About this Issue
To some degree, we all know what life is like under drug prohibition. It’s been the status quo for decades. But what would life be like without the war on drugs? This is much harder to imagine.
Those who support drug prohibition often do so with the premise, implicit or explicit, that life without prohibition would be marked by vastly more irresponsibility, addiction, accidents, health problems, and death. Those who favor ending drug prohibition are forced to argue, not only for an unfamiliar policy, but also against this parade of horribles. Yet are we not able to think about and manage these substances rationally and responsibly? If we are, then as a society, the more effective way to face psychoactive substances may simply be to allow each individual to decide for himself what role, if any, these substances will have.
For this month’s lead essay, we have invited Earth and Fire Erowid, the maintainers of the drug information site Erowid.org, to discuss how prohibition itself has shaped the way we think about drugs, and how the drug war has prevented us from forming responsible, well-informed views of psychoactive substances.
Prohibition, they argue, has created an oversimplified and caricatured view of psychoactive drugs: On the one side are legal drugs, which are presumed to be relatively safe; on the other are the illegals, and public understanding of their effects often reaches no further than rumors and “Just Say No.” This simplistic understanding has stunted any efforts toward building a culture of responsible use. Although it is virtually impossible to say that greater prohibition efforts have meant decreased drug use, these efforts certainly have produced less-informed drug use, and this has produced precisely the irresponsibility, addiction, accidents, and health problems that all of us worry about.
Commending on the Erowids’ essay will be Jonathan Caulkins, former co-director of the RAND Corporation’s Drug Policy Research Center and Professor of Operations Research and Public Policy at Carnegie Mellon University’s Qatar Campus; Jacob Sullum, senior editor at Reason magazine and author of Saying Yes: In Defense of Drug Use; and Mark Kleiman, professor of policy studies at the UCLA School of Public Policy and Social Research.
Towards a Culture of Responsible Psychoactive Drug Use
Psychoactive drugs are everywhere. Any discussion of drug use needs to take this into account. The broad category of “psychoactive drugs” consists of natural and synthetic substances that alter a person’s thoughts or feelings. There exist hundreds of plants, which, if eaten, smoked, snorted, or injected, will affect the mind—whether acting as a stimulant, depressant, or psychedelic. Thousands of known chemicals will do the same. Used recreationally, medicinally, or for work, some are illegal and others not: They include coffee, wine, and tobacco; prescription pain medications, sleep aids, and antidepressants; as well as cannabis, LSD, and heroin. Psychoactives are in the kitchen, in the hardware store, in the greenhouse, in home medicine cabinets, and in fuel tanks across the country.
Everyone uses them. Would you believe that nearly 90% of 45-year-olds in the United States have tried an illegal drug in their lifetime? As of 2006, more than 35 million Americans had taken an illicit drug in the previous year. Monitoring the Future (MTF), the best current survey about illegal drug use in the United States, reports that one in five college students used an illicit drug in the past month. Nearly all adults in the U.S. have tried alcohol, while over 80% use caffeine daily. Last year there were over 180 million prescriptions written for opiates alone, and a diverse assortment of psychoactives are increasingly used by older Americans from coast to coast.
They are not going away. Humans have used psychoactive substances for as long as we have records and some of the largest corporations in the world are actively developing new ones for the future. There is no magic bullet that will suddenly make these compounds disappear from our society. If there were, the past century of ever-increasing penalties for possession and sale of recreationally used drugs, along with massive anti-drug “education” campaigns, would have reduced use. But they have not.
The United States has implemented random drug testing of junior high and high school students who participate in chess club. No-knock warrants allow police to invade private homes with guns drawn in case a suspect might try to flush illegal drugs down the toilet. Taxpayers spend 8 billion dollars each year to incarcerate drug law offenders,[8,9] and pay for ideologically driven, abstinence-only education programs that are so factually misleading that they often fail to acknowledge the pleasurable or useful effects of the substances they teach about.
Despite these extreme measures, a majority of the population age 18-65 has chosen to try an illegal drug. The mainstream reaction is to continue the calls for “getting tougher.” Instead of working towards unrealistic, naïve goals such as a “drug free century,” our response has been to step back and reassess, asking: How can society adapt to the realities of the communication age and develop more sophistication and balance regarding the use of psychoactive drugs?
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. But above all else, in a world filled with materials and technologies that affect the mind, adults must have the robust education and accurate, pragmatic information necessary to help them take charge of their relationships with psychoactives and teach their children how to do so from an early age.
EVERYONE MAKES CHOICES
Many people would agree that drug culture reform is needed, but we must recognize that “the drug culture” now includes everyone. Modern life involves daily decisions about psychoactives. The option of caffeine use is encountered multiple times a day. It is rare to watch an hour-long television show without seeing an advertisement for a mind altering pharmaceutical or a legal recreational drug. Late night coverage of the 2008 Summer Olympics was sponsored by Ambien, a popular sleep aid with memory-scrambling side effects whose commercials enticed audiences nationwide with comforting images of dreamy, refreshing, sedative-assisted sleep. A large portion of the population is exposed to the possibility of taking LSD, even if only 10-20% ever try it.[11,12] In today’s world, everyone must choose how they relate to innumerable psychoactive drugs. Whether or not one decides to use a specific drug, that decision should be made with skill, knowledge, and self-awareness, supported by accurate information.
Struck by the quantity and complexity of choices being made about psychoactives, and dismayed by the poor quality of accessible information, in 1995 we began a project called Erowid. Dedicated to providing an online library of information about psychoactives to the public through its website Erowid.org, the project has grown to serve over 60,000 visitors per day. In 2008, Erowid became an educational 501(c)(3) non-profit under the name Erowid Center.
In thirteen years of learning about both legal and illegal psychoactives, we have collected over 30,000 documents and 75,000 self-reports that catalog the choices people make and provide insight into the results of those choices. These reports include everything from pedestrian recreational use to life-changing spiritual experiences and personal tragedies. We have also learned that there are many subcultural niches in which responsible use of psychoactive drugs is taken very seriously. These communities disapprove of recklessness, and consider care a top virtue, regardless of whether use is for recreational, medicinal, self-improvement, work-productivity, or spiritual purposes.
WHAT DOES RESPONSIBLE USE LOOK LIKE?
“Know your body. Know your mind. Know your substance. Know your source.” One of Erowid’s earliest slogans, this directive encourages people to pay close attention to multiple aspects of their psychoactive substance use. These include understanding the individuality of response; avoiding drugs contraindicated because of health issues; learning enough about each substance to avoid unexpected effects and overdoses; and choosing both substance and information sources carefully in order to reduce risks. While these principles may seem obvious, they are seldom taught in contemporary drug education.
Alcohol is a good case to study, as its use is accepted in our culture and is not illegal for those over 21. Yet healthy and pragmatic drinking practices are seldom taught by parents, schools, or the government. By the time young adults reach the legal drinking age in the United States the vast majority of them have already consumed alcohol. In 2006, according to the National Survey on Drug Use and Health, the average age at which Americans first tried alcohol was 16.5, with only one in ten waiting until they were legally of age to drink. And they haven’t just had a sip; nearly 40% of 20-year-olds have gotten drunk in the last month. The opportunity to teach responsible use of alcohol—the most commonly consumed and arguably one of the most dangerous strong psychoactives—is missed. The situation is much worse for controlled substances.
Teaching responsible, intentional use to young people does not require giving detailed instructions on how to use illegal psychoactives. The general principles can be taught through education about prescribed medications, alcohol, or other legal drugs. There are many practical lessons about how to safely and responsibly use psychoactives, whether learned from personal subjective experience, research, or the hard-won wisdom of others.
Fundamentals of Responsible Psychoactive Use
- Investigate the health risks and dangers of the specific psychoactive and of the class of drugs to which it belongs.
- Learn about interactions with other recreational drugs, medications, supplements, and activities.
- Review individual health concerns, predispositions, and family health history.
- Choose a source or product carefully to help ensure correct identification and purity
(avoid materials with an unknown source or of unknown quality).
- Know whether the drug is likely to reduce the ability to drive, operate equipment, or pay attention to necessary tasks.
- Take oneself “off duty” from responsibilities that might be interfered with (job, child care, etc.), and arrange for someone else to be “on duty” for such responsibilities.
- Anticipate reasonably foreseeable risks to oneself and others and employ safeguards to minimize those risks.
- Choose an appropriate occasion and location for use.
- Select and measure dosages carefully.
- Begin with a low dose until individual reactions are known and thereafter use the minimum dose necessary to achieve the desired effects: lower doses are safer doses.
- Reflect on and adjust use to minimize physical and mental health problems.
- Note changes in health over time that may be related to use.
- Modify use if it interferes with work or personal goals.
- Check in with peers and family and accept feedback about one’s use.
- Track reactions to specific drugs and dosages in order to avoid repeating mistakes.
- Seek treatment if needed.
- Decide not to use when the time isn’t right, the material is suspect, or the situation is otherwise problematic.
People are usually willing to modify their behavior to reduce harms and increase benefits. Just as most of those who drink alcohol prefer to avoid hangovers and dangerous levels of consumption (so long as they can still enjoy alcohol’s intoxicating effects), most users of other psychoactive drugs would also happily take steps to minimize risks. In a pilot paper looking at the impact of web-based data about psychoactive substances, Boyer et al. found that:
”[…] all respondents in our cohort modified their drug use after reviewing online drug information. This observation suggests that the Internet has a profound ability to affect decisions related to psychoactive substance use in a cohort of innovative drug users. Interestingly, 8 of the 12 participants adopted behaviors intended to minimize the risks associated with drug use, a finding that suggests that attempts to reduce the harm associated with psychoactive substances are fostered by online information.”
Some might argue the same point that professor Mark Kleiman makes in his book Against Excess: “The fact that some people can use a drug responsibly and even beneficially does not imply that it is safe. We all know people who drink and take no harm from it, and we all know people whose lives have been wrecked by alcohol.” But as Kleiman also notes, just because some people do not work to minimize risks and use a drug dangerously or to their own detriment does not mean that is true of everyone who tries it.
OBSTACLES TO RESPONSIBLE USE
Unfortunately, some actions that are part of a responsible relationship with psychoactives can also expose individuals to social and legal problems if applied to illicit drugs. Current policies and programs pose complex challenges for those wishing to use these substances as conscientiously and safely as possible.
