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On Moral Arguments Against Recreational Drug Use

Rob lovering considers some of the arguments, and what they amount to..

December 5, 2015, marked the eighty-second anniversary of the United States’ repeal of the National Prohibition Act, an erstwhile constitutional ban on ‘intoxicating beverages’. The Act’s repeal did not bring an end in the U.S. to the legal prohibition of every intoxicating substance, of course – the recreational use of cocaine, heroin, ecstasy, and many other intoxicating substances remains illegal; but it did reinstate alcohol as one of many intoxicating substances – of many drugs , lest there be any confusion – that Americans are legally permitted to use recreationally. The list also includes caffeine and nicotine.

One might wonder why all countries currently legally permit the recreational use of some drugs, such as caffeine, nicotine, and (usually) alcohol, but prohibit the recreational use of others, such as cocaine, heroin, ecstasy and (usually) marijuana. The answer lies not simply in the harm the use of these drugs might cause, but in the perceived immorality of their use. As former U.S. Drug Czar William Bennett once put it, “I find no merit in the legalizers’ case. The simple fact is that drug use is wrong. And the moral argument, in the end, is the most compelling argument” ( Drugs: Should We Legalize, Decriminalize or Deregulate? , ed. Jeffrey A. Schaler, 1998, p.65). Yet, despite strong rhetoric from the prohibitionists, it is surprisingly difficult to discern their reasons for believing that the recreational use of certain drugs is morally wrong. Most of the time, no reasons are even provided: it is simply declared, à la Bennett, that using some drugs recreationally is morally impermissible.

This is not to say that there are no reasons for believing that using some drugs recreationally is wrong. Indeed, there is a wide array of arguments for the immorality of certain recreational drug use, ranging from the philosophically rudimentary to the philosophically sophisticated. But the vast majority of these arguments are unsuccessful, and those that succeed are quite limited in scope.

Some Rudimentary Arguments

Take, for example, one of the philosophically rudimentary arguments: Recreational drug use is generally unhealthy for the user; therefore, recreational drug use is wrong.

Now it is true that recreational drug use is generally unhealthy for the user in one respect or another, to one degree or another. Just how unhealthy it is for the user depends not only on which drug, but on the amount and frequency of its use, the manner in which it is administered, the health of the person using it, and more. In any case, there is little question that recreational drug use is generally unhealthy for the user.

But does it follow then that recreational drug use is wrong ? It does if the mere fact that an activity is generally unhealthy – or, more broadly, generally harmful – to the one who engages in it renders that activity morally wrong. However, this idea is very difficult to justify. Indeed, there seem to be conditions under which harming oneself, even damaging one’s health, does not involve wrongdoing, such as when the harm is done with one’s voluntary, informed consent. From boxing to BASE jumping, playing contact sports to mixed martial arts, snowboarding to bull-riding – each of these activities can be and often is unhealthy to the individuals who engage in them; but none of them seem to be thereby morally wrong when those engaging in them do so with their voluntary, informed consent. Imprudent, perhaps, but not immoral. Or consider people who eat unhealthy food and refuse to exercise. Their voluntary and informed eating of unhealthy food and refusing to exercise does not seem to be morally wrong in and of itself.

Here’s another philosophically rudimentary argument: Recreational drug use is unnatural; therefore, recreational drug use is wrong.

Now there are at least seven different meanings of ‘unnatural’ that one may employ in this argument: statistically abnormal or unusual; not practiced by nonhuman animals; does not proceed from an innate desire; violates an organ’s principal purpose; gross or disgusting; artificial; and contrary to divine intention. But regardless of which meaning is employed, this argument is also unsuccessful.

Consider just one meaning of ‘unnatural’: ‘artificial’. What’s typically meant by the claim that recreational drug use is artificial is that it involves inducing mental states that would not have occurred were it not for human intervention or contrivance. But what’s wrong with artificially inducing mental states? This is precisely what individuals taking medication for depression or bipolar disorder do; yet hardly anyone believes that taking medication for depression or bipolar disorder is wrong. Granted, artificially inducing mental states for depression or bipolar disorder differs from artificially inducing mental states for recreational purposes in a particular and perhaps morally significant way: the former use is medical in nature while the latter is not. But if the claim, as here, is simply that it is wrong to artificially induce mental states, then why the mental states are artificially induced makes no difference to the argument. Furthermore, even if the reason the mental states are artificially induced were relevant to the argument, this would not necessarily entail that artificially inducing mental states for recreational purposes renders doing so wrong. Indeed, we have good reasons to think that artificially inducing mental states for recreational purposes is morally permissible in some cases: by way of listening to music or reading a novel, for instance. Both the music and the novel are products of human contrivance. To that extent, the mental states induced by listening to music or reading a novel are induced artificially. Nevertheless, there seems to be nothing immoral about artificially inducing mental states by doing either of these things.

