J.C., Warner L.A., & Kessler R.C. (1994). “Comparative epidemiology of dependence on tobacco, alcohol, controlled substances, and inhalants: Basic findings from the National Comorbidity Survey.” Experimental and Clinical Psychopharmacology 2:244-268.

Also from this issue

Lead Essay

  • In their lead essay, Earth and Fire Erowid stress the importance of developing responsible, fully informed relationships toward psychoactive drugs. Although drug prohibition has persisted for decades, the overwhelming majority of adults have tried at least one illegal drug, and these substances aren’t going away any time soon. Sadly, prohibition itself has stunted our knowledge of these substances, and, as in so many things, ignorance is both dangerous and irresponsible. Provocatively, they criticize even the word “drugs” as a tag for illegal psychoactives: Lumping them all together, they write, betrays a lack of understanding of their vastly different effects, risk profiles and — yes — benefits.

Response Essays

  • Jonathan Caulkins argues that the responsible use of psychoactive drugs is an overstretched concept, if by “psychoactive drugs” we mean everything from caffeine to heroin. In many cases, he argues, temperance may be the only responsible “use” of a given substance.

    Further, state prohibitions on pleasurable but risky acts are hardly confined to this area of law; their violation is not a genuine form of civil disobedience as long as pleasure itself is the real goal of the act. And the risks remain regardless. Duly enacted laws in a democracy deserve far more respect than this, and following the law is a part of the responsibility of all citizens.

  • Jacob Sullum notes that temperance and abstinence have been wrongly conflated, and that the Aristotelian view of temperance encompassed all of the moderate, reasoned, and honorable pleasures of life. He reiterates that virtually everyone uses psychoactive drugs of one kind or another, and that the overwhelming majority of use is responsible. He challenges the notion that the state has any interest in the private actions of individuals that do not harm anyone else, and he terms the impulse to protect people from themselves “unethical” and “an open-ended rationale for government intervention that logically leads to totalitarianism.”

  • Mark Kleiman takes up a theme already addressed by the other participants, namely the distinctions to be found within the catchall category “illegal drugs.” He notes that the risk profiles, motivations for use, and public health considerations of these substances are so far removed from one another that it may make no sense to continue to treat them as similar in public policy. Given the choice between full legalization and the status quo, he would choose the status quo, but, he argues, these alternatives should not be the only ones we consider.