Twentieth-century drug control policies were largely based on the idea that prohibition was the most effective way to reduce problems associated with psychoactive use. Disturbingly, prohibitionist policies have compromised individual responsibility as well as the integrity and objectivity of education, medicine, and science.
One of the fundamentals of responsible use is to know the identity and purity of psychoactives that are consumed. Yet current policies make it difficult to be sure that materials purchased on the black market are pure or even correctly identified. For example, the Drug Enforcement Administration (DEA) prohibits most testing that would help identify street drugs. Erowid Center operates the only public ecstasy testing program in the United States (www.ecstasydata.org). However, the program is hamstrung by a 1974 DEA policy that prohibits laboratories from providing quantitative data about anonymously submitted samples of controlled substances—a policy that was enacted out of concern that such testing would provide “quality control” for the black market. When forced by circumstances, most people will use illicit psychoactives without quality control. The DEA’s censorship policy is an ineffective control strategy, which stands in the way of responsible use and public health, and which gives the DEA exclusive access to information about the contents of black market drugs.
Clearly, the population should be educated about the potential harms associated with psychoactive use, but providing any other, more practical information is heretical and potentially criminal. Our government explicitly discourages nuanced education about psychoactives. For example, for state-funded programs related to illicit drugs or alcohol, California legislates that “No aspect of the program may include a message on ‘responsible use.’” Media campaigns and educational materials almost universally share a single target message, prioritizing a decrease in use over accuracy and balance. Further, many web filtering systems, including those employed by hospitals and schools across the country, explicitly censor sites such as Erowid.org because they provide useful information.
While physicians are the primary experts available to give medical opinions about drug-related health issues, current policies cause many psychoactive users not to seek treatment or advice. Those who do so may risk legal trouble, insurance problems, and disclosure of their use to employers and family. Teens, faced with a friend who has overdosed, often hesitate to call an ambulance for fear of serious repercussions; they are well aware that physicians and the health care system can not be trusted as confidants or allies when it comes to psychoactive drugs. It is important for the public to have access to the sort of personalized medical advice that is only available when they can talk to their physicians without fearing the consequences.
Current policies also skew the science. With over a billion dollars per year in public financing, the National Institute on Drug Abuse (NIDA) funds 85% of the world’s research on recreational drugs. However, it is narrowly dedicated to studying “the addictive and adverse health consequences of drugs of abuse.” NIDA’s mandate artificially stacks the deck with findings that show negative effects. Policy makers, judges, and even experts in the field can draw mistaken conclusions from this imbalanced collection of research, leading many to dismiss responsible use as an unreasonable objective.
Developing and promoting more sophisticated language, thereby learning to better discriminate between different types and classes of drugs, is the first step towards a culture of responsible use. Unfortunately, it is common for those on the national stage to use the unqualified term “drugs” when discussing psychoactive substances, as if everyone knows exactly what is meant. But cannabis is not oxycodone, nor do stimulants behave like depressants.
This “drugs” meme has done long-term damage to the public’s critical thinking skills due to the unspoken assumption that everyone knows which drugs are the bad ones. Certainly they’re not talking about ibuprofen, and probably not coffee—but how about Viagra, Prozac, or dextromethorphan (a common ingredient in cough medicines, also used recreationally)? One often hears that people should not drive while on “drugs,” but this is much truer of depressants and psychedelics and less true of stimulants. The right dose of caffeine or amphetamine has been shown to improve driving, especially among tired individuals[24,25]—a fact well known to long-distance drivers and the U.S. military. Specificity in language is necessary for making good personal decisions, teaching others, and drafting appropriate laws. Not everyone has to be an expert on all psychoactive drugs, but we do need to be critical thinkers.
EDUCATION AND ACCURATE KNOWLEDGE
Responsible psychoactive use requires access to accurate, detailed, and practical information. Education is more important than changes to control policies or social reform. Those who choose to use caffeine, cannabis, LSD, amphetamine, Ritalin, or heroin need to know how much is too much, which drugs might interact dangerously, and how to minimize risks and optimize benefits. People need to be trained to seek this information and to put it to use.
As Boyer et al. found, people are willing to modify their behavior in order to reduce risks, but this is only possible if they know what the actual risks are. Unfortunately, there are severe problems with partisan, policy-driven information sources. While the quality of government-sponsored sources has improved over the last decade, sites such as Freevibe.com, a youth-oriented website funded by the federal government, still include laughable exaggerations like “heart and lung failure“ as a general effect of hallucinogens—a deceptive claim they have made for more than eight years. Scientific literature reviews on the most common hallucinogens do not support their claims; most recently, Johns Hopkins researchers found that, “hallucinogens generally possess relatively low physiological toxicity and have not been shown to result in organ damage.” Once people realize that a source is deceptive, as is the case for those teens visiting Freevibe who know someone who has tried LSD or psilocybin-containing (“magic”) mushrooms, they will be inclined to distrust all information from that source.
Public information sources should prioritize accuracy and completeness over maintaining a single, politically driven message. It is inconsistent with the democratic ideals of American culture to corrupt information in order to support public policies. The issues are complex and sources should reflect that.
In government-sponsored information, the benefits of disapproved drug use are absent, a void obvious to all but the least curious reader. Individuals try psychoactives largely based on the belief that they will be beneficial in some way: fun, enlightening, anti-depressive, anxiolytic, inhibition-reducing, etc. A recent study has confirmed what many users of “magic” mushrooms have described for decades: In the right context, the effects can be profound and can improve quality of life. According to the researchers, “67% of the volunteers rated the experience with psilocybin to be either the single most meaningful experience of his or her life or among the top five most meaningful experiences of his or her life.”
While there is no question that the specialized, supportive circumstances of this research made positive reactions more likely and reduced the chance of negative outcomes, the findings are also consistent with a large survey conducted on Erowid.org in 2005 that asked about the life impact of LSD use. With nearly 50,000 valid responses, 53.4% of those who reported having taken LSD said that it had affected their life positively, compared to 3.4% who said it had a negative impact (21.9% reported “no effect,” 17.2% reported a “mix of positive and negative effects,” and 4.1% did not answer or didn’t know). As of September 2008, none of the top government-funded public drug information websites had a single mention of any benefit associated with psilocybin.
Misrepresentation and oversimplification in this complex field of study damage society’s ability to engage in accurate and honest dialog about issues that affect everyone’s daily lives. When private or government-sponsored prohibitionist organizations are found untrustworthy, people seek information elsewhere. Unfortunately, advice provided by peers about the risks and benefits of recreational drugs can also be of dubious value. Teenagers, especially, can not provide each other with the quality of information they need and deserve.
Public educational resources need to provide comprehensive, honest information in order to be worthy of trust. To climb out of the well of distrust our culture has dug, students, teachers, parents, law enforcement officers, medical professionals, marginalized subcultures, and the general public all need to look to the same libraries, rely on the same sources, and expect balance and neutrality in the reporting of scientific findings. Establishing a culture of responsible use—built on a foundation of unbiased, factual information—is essential to the practical long-term management of psychoactives in our society.
[Conflict of Interest Disclosure: This article was written partially under the influence of oolong tea, diet cherry Coke, and California chardonnay.]
Fire and Earth Erowid are the co-founders of Erowid Center, an IRS-approved 501(c)(3) non-profit educational organization which runs Erowid.org, an online library of information about psychoactive plants and chemicals.
 Johnston LD, O’Malley PM, Bachman JG, et al. “Monitoring the Future National Survey Results on Drug Use, 1975-2006. Vol II.” NIDA. 2007. 98.
 SAMHSA. “Results from the 2006 National Survey on Drug Use and Health: Appendix G.” 2007. Table G.3.
 Erowid E, Erowid F. “How Do They Measure Up? Part II: The Problems.” Erowid Extracts. Nov 2005;9:16-21.
 Griffiths RR, Mumford GK. Caffeine: A Drug of Abuse? in Psychopharmacology: The Fourth Generation of Progress. Edited by Bloom FE, Kupfer DJ. New York, Raven Press, 1995.
 Volkow ND. “Statement on Scientific Research on Prescription Drug Abuse before the Senate Judiciary Subcommittee on Crime and Drugs.” Mar 12, 2008.
 SAMHSA. “Older Adults: Substance Use and Mental Problems.” http://www.oas.samhsa.gov/aging.cfm Accessed Sep 4, 2008.
 Erowid. “Alcohol Timeline.” Erowid.org. Jul 9, 2006. Available from http://www.erowid.org/alcohol/alcohol_timeline.php. Accessed Sep 2, 2008.
 Drug War Facts. “Prisons, Jails and Probation – Overview.” drugwarfacts.org. Aug 1, 2008. Available from http://www.drugwarfacts.org/prison.htm. Accessed Sep 2, 2008.
 Federal Register. Jun 6, 2007;72(108):31343. http://cryptome.org/bop060607-2.htm.
 Substance Abuse and Mental Health Services Administration (SAMHSA). “Results from the 2006 National Survey on Drug Use and Health: Detailed Tables.” 2007. Tables 1.11A.
 Substance Abuse and Mental Health Services Administration (SAMHSA). “Results from the 2006 National Survey on Drug Use and Health: Detailed Tables.” 2007. Tables 1.1+.
 Johnston LD, O’Malley PM, Bachman JG, et al. Monitoring the Future National Survey Results on Drug Use, 1975-2006. Vol II.” NIDA. 2007. 108.
 Erowid. “The Distillation: Erowid Traffic Statistics.” Erowid Extracts. Jun 2008;14:25.
 SAMHSA. “Results from the 2006 National Survey on Drug Use and Health: National Findings.” Office of Applied Studies, NSDUH Series H-32, DHHS Publication No. SMA 07-4293. 2007.
 SAMHSA, Office of Applied Studies, “National Survey on Drug Use and Health.” 2002, 2003, 2004, 2005, and 2006. http://oas.samhsa.gov/NSDUH/2k6NSDUH/AppG.htm#TabG-20. The statistic comes from the survey’s definition of binge drinking, namely consuming five or more drinks on a single occasion.
 BBC News. “Scientists Want New Drug Rankings.” news.bbc.co.uk. Mar 23, 2007.