There are many other philosophically rudimentary arguments: one grounds the supposed wrongness of recreational drug use in the claim that it squanders the user’s talents; another in the claim that the pleasure of recreational drug use is unearned, and so on – but let this suffice for now. Equivalent analogies can be cited to show why these other arguments don’t work either.

More Sophisticated Arguments

More philosophically sophisticated arguments for the moral wrongness of certain recreational drug use fare no better. Consider the following argument: By using drugs recreationally, the user instrumentalizes himself; therefore, recreational drug use is wrong. To instrumentalize oneself is to use oneself for a purpose to which one, as a rational moral agent, cannot in principle agree. (A rational moral agent is someone who can think in terms of moral reasons and act on that basis.) Most simply put, to instrumentalize oneself is to agree to behavior to which one could not rationally assent. For instance, if Joe necessarily desires x , then Joe cannot rationally agree to behavior that thwarts x , since doing so would involve contradicting himself – for were Joe to assent to behavior that thwarts that which he necessarily desires, Joe would be at once desiring both x and not- x .

So, does recreational drug use involve using oneself for a purpose to which one cannot in principle agree? That depends on what the purpose of recreational drug use is. This, in turn, depends partly on the drug in question. For the sake of space, let us consider the recreational use of just one drug: marijuana.

Typically, the purpose of using marijuana recreationally is to get high. The question, then, is whether the marijuana user can in principle rationally agree to the end of getting high. At first glance, it appears she can – the individual agreeing to get high does not on the face of things seem to be contradicting herself in doing so. But to be sure about this, we need to determine whether a pot smoker necessarily desires something that getting high thwarts.

Although lots of things might be proposed here, but again for the sake of space, I will consider just one: Perhaps as a rational moral agent, the pot smoker necessarily desires all that is required for the preservation and exercise of rational moral agency. And it may be that not being high – in a word, sobriety – is required for the preservation and exercise of rational moral agency. Two questions now arise: do rational moral agents necessarily desire all that is required for the preservation and exercise of rational moral agency? And, is sobriety required for the preservation and exercise of rational moral agency?

Properly addressing the first question would involve a lengthy digression into the nature of rational moral agency. Instead, I will simply assume that rational moral agents do necessarily desire all that is required for the preservation and exercise of rational moral agency.

This brings us to the second question: Is sobriety required for the preservation and exercise of rational moral agency? Arguably not . To be sure, sobriety may be required for the optimal exercise of rational moral agency, but it is not required for the exercise, much less the preservation, of rational moral agency. The high individual can and typically does think in terms of moral reasons and act on that basis. As Jeffrey Reiman writes, “Even drug-beclouded individuals know the difference between right and wrong and can understand when they are hurting others and so on” ( Critical Moral Liberalism: Theory & Practice , 1997, p.89).

Getting high, then, does not necessarily thwart all that is required for the preservation and exercise of rational moral agency. Accordingly, the marijuana user can indeed agree in principle to the end of getting high, even given that she necessarily desires all that is required for the preservation and exercise of rational moral agency. Substitute alcohol, cocaine, heroin, or ecstasy for marijuana here, and similar arguments may be proffered for the view that users of these drugs can also agree in principle to the end of these drugs’ intoxicating effects – at least up to the point of the incapacity of rational thought.

Another philosophically sophisticated argument for the wrongness of recreational drug use is worth mentioning, given its popularity: By using drugs recreationally, the user may become addicted and thereby diminish his autonomy; therefore, recreational drug use is wrong.

Perhaps the most important word in this argument is ‘autonomy’. And although there are many definitions of this word, for present purposes we will use ‘the capacity to govern oneself’.

It is clear that, generally speaking, recreational drug users may become addicted to their drug of choice. Indeed, in Drug Legalization: For and Against (eds. Rod L. Evans and Irwin M. Berent, 1994), psychiatrist Michael Gazzaniga estimates that there is a ten per cent chance that any user of any drug will become addicted to it.

To what extent a drug is addictive may be determined in a number of ways, two of the more common ways being by establishing how likely it is that an occasional user of a drug becomes a habitual user of it; and by establishing how difficult it is for the habitual user to quit (see for instance Jim Leitzel, Regulating Vice: Misguided Prohibitions and Realistic Controls , 2008, p.61). Under both methods, nicotine is considered the most addictive of commonly-used drugs. Marijuana is much less addictive. Alcohol, heroin, and cocaine all fall somewhere in between nicotine and marijuana. And some recreational drugs, such as LSD and other hallucinogens, are considered virtually non-addictive, if at all: as Brian Penrose writes, “Whatever else may be true of [hallucinogens], they’re more or less universally recognized as non-addictive” ( Regulating Vice ).