 Boyer EW, Shannon M, Hibberd PL. “The Internet and psychoactive substance use among innovative drug users.” Pediatrics. 2005;115(2):302-5.
 Kleiman MAR. Against Excess: Drug Policy For Results. Basic Books. 1992. 386.
 “Effectiveness of Drug Analysis Curbed.” The PharmChem Newsletter. 1974;3(4):1.
 Safe and Drug Free Schools and Communities Act. U.S. Code, Title 20, Ch. 70, Subch. IV, Pt A, Subpt 4, § 7162.
 National Institute on Drug Abuse. “NIDA Research Identifies Factors Related to Inhalant Abuse, Addiction.” Sep 28, 2004. http://www.drugabuse.gov/Newsroom/04/NR9-28.html. Accessed Sep 2, 2008.
 Volkow ND. “Statement by NIDA Director Nora D. Volkow. Nida.nih.gov. Jul 11, 2006. http://www.nida.nih.gov/about/welcome/messagepsilocybin706.html. Accessed Sep 2, 2008.
 Silber BY, Croft RJ, Papafotiou K, et al. “The acute effects of d-amphetamine and methamphetamine on attention and psychomotor performance.” Psychopharm. Aug 2006;187(2):154-69. http://www.ncbi.nlm.nih.gov/pubmed/16761129.
 Michael N, Johns M, Owen C, et al. “Effects of caffeine on alertness as measured by infrared reflectance oculography.” Psychopharm. Jun 9, 2008. http://www.ncbi.nlm.nih.gov/pubmed/18537025.
 Borin E. “The U.S. Military Needs Its Speed. Wired. Feb 10, 2003.
 Johnson MW, Richards WA, Griffiths RR. “Human hallucinogen research: guidelines for safety.” J Psychopharm. Aug 2008;22(6):603-20.
 Griffiths RR, Richards WA, McCann U, Jesse R. “Psilocybin can occasion mystical-type experiences having substantial and sustained personal meaning and spiritual significance.” Psychopharm. Aug 2006;187(3):268-83.
 Erowid F, Erowid E. “Erowid Visitors on LSD.” Erowid Extracts. Jun 2006;10:10-12.
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.
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.
 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.
To say that “modern humans must learn how to relate to psychoactives responsibly,” as Earth and Fire Erowid do, is not the same as “denying or denigrating an individual’s right to choose temperance,” as Jonathan Caulkins suggests. First of all, what the Erowids are preaching is temperance. Aristotle defined that virtue this way:
The temperate man holds a mean position with regard to pleasures… . Such pleasures as conduce to health and bodily fitness he will try to secure in moderation and in the right way; and also all other pleasures that are not incompatible with these, or dishonorable, or beyond his means… . The temperate man desires the right things in the right way and at the right time.
This was the approach initially advocated by the American temperance movement: moderation enforced by self-discipline. Eventually activists concerned about alcohol abuse adopted a different goal, demanding abstinence enforced by law. That change was driven by the conviction that voluntary temperance was a dangerous illusion because alcohol was inherently addicting—the same sort of false belief that underlies the prohibition of the currently illegal intoxicants. I realize Caulkins is merely following semantic convention when he uses temperance to mean abstinence. But the equation of temperance with abstinence lies at the heart of the ideology behind the war on drugs, according to which all use of illegal drugs is abuse.
Recognizing the error of that view does not mean insisting that everybody must get stoned. For some individuals, abstaining from certain drugs might be the most responsible way of relating to them. If you do regrettable things when you drink, have bad trips when you use psychedelics, or go on binges when you snort cocaine, these drugs may not be for you.
Still, very few people consistently avoid psychoactive substances. Even those who ostensibly do, usually for religious reasons, tend to make exceptions. Mormons, though officially drug free, do not eschew chocolate, and they disagree about whether caffeinated beverages other than tea and coffee are permitted. Mostly Mormon Utah leads the country in antidepressant prescriptions.
The point is not to mock the Mormons for their inconsistency but to suggest that the urge to achieve altered states of consciousness (often, but not necessarily, with the help of drugs) is deeply rooted in human nature. As the psychopharmacologist Ronald Siegel has shown, this is not a tendency limited to “modern humans” (or even to humans). For as far back as we have archeological evidence, and in cultures all over the world, there are indications of psychoactive drug use. Nowadays the options for those seeking to satisfy what Siegel calls “the fourth drive” are more numerous and varied than ever before, so in a sense it is harder to be well-informed and choose wisely. At the same time, it is easier to obtain relevant information (from sources such as Erowid.org) and find the drug that is right for a particular person and purpose.
Caulkins suggests it’s unrealistic to expect people to make responsible drug choices, saying, “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.” But while it’s impossible, by definition, for all drivers to be above average, Caulkins himself concedes that the vast majority of people are able to use drugs without causing serious harm to themselves or others. This majority probably would be even bigger in the absence of prohibition, which most deters those least prone to abuse, creates additional drug hazards, and makes it harder to inculcate a culture of responsible use.
Indeed, Caulkins argues that it’s impossible to use illegal drugs responsibly, because “the responsible decision is to obey the law.” He claims it’s wrong to disobey a prohibition approved by the majority, except through open civil disobedience. While the illegal status of a drug creates additional risks that a prudent user must weigh, including the possibility of arrest and the unreliable quality of black-market products, I can’t agree that people are morally obligated to obey an unjust law.
I see the drug laws as unjust because they go beyond the proper function of government by punishing people for actions that violate no one’s rights. By likening drug use to speeding and to driving while intoxicated, Caulkins obscures the distinction between self-harming behavior and behavior that endangers others. Still, he clearly believes it’s appropriate to forcibly protect people from risks they voluntarily assume, whether by using drugs, “riding a motorcycle without a helmet, driving without a seatbelt, or swimming when there is no lifeguard” (even in your own swimming pool?). I see “laws designed to protect people from their own poor choices” as unethical impositions and dangerous precedents, based on an open-ended rationale for government intervention that logically leads to totalitarianism.
We are not going to resolve this issue here, but it might be helpful to consider suicide: Does the government have a right and/or duty to prevent people from deliberately killing themselves? If so, perhaps it also has a right to prevent them from engaging in activities that might lead to death or serious injury, or even to the more benign fate of a drug habit (involving marijuana or legal opiates, say) that causes little measurable harm. But if the government does not have any business second-guessing someone’s decision to commit suicide, it’s hard to see how it can justifiably use force to stop him from smoking pot or snorting cocaine.
“Just as I would not want the Erowids to denigrate someone’s choice to pursue a drug free life,” Caulkins writes, “I would never deny someone who opts for a drug-related life the chance to try following the Erowids’ Principles.” Yet clearly he would, because “the responsible decision is to obey the law.” That injunction is inconsistent with the Erowids’ approach to drugs, which says we should decide whether and how to use them based on a rational assessment of their risks and benefits, as opposed to blindly heeding the arbitrary distinctions enshrined in our drug laws.
Jacob Sullum, a senior editor at Reason and a nationally syndicated columnist, is the author of Saying Yes: In Defense of Drug Use (Tarcher/Penguin).
 Aristotle, Ethics, translated by J. A. K. Thomson. New York: Viking Penguin, 1976, pp. 139, 141.
 Julie Cart, “Study Finds Utah Leads Nation in Antidepressant Use,” Los Angeles Tiems, February 22, 2002.
Ronald K. Siegel, Intoxication: Life in Pursuit of Artificial Paradise. New York: E. P. Dutton, 1989.
Drug Policy in Principle, and in Practice
I should start where Earth and Fire Erowid ended: by declaring my conflicts of interest. Earth and Fire are my longtime friends, and I greatly admire the erowid.org project of conveying accurate information about psychoactives to people facing real choices about their own behavior. Jonathan Caulkins has been my friend for even longer, and I have been learning from him ever since he was a graduate student and I was an outside reader of his Ph.D. thesis. Jacob Sullum I don’t know personally, but I have benefited from his writing even when (as I usually do) I disagreed with it. Cato Unbound is to be commended for having assembled a symposium free both of the usual drug war rant and of the usual “drug policy reform” rant.
It seems to me that to some extent Jon Caulkins on the one hand and the Erowids and Jacob Sullum on the other are talking past one another. Earth and Fire, and Jacob, are thinking primarily about drugs from which people often derive, or at least think they derive, lasting benefit: cannabis and the hallucinogens. Jon is thinking primarily about drugs from which people often derive damage, and as a result of which they damage others: cocaine and heroin and smoked, snorted, or injected methamphetamine.
In making that differentiation, I am relying neither on pharmacology nor on my own subjective impressions, but on user self-reports. I have both read and heard many accounts in which people described in some detail the benefits they think they have received, and what they think they have learned about themselves, other people, and the world they live in, from the use of cannabis and the hallucinogens, and argued that others should at least consider their use. But although I have heard and read many accounts of the pleasures of heroin, methamphetamine, and cocaine use (and, for that matter, alcohol and tobacco use) I have never heard or read anyone explain what he or she purports to have learned from the use of those drugs, or any other sort of lasting benefit. (Put aside for the moment the benefits of moderate alcohol consumption in reducing “bad” cholesterol.) That is not to deny that cannabis and the hallucinogens can do damage; of course they can. But (and this is scientifically demonstrable) the rates of damage are much, much lower for cannabis than for the heroin, cocaine, methamphetamine, alcohol, and tobacco, and so much lower for the hallucinogens as to constitute them a separate topic.
So Jonathan and the others are feeling different parts of the elephant. No surprise that they offer different reports about its nature. Caulkins can reasonably dismiss the benefits forgone in obeying the current drug laws as mere “pleasure,” because he is concentrating on drugs that merely give pleasure. The Erowids and Sullum aren’t prepared to concede that point, because they’re thinking about a different group of drugs. Banning “magic” mushrooms has more in common with religious persecution than it does with sound policy to protect public health and safety. [Gable 2008; Griffiths et al. 2006]
The abuse statistics quoted by Caulkins are correct so far as they go, but require handling with caution. Even fairly severe drug abuse is, more often than not, a transient phenomenon. About two-thirds of those who meet diagnostic criteria for substance abuse disorder now will not meet those criteria three years from now, with only a negligible fraction having had any formal treatment. [Heyman 1996] We think of drug abuse as a “chronic, relapsing disorder” because only those with the chronic, relapsing form of drug abuse disorder come in for treatment, and primarily the same people show up in the criminal justice system. This proposition is true about alcohol abuse as well as about the abuse of the currently illicit substances.
Still, I think Caulkins could make a plausible case that the decision to start to use alcohol or tobacco or cocaine or heroin or methamphetamine (in other than pill form) is an ex ante bad decision, because the relatively modest gain from successfully controlled use, multiplied by the probability of achieving controlled use, is outweighed by the very heavy losses from falling into even relatively transient abuse and the extreme losses from falling into chronic abuse, multiplied by those probabilities. The expected value of the gamble may well be negative, even if most people who take the gamble come out somewhat ahead of the game, because the average loser loses more than the average winner gains.
Thus Caulkins has a reasonable argument that voters might reasonably decide to protect their fellow citizens from the risk of falling into substance abuse disorder, even at the expense of missing the pleasures of moderate use. But that argument applies with much less force to cannabis, where the risks of falling into abuse are comparable (somewhat lower, but still in the range of 10%) but the losses are much smaller than is the case for the other “big three” illicit drugs or for alcohol. And it would be extraordinarily hard to make out a comparable case for, e.g., psilocybin. At the same time, alcohol is much closer in its risks to snorted cocaine than it is to cannabis. So I am less willing than Jonathan is to attribute even a workable level of rationality to the electorate, as influenced by various sorts of opinion leaders and public officials, and therefore less willing to give those political outcomes great moral weight.
It seems to me that Jacob Sullum is right to say that Caulkins takes away with one hand what he gives with the other: First he claims that he would not deny anyone the choice of trying to achieve moderation in drug use, but he goes on to argue that, under legal prohibition, the only moderate course is complete abstinence. Again, that seems to me largely true about the drugs Caulkins has most in mind (though I would differ with him on cannabis) but not true for a range of other drugs.
And while it is arguably the duty of a good citizen not to support illicit enterprise, it should be noted that if everyone followed the Caulkins rule there would be little opportunity to accumulate new information about whatever drugs are currently illicit, and thus no chance to revise the laws in light of new experience, especially given the pressures to conform science to policy in the name of “drug abuse prevention.” Here John Stuart Mill’s argument for the value of deviation from social norms in adding to the stock of knowledge seems to me to deserve considerable weight.
Still, having thus far largely disagreed with Caulkins in principle, I largely agree with him in practice. The damage done to users and others by heroin, cocaine, and methamphetamine dwarfs in social importance the gains and losses, actual and potential, from cannabis and the hallucinogens. So given a straight-up choice between the current drug laws and a libertarian regime under which all drugs would be treated as more or less ordinary articles of commerce, I think about what the brewing and cigarette industries, and their marketing (and lobbying) arms, could do if given cocaine to play with, and recoil in horror toward the current state of affairs.
The argument “Crack is bad; therefore psilocybin should remain illegal” is transparently false. But so is the corollary “Psilocybin has moderate risks and great potential in facilitating personal growth; therefore crack should be sold at the 7-11.”
Caulkins and I could probably go on at length about all the ways in which the costs of the current prohibitions, especially in the forms of violence, incarceration, and infectious disease, could be reduced without allowing the massive increases in abuse levels that would surely result from commercialization. [Boyum and Reuter 2005; MacCoun and Reuter 2001] To offer three specifics: We could reduce violence and drunken driving by raising alcohol taxes [Cook 2007, Cook forthcoming], we could shrink the illicit drug markets and reduce recidivism by using drug testing and swift, automatic, and mild sanctions to force probationers to stop using expensive illicit drugs [Kleiman 1998, Hawken and Kleiman 2007, Schoofs 2008], and we could break up street drug markets, thus protecting neighborhoods, with low-arrest drug crackdowns [Kennedy 2008, Schoofs 2008]. I would far rather discuss those opportunities for practical improvement than debate the largely academic question about whether the regulation of abusable psychoactives is a legitimate function of the state.
Surely Earth and Fire are right that achieving the optimal level of use for the wide and widening variety of available psychoactives is a challenge that faces contemporary individuals. Surely Jon is right that for many of those psychoactives the optimum is zero. But I doubt that the line between drugs that might responsibly be tried and those best left entirely alone follows the line between currently licit and currently illicit substances.
Mark Kleiman is professor of public policy at the UCLA School of Public Affairs. He is the editor of the Journal of Drug Policy Analysis. His book When Brute Force Fails: Strategy and Crime Control will be out from Princeton University Press next summer.
Boyum, D. and P. Reuter (2005) An Analytic Assessment of U.S. Drug Policy. Washington: AEI Press.
Cook, P. J. (2007) Paying the Tab: The Costs and Benefits of Alcohol Control. Princeton: Princeton University Press.
————— (2008) “A Free Lunch.” Journal of Drug Policy Analysis (forthcoming).
Gable„ R. S. (2008) “Regulatory Risk Management of Psychoactive Substances.” Law & Policy 14(4):257-276.
Griffiths, R.R., W. A. Richards, U. McCann and R. Jesse(2006) “Psilocybin can occasion mystical-type experiences having substantial and sustained personal meaning and spiritual significance.” Psychopharmacology 187:268–283.
Hawken, A. and M. Kleiman (2007) “H.O.P.E. for Reform: What a novel probation program in Hawaii might teach other states.” American Prospect Online, April 10.
Heyman, G.M. (1996). “Resolving the contradictions of addiction.” Behavioral and Brain Sciences 19(4): 561-610.
Kleiman, M. (2001) “Controlling drug use and crime with testing, sanctions and treatment” in Heymann, P. & Brownsberger, W., Drug Addiction and Drug Policy: the Struggle to Control Dependence, pp. 168–192. Cambridge, MA: Harvard University Press.
MacCoun R. J. and P. Reuter (2001) Drug War Heresies: Learning from Other Vices, Times, and Places. Cambridge: Cambridge University Press.
Schoofs, M. (2006) “Novel Police Tactic Puts Drug Markets Out of Business.” Wall Street Journal September 27, p. A1.
——–. (2008) “Scared Straight…by Probation.” Wall Street Journal, July 24, Page A11.
Comments on Integrating Use into Life, Civil Disobedience
I fully agree with Sullum that saying modern humans must relate to psychoactives responsibly is not the same as denying an individual’s right to choose temperance. However, the Erowids’ full statement was
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.
I explicitly wrote that “most of that assertion is innocuous,” but singled out the part about the necessity of integrating use into life as not respecting someone’s right to choose not to use a drug.
The rest of Jacob’s essay goes on to articulate clearly where he and I do disagree. We both agree that people are not morally obligated to follow a sufficiently unjust law, but disagree about whether prohibiting recreational use of certain psychoactive drugs is sufficiently unjust in
this sense. I believe a citizen’s general obligation to obey democratically enacted laws holds in all but extreme cases; examples of exceptions might include overtly racist laws such as the former apartheid laws in South Africa. A law can be misguided or ineffective or paternalistic without being unjust in the sense of nullifying one’s duty to obey that law.
As a final clarification, I’m not sure, as Sullum suggests, that I “clearly [believe] it’s appropriate to forcibly protect people from risks they voluntarily assume.” I approach such issues on a case-by-case basis, with a strong prior bias against government intrusion. However, if my side loses in the political process, and a restrictive law is passed, I think it is my responsibility to accept the disappointment gracefully and comply with the law (again, assuming the law is constitutional, is not akin to South Africa’s old apartheid laws, etc.).
What’s Wrong with Pleasure?
First, let me say that I appreciate the (sadly rare) opportunity to debate drug policy with well-informed, intellectually honest people who do not take for granted the correctness of the categories laid out in the Controlled Substances Act. I think all of us agree that many aspects of the war on drugs are counterproductive, if not downright cruel, and that much of what the government says about illegal intoxicants is not true.
I guess I disagree with both Jonathan Caulkins and Mark Kleiman about how big a deal it is to dictate which substances people may introduce into their bodies. Since I start from the premise that self-ownership is the source of all rights, the attempt to regulate the contents of people’s bloodstreams (and, indirectly, the contents of their minds) seems like a fundamental violation of liberty to me. In my view, this sort of restriction would be justified only in the most extreme cases, involving violations of other people’s rights. If a particular drug consistently drove people to violence, for example, prohibiting consumption of that drug might be justified, since consuming it would be tantamount to an act of aggression. More generally, if psychoactive substances really were the magical potions they are reputed to be, causing people to do evil without regard to their own values, intentions, and choices, prohibition would make a lot more sense, although I suspect it would hardly be necessary, since few people would want to surrender their wills in this way.
While Mark recognizes the important role psychedelics can play in people’s lives, I fear he is too ready to judge the value of other people’s drug use and deny them the freedom to consume psychoactive substances when the benefit does not rise above “mere pleasure.” I don’t know about you, but I like pleasure. I see nothing wrong with taking LSD simply because it’s fun, even if no revelations are forthcoming. Likewise snorting cocaine at a party, taking MDMA at a rave, or smoking pot to enhance the enjoyment of music or a good meal. I will go out on a limb and say that if people can get pleasure without hurting themselves or anyone else, that’s a good thing.
Even if I’m puzzled by the ways other people get pleasure, I would not presume to forcibly stop them except in defense of myself or others. The state should be governed by the same principle.
Mark puts alcohol (cardiovascular benefits aside) in the category of merely fun drugs. Although I’m not sure I’ve ever really “learned” anything from alcoholic beverages (except, perhaps, when to stop drinking), they enhance my life in many ways. I resent the idea that I should be prohibited from consuming them simply because other people use them to excess. Most Americans feel the same way about this particular variety of the addict’s veto. But they do not see the war on drugs as analogous to alcohol prohibition, because they believe the currently illegal intoxicants are intrinsically different from alcohol in a way that makes it impossible to use them responsibly. By contrast, the participants in this discussion recognize that virtually all of the problems associated with illegal drugs are also associated with alcohol, usually to a greater degree. Despite that fact, I would not support a ban on alcohol, which I see as unjustified in principle and apt to cause more harm than it prevents.
I don’t think Mark or Jonathan wants to bring back alcohol prohibition either, but I’m curious about their reasoning. How important is the lack of majority support for such a policy? Do Mark and Jonathan oppose alcohol prohibition simply because they believe the costs would outweigh the benefits? And why does the cost-benefit analysis come out differently in the case of alcohol than it does in the case of cocaine, heroin, or methamphetamine? Does the moderate drinker (or the alcoholic, for that matter) have a valid moral objection to prohibition?