However, even given that recreational drug users may become addicted to their drug of choice, and, in turn, diminish their autonomy to a greater or lesser degree, this does not itself render recreational drug use wrong. After all, most of us diminish our capacity to govern ourselves from time to time in ways that appear to be morally innocuous. Consider someone who is having trouble sleeping and decides to take a sleeping pill. In doing so, the individual chooses a course of action that will result in the diminishing of his capacity to govern himself. But does he thereby do something morally impermissible? It seems not.

Of course, taking a sleeping pill involves the use of a drug. And since what is at issue here is the moral status of using drugs – recreationally, of course, but using drugs nonetheless – it might be helpful to invoke a case that does not involve the use of a drug. So consider enlisting in the military. Those who do so diminish their capacity to govern themselves rather severely – with respect to where and with whom one resides, when one goes to and gets out of bed, what and when one eats and drinks, whom one considers to be an enemy, whom one considers to be an ally, whose commands one deems authoritative and obeys, what one considers to be acceptable conduct, under what conditions one will kill another human being, and so on. Even so, it does not seem to be morally wrong to join the military – at least, not on the grounds that doing so diminishes one’s capacity to govern oneself. (It may be imprudent in some ways, of course.) This suggests that other cases involving a less-than-extreme diminishing of one’s capacity to govern oneself are not morally wrong either.

To be sure, the diminishing of one’s capacity to govern oneself that occurs through joining the military is not the result of using a drug. But again, this fact is inconsequential to the argument. If it is precisely the diminishing of one’s capacity to govern oneself that renders certain recreational drug use wrong, as is alleged here, then any activity that involves the diminishing of one’s capacity to govern oneself will also be wrong, regardless of the means by which this is achieved.

To make this clear, suppose that what makes murder morally impermissible is that it involves the intentional permanent destruction of an innocent individual’s consciousness against their will. On this supposition, any activity that involves the intentional permanent destruction of an innocent individual’s consciousness against their will should be morally impermissible – including the intentional rendering of an innocent individual permanently comatose against their will. The means by which the permanent destruction of the individual’s consciousness is achieved is different in the comatose case, of course; but it is the permanent destruction of the individual’s consciousness nonetheless – so rendering someone comatose will be wrong for the same reason that murder is wrong. Similarly, if diminishing one’s capacity to govern oneself is morally wrong in and of itself, then joining the military is thereby morally wrong. But this is implausible.

There are many other philosophically sophisticated arguments – one which grounds the wrongness of recreational drug use in the claim that it blocks basic goods; another which grounds it in the claim that it degrades the user, and so on – but the preceding considerations will do for now.

Much more can also be said about each of the arguments above, and I have done just that in my book A Moral Defense of Recreational Drug Use (2015). Suffice it to say that if the objections that I have raised against these arguments for the immorality of recreational drug use are cogent, then to that extent the moral case for legally prohibiting recreational drug use is undermined.

© Rob Lovering 2016

Rob Lovering is Associate Professor of Philosophy at the College of Staten Island, City University of New York. His book A Moral Defense of Recreational Drug Use is available from Palgrave Macmillan.

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Drug Legalization?: Time for a real debate

Subscribe to governance weekly, paul stares ps paul stares.

March 1, 1996

• 11 min read

Whether Bill Clinton “inhaled” when trying marijuana as a college student was about the closest the last presidential campaign came to addressing the drug issue. The present one, however, could be very different. For the fourth straight year, a federally supported nationwide survey of American secondary school students by the University of Michigan has indicated increased drug use. After a decade or more in which drug use had been falling, the Republicans will assuredly blame the bad news on President Clinton and assail him for failing to carry on the Bush and Reagan administrations’ high-profile stand against drugs. How big this issue becomes is less certain, but if the worrisome trend in drug use among teens continues, public debate about how best to respond to the drug problem will clearly not end with the election. Indeed, concern is already mounting that the large wave of teenagers—the group most at risk of taking drugs—that will crest around the turn of the century will be accompanied by a new surge in drug use.

As in the past, some observers will doubtless see the solution in much tougher penalties to deter both suppliers and consumers of illicit psychoactive substances. Others will argue that the answer lies not in more law enforcement and stiffer sanctions, but in less. Specifically, they will maintain that the edifice of domestic laws and international conventions that collectively prohibit the production, sale, and consumption of a large array of drugs for anything other than medical or scientific purposes has proven physically harmful, socially divisive, prohibitively expensive, and ultimately counterproductive in generating the very incentives that perpetuate a violent black market for illicit drugs. They will conclude, moreover, that the only logical step for the United States to take is to “legalize” drugs—in essence repeal and disband the current drug laws and enforcement mechanisms in much the same way America abandoned its brief experiment with alcohol prohibition in the 1920s.