Taxation and Specific Prohibition
Jacob Sullum asks whether I’d favor alcohol prohibition. Under existing U.S. conditions, I wouldn’t. There’s no public support for it. Compliance would be poor, and the illicit market large. The amount of public force required to overcome such a strong cultural pattern is greater than the evils of alcohol can justify. Cocaine is different, not especially because it’s more dangerous (I don’t think we know that, and in fact what I’d be most worried about is use of the two drugs together) but because there are fewer cocaine users.
Were I asked to legislate for a nation where alcohol was currently banned and where drinking was not currently a well-established practice, I’d be inclined to leave the law as it was. Why import a drug problem you don’t already have?
But since neither alcohol prohibition nor cocaine legalization is in the set of potentially politically feasible options, it might be more productive to talk about things we could do to reduce the damage done by alcohol and by cocaine without changing the legal status of either drug.
The average tax on a drink (about three-quarters of an ounce of absolute alcohol) in the form of a 12-ounce can of beer is about a dime. The tax on alcohol packaged as wine is somewhat less, on spirits somewhat more. Doubling those taxes would reduce the rates of homicide and motor-vehicle fatalities by several percent. The burden on moderate drinkers would be light: At two drinks a day, the tax increase would be about $6 per month. I support that increase. (I would support an even larger increase if I thought it had a chance of passing into law.) How about you, Jacob?
Right now, someone convicted of drunken driving loses his license to drive. But his license to drink is irrevocable, no matter how badly he behaves under the influence. I support a proposal originally offered by John Stuart Mill: a “specific prohibition” on drinking (for some period of time) for those convicted of drunken driving, drunken assault or sexual battery, or repeated instances of disorderly conduct under the influence. That prohibition would have to be enforced by the sellers; in effect, everyone would have to be “carded” before buying a drink or a bottle or a six-pack, just as youthful-looking buyers now are, and the driver’s license or other identity document used to establish age would have to be re-issued after a conviction to make it not usable as a “drinker’s license.” Here we are dealing with people whose drinking has already caused them to violate the rights of others. Jacob, can I count on your support?
A License to Drink?
Mark, I am curious about the basis for your assertion that doubling alcohol taxes “would reduce the rates of homicide and motor-vehicle fatalities by several percent.” I agree that the tax rate per ounce of pure ethanol should be the same for different alcoholic beverages, but in my view the appropriate rate is zero. I oppose special taxes on alcohol because they punish the majority for the sins of a minority.
In principle, I do not object to the idea of demanding that people convicted of driving while intoxicated stop drinking for a specified period of time as part of their sentence. It does seem analogous to demanding that they stop driving, and (unlike in the case of alcohol taxes) the burden is imposed on individuals who have actually harmed others (or at least endangered them).
But if enforcing such restrictions entails issuing everyone a revocable “drinker’s license,” this narrowly focused solution becomes a broad burden on drinkers generally. It transforms a right into a privilege, inviting activists, public health officials, judges, and legislators to invent new reasons for telling people they may no longer drink. These may include excessive consumption that hurts only the drinker himself or even misdeeds with no connection to alcohol at all, just as driver’s licenses can be suspended for offenses (marijuana possession, for example) that have nothing to do with driving. Instead of requiring all drinkers to obtain, maintain, and present licenses that allow them to consume alcoholic beverages, why not require people convicted of drunken driving to demonstrate their sobriety through ignition interlocks and/or random, unannounced testing?
I notice that both Mark and Jonathan Caulkins want to limit this discussion (and drug policy debate generally?) to reforms they consider politically feasible. I’m happy to discuss modest changes that can realistically be achieved in the short term, and I welcome the contributions that both Mark and Jonathan have made to reducing the harm caused by the war on drugs. But I reject the idea that more dramatic changes, such as the full-scale decriminalization of marijuana or the wholesale repeal of drug prohibition, should always be off the table because they’re not going to happen anytime soon. Clearly, such changes do happen: Drugs that once were legal are now prohibited, and vice versa. Talking about big changes in the law is part of the process of making them happen. Those of us who see drug prohibition as a great injustice are in this for the long haul; we realize that it took many years to reverse other egregiously wrong policies that were once considered beyond debate by serious people.
Reductio ad Absurdum
I can think of no more powerful argument for maintaining the existing drug prohibitions than the almost universal opposition on the part of people who call themselves “drug policy reformers” to any effective action to control the damage done by the currently licit drugs.
Every year, more than 20,000 Americans die as the result of other people’s drinking, and yet Jacob is against even modest taxes on alcohol. He nominally supports a ban on drinking by people who behave badly while drunk while opposing the one administrative mechanism that would make such a ban effective. Is a dime a drink and showing your driver’s license to the bartender such an intolerable price to pay for saving thousands of lives? [For the data about the benefits to non-drinkers of raising alcohol taxes, see Philip J. Cook’s book Paying the Tab (Princeton University Press, 2007).]
In practice, the slogan “Let’s replace prohibitions with taxes and regulations” turns out to mean “Let’s make addictive intoxicants ordinary articles of commerce.” John Stuart Mill would not approve. Drinking, even to excess, can be, Mill says, self-regarding behavior and beyond the legitimate scope of regulation. But commerce, he points out, is irreducibly social, and the sellers of dangerous commodities can reasonably the required to take steps to moderate those dangers.
Not an Argument for Legalization
It is surprising and unfortunate that Jonathan Caulkins chose to read our essay as an argument for “legalization,” as it neither included any calls for major changes in current drug control policies nor did it lay out an idealized drug policy for the future. The suggestion we are making, instead, is for providing accurate, pragmatic information to the public about psychoactives (regardless of their legal status) in order to help everyone make decisions about these substances as responsibly as possible.
The three respondents to our article declined to address its central theses, preferring to spin off onto arguing the “by-now dull legalization debate.” Perhaps we should have subtitled our article
“Not An Argument For Legalization.” The inability to discuss topics even related to the War on Drugs without being driven into a position for or against “legalization” is symptomatic of the wider problems around psychoactive drugs and drug policy in our culture. The discussion that has followed was articulate, highly informed, and interesting, but had little to do with the topic of our essay.
Despite Caulkins’ dramatic claim that we assert that “abstinence is inconsistent with being modern,” we do not argue that everyone must consume illegal drugs, nor do we suggest that absolutely everyone uses psychoactives. We are simply pointing out an obvious but poorly understood reality: Every adult is confronted with choices about psychoactives, since they are widely present in foods, drinks, and medications. A vast majority of the population does ingest psychoactive drugs with varying degrees of education or awareness. We appreciate Caulkins taking up the cause of the 0.5-2% of the population who are lifetime abstainers, since our essay could apparently be read as ignoring that population. Thanks to Jacob Sullum for taking on Caulkins’s mischaracterization.
Caulkins seems resistant to looking at these substances as a broad category spanning legal to illegal, safer to more dangerous, plants to pharmaceuticals. We believe that it’s necessary to draw appropriate parallels between legal and illegal psychoactives (for instance, talking about the similarities in the effects and uses of the stimulants caffeine and amphetamine) as well as appropriate distinctions between specific drugs. More resolution in education will help our society have a healthier dialog about the inherently complex process of choosing whether or not to use drugs that directly affect the decisionmaking process itself.
The increasing exposure to psychoactive drugs (and non-drug technologies, a critical subject not explored in our essay) heightens the need for high-quality education. Society should, we argue, teach its citizens to be aware the effects of the pharmaceuticals they ingest, to be aware that their morning coffee or evening glass of wine affects their attention and judgment, to know that trying MDMA (ecstasy) or antidepressants can affect their worldview, to consider that regular use of methamphetamine or Xanax (alprazolam) can influence the decisions that they make. People should be taught the skills and techniques necessary to stop and think through the realistic possible outcomes of specific types of psychoactive use before they are faced with making real life decisions about their own use, keeping in mind, of course, that this definition of use encompasses abstinence on one end of a continuum.
Caulkins says, “… nothing about American alcohol policy precludes application of [our Fundamentals of Responsible Psychoactive Use].” He seemingly missed the point in our article where we note that California legislates that (with regard to underage use) “No aspect of the program may include a message on ‘responsible use’ [of alcohol].” Caulkins then comments that if the “Fundamentals” worked with alcohol, he would take them more seriously with respect to all psychoactives — specifically pointing out methamphetamine. Yet methamphetamine is a prescription drug, and presumably many people who use it legally do so without problems. On a societal level, there has been a change — with regard to alcohol — where one of the Fundamentals (“Anticipate reasonably foreseeable risks to oneself and others and employ safeguards to minimize those risks”) is much more widely accepted and promoted these days than in the past. Many drinkers designate a sober driver or take cabs; surely these practices have reduced harm. Our list of Fundamentals is not presented as a perfected solution, but is instead intended to illustrate the types of actions and considerations that can help improve people’s interactions with psychoactives.
Though Caulkins says that he “would never deny” people the chance to try following our Fundamentals of Responsible Psychoactive Use, he appears to dismiss both the potential benefits of the Fundamentals as well as even the possibility of “Responsible Use” of illicit psychoactive drugs. We strongly disagree with the implications of his final paragraph, which implies that responsible use of an illegal substance is impossible, because the very act of breaking the law is fundamentally irresponsible. One arguably irresponsible act does not have to result in all following choices being made irresponsibly and unhealthily as well. Those who drink alcohol underage or use heroin in their home have broken the law, but we would still choose to persuade such people not to get in a car and drive. Whether it’s caffeine while working, daily crack cocaine use, or the once-in-a-lifetime experiment with LSD, we would like to see everyone be trained to evaluate their behavior against a set of responsible use guidelines. We don’t argue that our proposed guidelines are the be-all and end-all for this list, but they’re a starting point.
Regardless of whether our society implements prohibition, legalization, or any control scheme in between, there will be people choosing to use strong psychoactives. Those who consume any psychoactive drug, legally or not, deserve access to pragmatic information, helpful use strategies, and guidelines that will reduce the harms and increase the benefits associated with use.
In reacting to the comments made by Caulkins, both Sullum and Kleiman got pulled into a debate over prohibition. By characterizing us and Sullum as being focused on cannabis and hallucinogens and Caulkins as being focused on cocaine, heroin, and methamphetamine, Kleiman suggests that we are simply talking past each other. However the miscommunication is not that we are focused on different substances. Does Kleiman think that government and educational institutions should intentionally misrepresent some drugs to promote prevention? If methamphetamine is the scourge of the 21st century, is it reasonable to exaggerate its harms and not mention that it is considered medically safe to prescribe to children?
For the purposes of our primary thesis about the importance of accurate information and our hypothesis that more robust education about psychoactives can lead to more responsibility over time, drug control policies are moot. We would argue the same points about cocaine, cannabis, or alcohol whether they were legally available or if they were the most strictly prohibited drugs. To restate this as clearly as possible: We are not arguing for “legalization;” we are arguing for better information and education.
Perhaps our ideas are so uncontroversial that they aren’t any fun to argue!
 We are unaware of any surveys that have attempted to assess individuals’ lifetime psychoactive use. Estimates of lifetime use of behaviorally active levels of caffeine vary between 96% and 99%. Lifetime use of alcohol among adults is estimated around 90%. Combining caffeine use statistics with ever-used alcohol, ever-used tobacco, and ever-used psychoactive medications, the portion of the population that are lifetime abstainers is likely between 0.2% and 2%.
Mark, Mill, and Me on Sin Taxes
If Mark “can think of no more powerful argument for maintaining the existing drug prohibitions than the almost universal opposition on the part of people who call themselves ‘drug policy reformers’ to any effective action to control the damage done by the currently licit drugs,” it sounds like he’s ready to support legalization. My impression, based on two decades of contact with drug policy reformers, is that the vast majority of them do favor what they consider to be effective action aimed at reducing the harm caused by currently licit drugs, although they may disagree about the details. Indeed, many of them support policies similar to what Mark advocates, including higher alcohol taxes.
“Every year,” Mark writes, “more than 20,000 Americans die as the result of other people’s drinking, and yet Jacob is against even modest taxes on alcohol.” He could, with equal logic, have said, “Every year, 37,000 Americans die as a result of driving, and yet Jacob is against even modest taxes on cars.” Or, “Every year, 30,000 Americans die as a result of gunshot wounds, and yet Jacob is against even modest taxes on firearms.” Or even, “Every year, 15,000 Americans die as a result of AIDS, and yet Jacob is against even modest taxes on sexual intercourse.” In each case, the principle is the same: Only a minority of the people subject to the tax are actually contributing to the death toll, and it is unfair to treat all of them as if they were equally irresponsible or anti-social.
I’m not sure John Stuart Mill’s opinion should be decisive on this question, but I don’t think he would have agreed with Mark’s position on alcohol taxes. “To tax stimulants [i.e., intoxicants] for the sole purpose of making them more difficult to be obtained,” Mill wrote in Chapter 5 of On Liberty, “is a measure differing only in degree from their entire prohibition; and would be justifiable only if that were justifiable. Every increase of cost is a prohibition, to those whose means do not come up to the augmented price; and to those who do, it is a penalty laid on them for gratifying a particular taste. Their choice of pleasures, and their mode of expending their income, after satisfying their legal and moral obligations to the State and to individuals, are their own concern, and must rest with their own judgment.” He went on to say that “sin taxes” nevertheless could be justified as a way of raising revenue from sales of “commodities the consumers can best spare” and whose immoderate use is “injurious.” But Mill clearly did not approve of using “sin taxes” primarily to discourage consumption of politically disfavored products, as Mark advocates.
Still, if doubling the alcohol tax is the price that must be paid for repealing drug prohibition, it would be well worth it. Deal?
Realistic Policy Proposals Versus Hypotheticals
A couple of points bear mentioning with respect to the exchange between Mark and Jacob.
First, increasing a tax, such as an alcohol tax, should not be thought of as happening in isolation. Unless the costs of administering the tax eat up all the revenue (not credible in this case since it is just increasing the rate of an existing tax), that increased revenue stream will either (1) fund a new government program, (2) reduce the deficit, or (3) allow reduction in another tax. The idea of increasing an alcohol tax and simultaneously reducing a tax on work (the income tax) so that the changes are revenue neutral might appeal to people who dislike raising the alcohol tax at least in part because they do not like increasing the tax burden generally.
Second, I’ll agree with Jacob that it can be useful to discuss changes that are not politically plausible at present, but I’d at least suggest discussants being clear whether they are trying to make practical suggestions for short- to medium-term changes vs. when they are discussing something more as a hypothetical. In that vein, I’d suggest not lumping together decriminalization of marijuana and across the board legalization of all drugs. Those two proposals have entirely different prospects. Indeed, quite a few U.S. states have already decriminalized marijuana, in varying ways. In this case, I think it is also important to make the distinction for substantive reasons. The stakes involved in decriminalizing marijuana vs. across the board legalization are entirely different, as is the degree of uncertainty surrounding the likely outcomes.
Prohibition and Black-and-White Thinking Go Hand in Hand
“For the purposes of our primary thesis about the importance of accurate information and our hypothesis that more robust education about psychoactives can lead to more responsibility over time,” the Erowids write, “drug control policies are moot.” I agree with pretty much everything the Erowids say regarding the importance of accurate information, but I think they underplay the ways in which drug control policies foster misinformation and impede honest discussion of the risks and benefits of drug use. They themselves note that a state policy against teaching students younger than 21 about responsible drinking obstructs harm-reducing education. That policy can be understood only in the context of the current drinking age and the official expectation that people will not touch a drop of alcohol until they turn 21, at which point they will magically know how to drink responsibly.
In the case of illegal drugs, official resistance to a responsible-use message is even stronger. And because the government is committed to defending the lines it currently draws between licit and illicit, it is driven to disseminate propaganda that grossly exaggerates the dangers of illegal intoxicants. The climate of opinion fostered by this propaganda is hardly conducive to a candid discussion about psychoactive substances.
Or consider how drug policy affects beliefs about narcotic painkillers, which are legally situated between alcohol and marijuana. For decades pain experts have complained that “opiophobia” impedes the appropriate use of these drugs. The exaggerated fear of narcotics underlies current policies, and current policies reinforce that fear. When doctors worry that the government is looking over their shoulders every time they decide whether to prescribe a narcotic, how much to prescribe, and for how long, they are naturally less inclined to use these drugs, and surveys suggest they internalize the message communicated by the official scrutiny, greatly overestimating the risk of addiction in pain patients.
So while drug policy does not affect the wisdom of the Erowids’ clear-eyed, scientifically informed approach to psychoactive substances, it does affect the likelihood that their recommendations will be carried out. By the same token, however, encouraging people to follow this approach could lay the ground for drug policy reform (even if that is not the Erowids’ intention).
As far as drug education in schools goes, the arguments resemble those about sex education (although the former debate is at a less advanced stage, with school districts still overwhelmingly preferring a DARE-style approach). While some say complete abstinence is the only acceptable choice and therefore the only option that should be discussed, other say large numbers of teenagers will be engaging in the prohibited activity regardless of what their parents and teachers say, and they should be equipped with information to minimize the dangers of doing so. I am sympathetic to the latter view, and I wonder what Mark and Jonathan think. Is there such a thing as excessively honest drug education? Does conceding the possibility of responsible drug use, or even distinguishing between more and less dangerous kinds of drug use, encourage teenagers who otherwise would be abstinent to drink or use illegal drugs?
Be Realistic about How Much Information Alone Changes Behavior
I am happy to agree with the Erowids that accurate information about drugs is generally preferable, but we should be realistic about how much accurate information alone will accomplish. I’ll elaborate in a moment about some history of information-only campaigns in drug prevention, but I do not think the limitations are unique to drug use. It might be an interesting exercise to list the success stories when objective information alone was enough to have a substantial effect on population behavior. I believe that most successful public health campaigns supplement factual information with social marketing. AIDS control campaigns have sought to promote condom use as sexy. Tobacco control campaigns have shown vivid pictures of diseased lungs. More recently they have highlighted the unattractive aspects of smoking (e.g., bad breath) and publicized the tobacco companies’ manipulation of nicotine levels, in no small part because there was evidence that this had a bigger effect on teen smoking.
There was a period when drug prevention programs provided accurate, almost clinical information about drugs. This was a reaction to the failure of the earlier (circa 1960s) programs that used scare tactics. To caricature, when youth discovered that those programs had exaggerated the dangers of marijuana, some mistakenly inferred that heroin was no more dangerous than marijuana. So many prevention programs of the 1970s emphasized providing straight information about the risks of drug use. However, those programs were generally found to have no measureable effect on drug use, and by the 1980s the programs had moved on to emphasize “resistance skills,” then “social influences,” and then a “comprehensive” approach, which seemed to work better.
In retrospect the failure of information-oriented programs should not have been surprising. Most adolescents’ decisions to start using a drug are not the result of some careful calculus of benefits and costs. They are more likely to be impulsive acts, often done out of curiosity or for social reasons (e.g., to fit in with a peer group or demonstrate independence form parental norms).
There is certainly a difference between saying just “Here is the information” and saying first “This is an important decision that you should make carefully” and then offering the information. So it is probably fair to say that the Erowids’ approach has not truly been tested. Indeed, rigorous testing might be a sensible next step. A general theme of the prevention literature is that many and perhaps even most programs that appear on the face of it to be logical and well-designed turn out to have little or no measureable effect on behavior. A randomized controlled trial of the Erowids’ Principles might be very useful. (It could be conducted in another country if one thought other prevention messages would contaminate the treatment group.)
My guess is that even if the goal is to induce responsible behaviors surrounding drug use, as opposed to reductions in use, it will turn out that clever social marketing is more effective than a pure information approach. The anti-drunk driving slogan “Friends don’t let friends drive drunk” might be a good example.
As a final note, inasmuch as we all agree that accurate information is important, I think we should get the facts out in this discussion about the prevalence of illegal drug use. The Erowids note that few people abstain from all psychoactives throughout their entire life, particularly when the term is used so broadly as to include something like caffeine. That is true, but it is also true that most people have committed at least one crime, particularly when the term is used so broadly as to include getting in a dust up on the playground in grade school. However, that does not mean it is useful to think of the vast majority of people as being criminals to some degree or another. If we narrow from lifetime use of any psychoactive to current use of an illegal drug, it is clear that drug use in that sense is far from normative. The National Survey on Drug Use and Health is the best available source of information on the prevalence of drug use in the general population. According to the latest survey, only 8% of Americans 12 years old and older are current (meaning past-month) users of an illicit drug, and more than half of them used only marijuana.