Although the legalization alternative typically surfaces when the public’s anxiety about drugs and despair over existing policies are at their highest, it never seems to slip off the media radar screen for long. Periodic incidents—such as the heroin-induced death of a young, affluent New York City couple in 1995 or the 1993 remark by then Surgeon General Jocelyn Elders that legalization might be beneficial and should be studied—ensure this. The prominence of many of those who have at various times made the case for legalization—such as William F. Buckley, Jr., Milton Friedman, and George Shultz—also helps. But each time the issue of legalization arises, the same arguments for and against are dusted off and trotted out, leaving us with no clearer understanding of what it might entail and what the effect might be.

As will become clear, drug legalization is not a public policy option that lends itself to simplistic or superficial debate. It requires dissection and scrutiny of an order that has been remarkably absent despite the attention it perennially receives. Beyond discussion of some very generally defined proposals, there has been no detailed assessment of the operational meaning of legalization. There is not even a commonly accepted lexicon of terms to allow an intellectually rigorous exchange to take place. Legalization, as a consequence, has come to mean different things to different people. Some, for example, use legalization interchangeably with “decriminalization,” which usually refers to removing criminal sanctions for possessing small quantities of drugs for personal use. Others equate legalization, at least implicitly, with complete deregulation, failing in the process to acknowledge the extent to which currently legally available drugs are subject to stringent controls.

Unfortunately, the U.S. government—including the Clinton administration—has done little to improve the debate. Although it has consistently rejected any retreat from prohibition, its stance has evidently not been based on in- depth investigation of the potential costs and benefits. The belief that legalization would lead to an instant and dramatic increase in drug use is considered to be so self-evident as to warrant no further study. But if this is indeed the likely conclusion of any study, what is there to fear aside from criticism that relatively small amounts of taxpayer money had been wasted in demonstrating what everyone had believed at the outset? Wouldn’t such an outcome in any case help justify the continuation of existing policies and convincingly silence those—admittedly never more than a small minority—calling for legalization?

A real debate that acknowledges the unavoidable complexities and uncertainties surrounding the notion of drug legalization is long overdue. Not only would it dissuade people from making the kinds of casual if not flippant assertions—both for and against—that have permeated previous debates about legalization, but it could also stimulate a larger and equally critical assessment of current U.S. drug control programs and priorities.

First Ask the Right Questions

Many arguments appear to make legalization a compelling alternative to today’s prohibitionist policies. Besides undermining the black-market incentives to produce and sell drugs, legalization could remove or at least significantly reduce the very problems that cause the greatest public concern: the crime, corruption, and violence that attend the operation of illicit drug markets. It would presumably also diminish the damage caused by the absence of quality controls on illicit drugs and slow the spread of infectious diseases due to needle sharing and other unhygienic practices. Furthermore, governments could abandon the costly and largely futile effort to suppress the supply of illicit drugs and jail drug offenders, spending the money thus saved to educate people not to take drugs and treat those who become addicted.

However, what is typically portrayed as a fairly straightforward process of lifting prohibitionist controls to reap these putative benefits would in reality entail addressing an extremely complex set of regulatory issues. As with most if not all privately and publicly provided goods, the key regulatory questions concern the nature of the legally available drugs, the terms of their supply, and the terms of their consumption (see page 21).

What becomes immediately apparent from even a casual review of these questions—and the list presented here is by no means exhaustive—is that there is an enormous range of regulatory permutations for each drug. Until all the principal alternatives are clearly laid out in reasonable detail, however, the potential costs and benefits of each cannot begin to be responsibly assessed. This fundamental point can be illustrated with respect to the two central questions most likely to sway public opinion. What would happen to drug consumption under more permissive regulatory regimes? And what would happen to crime?

Relaxing the availability of psychoactive substances not already commercially available, opponents typically argue, would lead to an immediate and substantial rise in consumption. To support their claim, they point to the prevalence of opium, heroin, and cocaine addiction in various countries before international controls took effect, the rise in alcohol consumption after the Volstead Act was repealed in the United States, and studies showing higher rates of abuse among medical professionals with greater access to prescription drugs. Without explaining the basis of their calculations, some have predicted dramatic increases in the number of people taking drugs and becoming addicted. These increases would translate into considerable direct and indirect costs to society, including higher public health spending as a result of drug overdoses, fetal deformities, and other drug-related misadventures such as auto accidents; loss of productivity due to worker absenteeism and on-the-job accidents; and more drug-induced violence, child abuse, and other crimes, to say nothing about educational impairment.