The Erowids and I disagree about whether breaking the law to use a psychoactive is inherently an abrogation of the responsibilities of citizenship. That’s fine. Hopefully we can just agree to disagree. But as an empirical matter, it is obeying not breaking the prohibition against illegal drug use that is the normative behavior.
Pot Smokers for Prohibition
Jonathan is right that, according to the government’s survey data, “current” (i.e., past-month) use of illegal drugs is relatively rare. Still, something done by one in 12 Americans (about 20 million people)—or one in seven (36 million), if we look at past-year use—is a significant phenomenon that involves many otherwise law-abiding people. (We should also acknowledge the possibility that self-reports underestimate the true prevalence of illegal drug use.) And while past-month or past-year use is not normative, lifetime use is, at least for Americans born after World War II, most of who have tried a prohibited intoxicant, typically marijuana, at some point. That fact ought to change the legal approach to marijuana at least. How many former pot smokers—whose ranks include political figures such as Bill Clinton, Al Gore, George W. Bush (probably), Clarence Thomas, Newt Gingrich, Barack Obama, and Sarah Palin—think they would have been better off, or more justly treated, if they had been arrested?
Yet according to FBI figures released this week, about 873,000 people were arrested in the United States on marijuana charges last year, the vast majority for simple possession. That’s yet another record-breaking total, and since 1991 the number of marijuana arrests has tripled (without a corresponding increase in marijuana use). Pot smokers who are arrested do not typically spend much time in jail. But they still bear substantial costs, including not just public humiliation, legal expenses, and fines but a variety of ancillary penalties that may include employment difficulties, loss of driver’s licenses, and suspension or revocation of professional licenses. I think this is an area where all of us agree a less punitive approach is appropriate.
25 Million Wrongs Don’t Make a Right
Jacob argues that the fact that so many people have violated a drug law “ought to change the legal approach to marijuana at least.” I’ve never understood that logic. The household survey estimates that 25 million Americans used marijuana in the last year, but the same survey estimates that 30 million drove a vehicle while under the influence of alcohol in the last year. If the frequency of violations were itself sufficient reason to change a law, then this logic would suggest changing the laws against driving under the influence. I have also seen — but can’t locate at the moment — statistics on lifetime prevalence of committing various felonies, and they are strikingly high for U.S. males.
The frequency of offending could factor into judgments about what is the most appropriate sanction, perhaps particularly for a first offense, but does not to my mind imply that the action ought not to be illegal.
Against the Ban on Cannabis Smoking; for the Ban on Cannabis Commerce
To be justified, a law needs to be beneficial in its results — net of the costs of enforcement — and a reasonable restriction on liberty. Compared to a law that allowed individuals to grow their own cannabis for personal consumption or gratis distribution, the current cannabis laws probably have quite modest impacts on the level of cannabis abuse. Yet they make tens of millions of otherwise law-abiding citizens into lawbreakers, and subject hundreds of thousands of them to arrest each year. The vast bulk of the damage from cannabis abuse rests on the abusers; pot smokers aren’t noticeably violent or accident-prone, and the healthcare costs of their habit aren’t very heavy. Moreover, those health costs could be made much smaller by encouraging means of breathing cannabis vapors other than combustion of the plant matrix, for example by the use of vaporizers or nasal inhalers, both of them blocked by current law.
So Jon’s comparison of cannabis smoking with drunken driving seems to me as off-point as Jacob’s earlier comparison of those killed as a result of other people’s drinking with those killed as a result of their own driving or sexual activity.
The mere cultural prejudice of a majority of voters against the cannabis consumption of the minority does not, in my view, constitute sufficient justification for the costs imposed on that minority. The fact that millions of non-addicted pot-smokers keep right on smoking despite not only the laws but the arrests suggests to me, by the canons of revealed preference, that smoking pot is a practice that those people value, and that other people might value were they allowed to pursue it within the law. Their lost consumers’ surplus ought to count as a cost of the law, and I see no countervailing benefit of comparable magnitude. In addition, by banning a practice that poses little social risk, we waste enforcement resources and encourage disrespect for the law.
So I conclude that the ban on cannabis smoking — as opposed to cannabis commerce — cannot be justified, and that the majority in this instance acts wrongfully in restricting the liberty of the minority for no particular public purpose. That does not shake my conviction that allowing commercial marketing of cannabis along the lines currently permitted for alcohol would risk a very substantial increase in the level of abuse, as the legalization of the old “numbers game” led to the substantial prevalence of problem lottery gambling we now observe.
Therefore I favor non-commercial legalization as the ethically and practically appropriate approach to the most widely used illicit drug.
Drug Information Isn’t Just for “Druggies”
Jonathan Caulkins sketches a little of the history of recent drug education policy in the United States, but it’s not clear what position he takes with regard to the government actively promoting misunderstandings and inaccuracies about disapproved drugs and their use. While Jonathan states that “accurate information about drugs is generally preferable,” [emphasis added] he appears to be so strongly focused on reducing the use of illegal drugs that accuracy takes a clear second place. If a blatantly false information campaign about illegal psychoactives could be crafted that would dramatically reduce use, would it be appropriate to run it? Does the answer depend at all on what possible harms are being avoided by reducing use (is it different for heroin or cannabis)? Is the standard for whether it’s acceptable for the government to lie about scientific facts a simple legislative majority?
In our view, the corrupted information about psychoactive drugs that is currently prevalent in the United States has taken over a century to develop and will take more than a few years to correct. It will likely take a generation or two for views to be moderated by access to balanced, comprehensive information. Legislators who banned LSD in the 1960s were influenced by the erroneous news reports trumpeting that it caused “chromosome damage.” The generation of representatives who wrote and passed the Controlled Substances Act were raised on Reefer Madness. It won’t be until 2040 that the average U.S. legislator will have been raised with online access to information about psychoactive plants and chemicals.
Highlighting our difference in views, Jonathan has repeatedly rejected the idea that caffeine is reasonably considered a psychoactive drug. He also seems to reject the idea that there are pertinent parallels between caffeine and psychoactive pharmaceuticals or illegal recreationally used drugs. We aren’t sure why he thinks it helps or changes the discussion to exclude caffeine, but we will offer a few points to consider.
Caffeine is a habit-forming drug, with daily use leading to both psychological and physical dependence. Physical withdrawal effects are similar in scale to those from discontinuing daily cannabis use. Caffeine overdoses can and do result in death. Caffeine abuse is a diagnosed condition. Caffeine use is associated with a variety of negative psychological and physical health symptoms including anxiety, insomnia, restless leg syndrome, and bruxism (teeth grinding). Caffeine is used recreationally and causes euphoria and sociability in higher doses. Caffeine use is ad libidum, not on a schedule prescribed by a doctor. We consider caffeine a classic example of a psychoactive drug, and a useful one for discussing the importance of dose, individual reaction, and risk while sidestepping the complex political and moral landscape that dominates discussions about disapproved psychoactive drugs.
It is, perhaps, illustrative to also mention purified sugar as an interesting parallel to psychoactive drugs. In a 2007 paper titled “Intense sweetness surpasses Cocaine Reward,” researchers demonstrated that both cocaine-naïve and cocaine-addicted rats chose natural and artificial sweeteners over cocaine. We are not contending that sweet foods should be considered “psychoactive,” but it is important to keep in mind that there are many ways that behavior is deeply affected by everyday substances we ingest.
Jonathan countered our statements about the widespread use of psychoactives (~98% lifetime use) by arguing that only illegal recreational use should be considered in such statistics. He chose to quote figures for past month use of any illicit drug, a number he cites as around 8%. He uses that to argue that “drug use […] is far from normative,” also implying that information about psychoactive drugs is only valuable to the 1/10th of the population who has used an illicit drug in the past month. We have a handful of comments about that.
First, the data he cites is from the National Survey on Drug Use and Health (NSDUH). Because of its data collection methods, NSDUH is known to underestimate general levels of illegal drug use and massively underestimate levels of heavy illegal drug use. Despite this, we agree that it is the best large survey on illegal drug use in the United States for populations not (yet) covered by Monitoring the Future (MTF), another major drug-use survey. MTF provides noticeably higher estimates for the prevalence of past-month use of illegal psychoactives.
Second, we generally regard past year use as a better measure of “current use” than past month use when talking about psychoactive drugs across the board. The definition of “current use” is probably best defined on a per-drug basis: Those who take psilocybin mushrooms likely consider themselves “current” users for considerably longer than a month after their last experience, while tobacco or crack cocaine users may no longer consider themselves “current” users after a few weeks of abstinence. Once-every-few-years smokers of cannabis who would consider taking a hit on their vacation are still involved with making decisions about illegal drug use.
Third, we would argue that the appropriate age range to consider when discussing current illegal drug use is adults aged 18 to 59. It is a little strange to talk about whether illegal drug use is “normative” in the population and include 12-year-olds (NSDUH statistics include 12 and older). It is also important to note that those over 60 are not part of the “normative” cohort for illegal drug use, according to the NSDUH. They are old enough not to have been exposed to widespread cannabis use in their youth like the rest of Americans have been. The percentage of people over 60 who have ever tried an illegal drug is well under 30%, whereas the number is substantially over 50% for 18-55-year-olds, according to the NSDUH. Using NSDUH 2007 data, the past-month use of any “illicit” drug among 18-59-year-olds is around 10% and past-year use is around 17%.
Fourth, we would argue that since over 50% of the adult population of the United States born after 1950 has tried an illegal drug, it is reasonable to call that “normative,” regardless of what current use levels are or how one defines current use. It may not be normative to continue to use cannabis after the age of 30, but it is clearly normative for adults in the United States to have broken the prohibition against illegal drug use.
By arguing that psychoactive drug use is non-normative in the context of a discussion about the value of accurate information about psychoactive drugs, Jonathan seems to be attempting to marginalize the need for such information. It’s a common error to think that drug information is only for “druggies.”