Advocates of legalization concede that consumption would probably rise, but counter that it is not axiomatic that the increase would be very large or last very long, especially if legalization were paired with appropriate public education programs. They too cite historical evidence to bolster their claims, noting that consumption of opium, heroin, and cocaine had already begun falling before prohibition took effect, that alcohol consumption did not rise suddenly after prohibition was lifted, and that decriminalization of cannabis use in 11 U.S. states in the 1970s did not precipitate a dramatic rise in its consumption. Some also point to the legal sale of cannabis products through regulated outlets in the Netherlands, which also does not seem to have significantly boosted use by Dutch nationals. Public opinion polls showing that most Americans would not rush off to try hitherto forbidden drugs that suddenly became available are likewise used to buttress the pro-legalization case.

Neither side’s arguments are particularly reassuring. The historical evidence is ambiguous at best, even assuming that the experience of one era is relevant to another. Extrapolating the results of policy steps in one country to another with different sociocultural values runs into the same problem. Similarly, within the United States the effect of decriminalization at the state level must be viewed within the general context of continued federal prohibition. And opinion polls are known to be unreliable.

More to the point, until the nature of the putative regulatory regime is specified, such discussions are futile. It would be surprising, for example, if consumption of the legalized drugs did not increase if they were to become commercially available the way that alcohol and tobacco products are today, complete with sophisticated packaging, marketing, and advertising. But more restrictive regimes might see quite different outcomes. In any case, the risk of higher drug consumption might be acceptable if legalization could reduce dramatically if not remove entirely the crime associated with the black market for illicit drugs while also making some forms of drug use safer. Here again, there are disputed claims.

Opponents of more permissive regimes doubt that black market activity and its associated problems would disappear or even fall very much. But, as before, addressing this question requires knowing the specifics of the regulatory regime, especially the terms of supply. If drugs are sold openly on a commercial basis and prices are close to production and distribution costs, opportunities for illicit undercutting would appear to be rather small. Under a more restrictive regime, such as government-controlled outlets or medical prescription schemes, illicit sources of supply would be more likely to remain or evolve to satisfy the legally unfulfilled demand. In short, the desire to control access to stem consumption has to be balanced against the black market opportunities that would arise. Schemes that risk a continuing black market require more questions—about the new black markets operation over time, whether it is likely to be more benign than existing ones, and more broadly whether the trade-off with other benefits still makes the effort worthwhile.

The most obvious case is regulating access to drugs by adolescents and young adults. Under any regime, it is hard to imagine that drugs that are now prohibited would become more readily available than alcohol and tobacco are today. Would a black market in drugs for teenagers emerge, or would the regulatory regime be as leaky as the present one for alcohol and tobacco? A “yes” answer to either question would lessen the attractiveness of legalization.

What about the International Repercussions?

Not surprisingly, the wider international ramifications of drug legalization have also gone largely unremarked. Here too a long set of questions remains to be addressed. Given the longstanding U.S. role as the principal sponsor of international drug control measures, how would a decision to move toward legalizing drugs affect other countries? What would become of the extensive regime of multilateral conventions and bilateral agreements? Would every nation have to conform to a new set of rules? If not, what would happen? Would more permissive countries be suddenly swamped by drugs and drug consumers, or would traffickers focus on the countries where tighter restrictions kept profits higher? This is not an abstract question. The Netherlands’ liberal drug policy has attracted an influx of “drug tourists” from neighboring countries, as did the city of Zurich’s following the now abandoned experiment allowing an open drug market to operate in what became known as “Needle Park.” And while it is conceivable that affluent countries could soften the worst consequences of drug legalization through extensive public prevention and drug treatment programs, what about poorer countries?

Finally, what would happen to the principal suppliers of illicit drugs if restrictions on the commercial sale of these drugs were lifted in some or all of the main markets? Would the trafficking organizations adapt and become legal businesses or turn to other illicit enterprises? What would happen to the source countries? Would they benefit or would new producers and manufacturers suddenly spring up elsewhere? Such questions have not even been posed in a systematic way, let alone seriously studied.

Irreducible Uncertainties

Although greater precision in defining more permissive regulatory regimes is critical to evaluating their potential costs and benefits, it will not resolve the uncertainties that exist. Only implementation will do that. Because small-scale experimentation (assuming a particular locality’s consent to be a guinea pig) would inevitably invite complaints that the results were biased or inconclusive, implementation would presumably have to be widespread, even global, in nature.

Yet jettisoning nearly a century of prohibition when the putative benefits remain so uncertain and the potential costs are so high would require a herculean leap of faith. Only an extremely severe and widespread deterioration of the current drug situation, nationally and internationally—is likely to produce the consensus—again, nationally and internationally that could impel such a leap. Even then the legislative challenge would be stupendous. The debate over how to set the conditions for controlling access to each of a dozen popular drugs could consume the legislatures of the major industrial countries for years.

None of this should deter further analysis of drug legalization. In particular, a rigorous assessment of a range of hypothetical regulatory regimes according to a common set of variables would clarify their potential costs, benefits, and trade- offs. Besides instilling much-needed rigor into any further discussion of the legalization alternative, such analysis could encourage the same level of scrutiny of current drug control programs and policies. With the situation apparently deteriorating in the United States as well as abroad, there is no better time for a fundamental reassessment of whether our existing responses to this problem are sufficient to meet the likely challenges ahead.