While Jonathan clearly disagrees with us on this point, we believe that there are many useful parallels to be drawn between responsible use patterns and decisions around ubiquitous drugs such as caffeine and strongly prohibited drugs such as cocaine. But, even if we accept Jonathan’s focus on recent illegal drug users, if we broaden the target audience for drug information to include friends, family members, co-workers, and employers (even if they don’t use illegal drugs themselves), we are probably looking at a majority of the U.S. population. If we also include educators, medical professionals, researchers, academics, law enforcement, policy makers, and government employees in the list (as Erowid Center does), then there is no question that there is a broad need for more accurate information about psychoactives. Every citizen who has a need for information about illegal psychoactive drugs should, as a bare minimum, be able to expect that government-provided information does not misrepresent facts.
We do not argue that “a pure information approach” is a panacea. We believe that widely available, accurate, and balanced information is necessary, though not sufficient, for developing a culture of responsible use of psychoactive drugs and technologies of all kinds.
 Lenoir M, Serre F, Cantin L, Ahmed SH. “Intense sweetness surpasses cocaine reward.” PLoS ONE 2(1), 2007:e698.
 Erowid E, Erowid F. “How Do They Measure Up? Part II: The Problems.” Erowid Extracts 9, Nov 2005,16-21.
 NSDUH gives 2006 past-month use statistics of any illicit drug for 45-49 year olds as 6.7% while MTF gives past 30 day use statistics for 45 year olds of 10%. This is similar to the difference for most age groups.
 SAMHSA. “Results from the 2007 National Survey on Drug Use and Health: Detailed Tables.” 2007. Table 1.1A.
Public Health Promotion is OK
The Erowids thought I was unclear about my position “with regard to the government actively promoting misunderstandings and inaccuracies about disapproved drugs and their use,” so I will be explicit. I think it OK (meaning not unconstitutional and not outrageous if the majority want it) for the government to promote health and well being through public health campaigns that seek to change behavior, particularly when the campaigns are directed toward youth. I generally prefer for such campaigns to achieve their ends simply by providing accurate information, but acknowledge that sometimes appealing to emotions or providing only selective information is more effective at changing behavior. So those who design and implement public health campaigns end up trying to strike a balance between two sets of values: promoting health and respecting individual autonomy by merely informing, rather than trying to sway decisionmaking.
None of that is specific to illegal drugs. The government and various nonprofits try to persuade youth to eschew not only illegal drugs, but also tobacco and alcohol, dropping out of school, becoming obese, and not exercising enough. All of those efforts include more than just providing complete, balanced information. For example, the income gap between high school graduates and dropouts is often reported without adjusting for omitted variables such as differences in intelligence; youth are left to infer, incorrectly, that the observed gap is all caused by dropping out of school. Likewise, my elementary school kids were taught that cigarettes contain rat poison. I suspect that is true in some sense. Among the very many chemicals in tobacco and its combustion byproducts, there is probably one that is an active ingredient in rat poison. But I doubt it is one of the top ten by weight, so omitting mention of the others is selective reporting, and describing the chemical as “rat poison” rather than using a more technically precise term is clearly appealing to emotions.
I understand that many Cato readers who are committed to libertarian principles could dislike any taxpayer-funded, government-managed campaign designed to promote healthy behavior. I personally do not mind being nudged to eat better and exercise more because my willpower is imperfect, but I can see why other adults might view that as meddlesome. It is important to remember, though, that most drug prevention programming is directed at youth, for the simple reason that few people initiate drug use as adults. Activities that bring immediate pleasure but carry a roughly one-in-six risk of substantial adverse outcomes a few years down the road are less likely to appeal to adults than to adolescents.
To avoid any misunderstanding, when I used the word “drug” in the previous paragraph I meant the big four illegal drugs (marijuana, cocaine/crack, heroin, and meth). The statement also happens to be true of tobacco. I have no idea whether it applies to caffeine, and I do not much care. That is not, as the Erowids imply, because I do not think caffeine can reasonably be considered to be a psychoactive drug. It is simply because I do not think caffeine poses problems that merit public policy discussion or intervention. There are many serious problems associated with drug use and/or attempts to control use, including overdose, family dysfunction, crime, violence, corruption, etc. Caffeine barely registers on any of those metrics.
If outcomes associated with a psychoactive substance were determined entirely by policy, and had nothing to do with the substance’s characteristics, then the absence of problems with caffeine would be tremendously important. We could, for example, regulate tobacco and alcohol the same way we do caffeine and save ~500,000 premature deaths per year.
The reason that idea is absurd is that alcohol and tobacco are very different from caffeine, even though all three are psychoactive drugs. Ditto for the big four illegal drugs. There is no reason all psychoactive substances need be treated the same with respect to public policy, and no reason that statements that apply to one substance need apply to another.
The Erowids had many nits to pick about my saying that only 8% of people report past-month use of an illegal drug in the household survey. First of all, I stand by the number. Anyone can check it by accessing the data set from the SAMHDA website. Second, anyone can nitpick. The Erowids’ original essay cited “nearly 90%” lifetime prevalence of illegal drug use among 45-year-olds based on the Monitoring the Future study (Johnston et al., 2007). They didn’t mention that the study authors reported it as 80-87% (pp.75-76), that it comes from a birth cohort with unusually high rates of use, and that it overstates because high school dropouts have lower rates of lifetime prevalence than do high school completers. (The opposite may be true for problematic use, but with respect to ever trying a drug even once, prevalence generally increases with education up through college completion.) They noted many weaknesses of the household survey but weren’t similarly critical of Monitoring the Future, even though, for example, sample selection biases can affect attempts to follow up subjects more than 25 years later.
I had let this selective reporting pass because the Erowids’ general point that most people will try an illegal drug at some point in their life is true, even if lifetime prevalence for typical cohorts is closer to 67% than to 90%. I think current use is more relevant for assessing what is normative because lifetime prevalence of many bad or dumb actions (theft, assault, sexual infidelity, etc.) is rather high. If anyone really doubts that current use of illegal drugs is not normative within the general population of the United States, we can dive into details, but I hope that isn’t necessary.
Finally, as for the Erowids’ last point: I agree that all people, not just users need to be informed about drugs. I’m not sure how I created the impression I thought otherwise and apologize for any confusion I created on that point.
Johnston LD, O’Malley PM, Bachman JG, et al. “Monitoring the Future National Survey Results on Drug Use, 1975-2006. Vol II.” NIDA. 2007. 98.
Politicians with Pot Problems
To clarify my analogies between taxing alcohol on the one hand and taxing cars, firearms, or sex on the other: In all these cases, some users — drunken drivers, reckless (but sober) drivers, violent criminals, promiscuous disease carriers — cause harm to others. But in my view, it is not fair to tax all users in an effort to deter the antisocial minority.
I did not mean to imply that the sheer number of drug offenders, by itself, tells us the law should be changed. (Another crucial point to consider is the fact that consuming a politically incorrect intoxicant, unlike committing a predatory felony, does not violate anyone’s rights.) But when we live in a society where most adults (current retirees excluded) have tried illegal drugs (usually marijuana), that fact might reasonably be expected to affect the views of policy makers regarding the treatment of pot smokers. Generally speaking, personal experience with marijuana reveals it to be not as big a deal as the government claims — which explains the government’s current emphasis on increases in potency that supposedly make today’s pot much more dangerous that what Mom and Dad smoked. For the vast majority of users, smoking pot is far less damaging than getting busted for it would be. Politicians who support the current policy of arresting pot smokers therefore have some explaining to do if they themselves smoked pot without suffering any legal consequences, unless they are prepared to say they should have been arrested — i.e., that such a life-disrupting brush with the law would have been entirely fair and appropriate. Does Barack Obama or Sarah Palin truly believe that? Smoking pot did not cause any noticeable harm to their lives or careers. But if they had been arrested, they probably would not be where they are today.
Best of the Blogs: Responsible Drug Use
Here are some thought-provoking excerpts from around the blogosphere commenting on this month’s edition of Cato Unbound.
I’ve always found Erowid to be an extremely interesting and remarkable website, not simply because it contains so much information about a somewhat taboo subject (although that’s fun too) but because it takes such a principled stand in favor of the value of access to information. Erowid’s founders write:
Public information sources should prioritize accuracy and completeness over maintaining a single, politically driven message. It is inconsistent with the democratic ideals of American culture to corrupt information in order to support public policies. The issues are complex and sources should reflect that.
This should not be a controversial position in our society. Indeed, it should be a principle that we struggle to support, because democracies don’t work very well when voters are deliberately misinformed.
Heal Spiel: Narcotics Unbound:
Earth and Fire Erowid effectively argue that the notion of responsible drug use has as much relevance now as it does for an idealized post-prohibitionist future. Today, many, many Americans practice self-control regarding psychoactive substances, which are relatively easy for otherwise law-abiding citizens to obtain, especially if one includes legal “drugs,” such as alcohol or caffeine. And no matter the endless shuffle of kids charged with “possession,” who languish in the Juvenile Hall next to my school, or the bluster and spectacle of high-profile raids on marijuana dispensaries that cater to cancer patients. These shining examples of the DEA’s good work (as well as its upcoming “Target America Campaign” which first takes aim at Los Angeles in October), do nothing to temper the reality that even the most socially isolated individual can gain access to the Internet and access to drugs, practically within same Charter Bundle Package.
Stop the Drug War.org: Jonathan Caulkins vs. the Boring Drug War Debate:
I just don’t agree that following the law is always inherently “responsible,” except to the extent that the law will sometimes get back at you for non-compliance. Moreover, [Caulkins is] responding to an article that went to great lengths to explain how prohibition interferes with the ability to use drugs responsibly (e.g., unknown purity of black market merchandise, breakdown of communication between users and medical professionals, laughably bad anti-drug education, etc.). Caulkins is entitled to his belief that it’s always irresponsible to break the law, but that’s somewhat beside the point.
The concern that you can’t use drugs responsibly in violation of the law is a problem with the law, not a problem with drugs.
Note to readers: If you’d like to be included in a future “Best of the Blogs” post, please join in the conversation by posting a thoughtful response at your own site. You’re more likely to be included if you do more than simply throw us a link. We don’t mind the links, but the conversation is what we’re all about. And also, as usual, reprinting here doesn’t imply endorsement.