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Should drugs be legalized? Legalization pros and cons

Source: Composite by G_marius based on Chuck Grimmett's image

Should drugs be legalized? Why? Is it time to lift the prohibition on recreational drugs such as marijuana and cocaine? Can we stop drug trafficking? if so what would be the best way to reduce consumption?

Public health problem

Drugs continue to be one of the greatest problems for public health . Although the consumption of some substances has declined over time, new drugs have entered the market and become popular. In the USA, after the crack epidemic, in the 80s and early 90s, and the surge of methamphetamine, in the 90s and early 21st century, there is currently a prescription opioid crisis . The number of casualties  from these opioids, largely bought in pharmacies, has overtaken the combined deaths from cocaine and heroine overdose. There are million of addicts to these substances which are usually prescribed by a doctor. This is a relevant twist to the problem of drugs because it shows that legalization or criminalization may not always bring the desire solution to the problem of drug consumption. On the other hand there is also evidence of success in reducing drug abuse through legal reform. This is the case of Portuguese decriminalization of drug use, which has show a dramatic decrease in drug related crime, overdoses and HIV infections. 

History of prohibition of drugs

There are legal recreational drugs , such as alcohol and  tobacco , and other recreational drugs which are prohibited. The history of  prohibition of drugs is long. Islamic Sharia law, which dates back to the 7th century, banned some intoxicating substances, including alcohol. Opium consumption was later prohibited in China and Thailand. The  Pharmacy Act 1868 in the United Kingdom was the first modern law in Europe regulating drug use. This law prohibited the distribution of poison and drugs, and in particular opium and derivates. Gradually other Western countries introduced laws to limit the use of opiates.  For instance in San Francisco smoking opium was banned in 1875 and in Australia opium sale was prohibited in 1905 . In the early 20th century, several countries such as Canada, Finland, Norway, the US and Russia, introduced alcohol prohibitions . These alcohol prohibitions were unsucessful and lifted later on. Drug prohibitions were strengthened around the world from the 1960s onward. The US was one of the main proponents of a strong stance against drugs, in particular since Richad Nixon declared the "War on Drugs ." The "War on Drugs" did not produced the results expected. The demand for drugs grew as well as the number of addicts. Since production and distribution was illegal, criminals took over its supply.  Handing control of the drug trade to organized criminals has had disastrous consequences across the globe. T oday, drug laws diverge widely across countries. Some countries have softer regulation and devote less resources to control drug trafficking, while in other countries the criminalization of drugs can entail very dire sentences. Thus while in some countries recreational drug use has been decriminalized, in others drug traficking is punished with life or death sentences.

Should drugs be legalized?

In many Western countries drug policies are considered ineffective and decriminalization of drugs has become a trend. Many experts have provided evidence on why drugs should be legal . One reason for legalization of recreational drug use is that the majority of adicts are not criminals and should not be treated as such but helped in other ways. The criminalization of drug users contributes to generating divides in our societies. The "War on Drugs" held by the governments of countries such as USA , Mexico, Colombia, and Indonesia, created much harm to society. Drug related crimes have not always decline after a more intolerant government stance on drugs. Prohibition and crime are often seen as correlated.

T here is also evidence of successful partial decriminalization in Canada, Switzerland, Portugal and Uruguay. Other countries such as Ireland seem to be following a similar path and are planning to decriminalize some recreational drugs soon.  Moreover, The United Nations had a special session on drugs on 2016r,  UNGASS 2016 , following the request of the presidents of Colombia, Mexico and Guatemala. The goal of this session was  to analyse the effects of the war on drugs. explore new options and establish a   new paradigm in international drug policy in order to prevent the flow of resources to organized crime organizations. This meeting was seen as an opportunity, and even a call, for far-reaching drug law reforms. However, the final outcome failed to change the status quo and to trigger any ambitious reform.

However, not everyone is convinced about the need of decriminalization of recreational drugs. Some analysts point to several reasons why  drugs should not be legalized  and t he media have played an important role in shaping the public discourse and, indirectly, policy-making against legalization. For instance, t he portrayal of of the issue in British media, tabloids in particular, has reinforced harmful, dehumanising stereotypes of drug addicts as criminals. At the moment the UK government’s response is to keep on making illegal new recreational drugs. For instance,  Psychoactive Substances Bill aims at criminalizing legal highs . Those supporting the bill argue that  criminalization makes more difficult for young people to have access to these drugs and could reduce the number of people who get addicted. 

List of recreational drugs

This is the  list of recreational drugs  (in alphabetic order) which could be subject to decriminalization in the future:

• Amfetamines (speed, whizz, dexies, sulph)
• Amyl nitrates (poppers, amys, kix, TNT)
• Cannabis (marijuana, hash, hashish, weed)
• Cocaine (crack, freebase, toot)
• Ecstasy (crystal, MDMA, E)
• Heroin (H, smack, skag, brown)
• Ketamine  (K, special K, green)
• LSD (acid, paper mushrooms, tripper)
• Magic mushrooms (mushies, magics)
• Mephedrone (meow meow, drone, m cat)
• Methamfetamines (yaba, meth, crank, glass)
• Painkillers, sedatives and tranquilizers (chill pills, blues, bricks)

Pros and cons of legalization of drugs

These are some of the most commonly argued pros of legalization :

• Government would see the revenues boosted due to the money collected from taxing drugs.
• Health and safety controls on these substances could be implemented, making recreational drugs less dangerous.
• Facilitate access for medicinal use. For instance cannabis is effective treating a range of conditions. Other recreational drugs could be used in similar ways.
• Personal freedom. People would have the capacity to decide whether they experiment with drugs without having to be considered criminals or having to deal with illegal dealers.
• Criminal gangs could run out of business and gun violence would be reduced.
• Police resources could be used in other areas and help increase security.
• The experience of decriminalization of drugs in some countries such as Portugal and Uruguay, has led to a decrease in drug related problems. 

Cons of decriminalizing drug production, distribution and use:

• New users for drugs. As in the case of legal recreational drugs, decriminalization does not imply reduction in consumption. If these substances are legal, trying them could become "more normal" than nowadays.
• Children and teenagers could more easily have access to drugs.
• Drug trafficking would remain a problem. If governments heavily tax drugs, it is likely that some criminal networks continue to produce and smuggle them providing a cheaper price for consumers.
• The first few countries which decide to legalize drugs could have problems of drug tourism.
• The rate of people driving and having accidents due drug intoxication could increase.
• Even with safety controls, drugs would continue to be a great public health problem and cause a range of diseases (damamge to the brain and lungs, heart diseases, mental health conditions).
• People may still become addicts and die from legalized drugs, as in America's opioid crisis.

What do think, should recreational drugs be legalized or decriminalized? Which of them?  Is legalising drugs being soft on crime?  Is the prohibition on drugs making the work of the police more difficult and diverting resources away from other more important issues? Join the discussion and share arguments and resources on the forum below .

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This Is a Very Weird Moment in the History of Drug Laws

The war on drugs failed, but decriminalization is facing its own backlash. what’s next.

[MUSIC PLAYING]

From New York Times Opinion, this is “The Ezra Klein Show.”

In 2020, voters in Oregon passed a ballot measure, a drug reform policy, that was beyond what I ever thought would pass in any state in America.

Overnight, Oregon became the first state in the country to decriminalize most street drugs.

Even drugs like cocaine, heroin, meth, and oxycodone.

It’s a sea change. Measure 110, which was passed by 58 percent of Oregon voters, treats active drug users as potential patients rather than criminals.

I’ve been involved in drug policy reform for a long time. I got into it in high school. And this was not a politics that seemed possible back then. In that era, the idea that you would have a state decriminalize heroin possession, I mean, it was unthinkable. But in the coming decades, there would be a real turn on the war on drugs — the overpolicing, the mass incarceration, the racism, the broken families. It was not achieving, as far as anybody could tell, anybody’s policy goals.

So we began to move in this other direction. Oregon was at the vanguard of this, but it wasn’t alone. In Washington state, you saw the Supreme Court overturn the law that had made a lot of drug possessions and felonies. In a bunch of different cities, you had these very liberal district attorneys who instead of running on tough on crime platforms were running against overpolicing, against mass incarceration.

Something that had really never been tried before in America was all of a sudden being tried. We were moving towards a radically different equilibrium than anybody had imagined even just a few years before on drugs. I mean, you could walk down the streets — you can right now in many states — and buy all kinds of cannabis products from shops. It was, again, unthinkable.

But this politics and these policies are not working out the way people had hoped. Chesa Boudin, who was the district attorney in San Francisco, one of these very liberal set of reformers, he was recalled. Legislation was passed rebuilding an enforcement structure around drugs in Washington state. There are a lot of concerns and, I think, quite bright ones about how cannabis legalization and particularly cannabis commercialization is working out in a bunch of places.

And in Oregon, Measure 110 was gutted. The results of it had not been what many of the advocates had hoped for. Drug policy feels very unsettled to me right now. The war on drugs was a failure, often a cruel one. The war on the war on drugs has not been the success its advocates had hoped. So what comes next?

Keith Humphreys is a professor at Stanford University who specializes in addiction and drug policy. He’s advised the White House, California, the UK. I always find that he balances compassion and rigor unusually well. So I wanted to have him walk me through what he has seen and where he’s landed. As always, my email for guest suggestions, for reflections, [email protected].

Keith Humphreys, welcome to the show.

Thanks, Ezra. Good to talk to you.

There’s a tendency to just use this term “drugs.” And that tendency just belies a huge amount of variation, I think, in how people think about different drugs, how they think about opioids, how they think about stimulants, how they think about psychedelics, how they think about cannabis, alcohol, caffeine. Is this a useful term?

So “drug” is an incredibly vague term that covers an enormous number of drugs that have very different properties. The biggest one, I think, is the capacity to instill addiction. People don’t get addicted to LSD, for example. But they do get addicted to heroin. That’s really important. They do get addicted to nicotine. That’s really important. So you would think about those drugs differently, the ones that have the ability to generate an illness with obsessive compulsion to use in the face of destructive consequences over and over and over again. Those belong in their own class, I think.

The second thing is that we should stop pretending that legal and illegal drugs are so different for lots of reasons. We could learn much more about what to do with illegal drugs if we looked at legal drugs. When I talk to policymakers, they say, well, I know what I don’t want. And that’s a carceral, racist war on drugs. I say, OK, I’m glad that option is off the table. That, of course, leaves millions and millions of other options to choose from.

And how some people have framed that is there’s really only two choices here. You can have that, that horrible thing. Or you can throw the switch the other way — tolerance, acceptance, public sale. And that’s going to be better.

And the problem with that argument, even before we get into what happened in places like Oregon, is the number one drug that kills people on the planet is cigarettes. The number one drug associated with arrests, violence, and incarceration is alcohol. Those drugs are legal. It’s not that drugs suddenly become easy to deal with once they’re legal.

You get to pick the set of problems you have, as our mutual friend Mark Kleiman used to say. But you don’t get to get rid of those problems. So people are right to identify substantial costs to prohibition of drugs or for that matter of everything. But that is different than saying there is some other framework that doesn’t also include pretty substantial costs.

So this major drug policy reform went into effect in Oregon in 2021, Measure 110. It passes. What happens next?

Part of what happens is exactly what the reformers hoped would happen, which is that there’s a dramatic drop in arrests — arrests for drug possession and arrests for drug dealing. So they say, wow, that’s a victory. On the other hand, some of the other aspects of it didn’t work out the way people planned.

So there was a system that they thought would encourage people to enter treatment in replacement of criminal penalties. You’d be written a ticket, let’s say, if you were using fentanyl on a park bench. And it said there’s $100 fine for doing this, but you don’t have to pay the fine. All you have to do is call this toll free number, and you can get a health assessment and a potential referral to treatment. Well, it turned out that over 95 percent of the people got those tickets simply threw them away, which, keeping with the spirit of the law, there was no consequence for doing that. Hardly anybody called. The new body they set up to distribute the new funds had very serious management problems because the people — they may have been terrific human beings, but they weren’t actually experienced in how do you run a government bureaucracy.

So there was no real improvement in the availability of treatment, no real improvement in the number of people interested in seeking it. And those things may well have contributed to Oregon having a very high overdose rate. So currently going up about 40 percent per year, 4-0. Of course, some of that is due to fentanyl, which is raising — I’m here in California. Our rate’s up 5 percent, but it’s certainly not up 40 percent.

And the last thing is the intangible. And I say this as someone who goes to Oregon a lot and talks to people there almost every week, which is just the change in neighborhoods was really palpable of what it was like to go out in the street or try to go to a park, how much visible drug use you saw, how much disorder connected to it. And this was accentuated even further by the pandemic. There were fewer people on the street who had the choice. So the experience became more frightening as people were perhaps outnumbered in their neighborhood by people who had clearly visible problems were using drugs. And that generated significant and, I think, understandable upset as to how things were going in Oregon.

So not everybody agrees that Measure 110 was a failure, certainly not as a policy. I mean, it definitely failed politically. The Drug Policy Alliance says that it failed because of disinformation because there was a concerted effort to undermine it. And they cite data from the Oregon Health Authority saying that, look, health needs screenings increased by almost 300 percent. Substance use disorder treatment increased by 143 percent. Is there some argument to this that we’re looking at the wrong measures and, judged according to its goals, 110 was actually kind of working?

If what you care about the most was a drop in drug arrests and involvement of people who use drugs and deal drugs in the criminal justice system, then it was a success clearly because there was very little contact anymore between law enforcement and people who sell and deal drugs. But on the health side, no, I don’t think that. And those statistics on treatment I believe count a lot of one time consultations. I think what most people, particularly people who love someone who has an addiction, are looking for is evidence on people getting better, people getting into recovery, not just at some point having some transitory contact with the system.

There’s another argument that’s made in the Drug Policy Alliance document and other things I’ve seen and that has occurred to me, too, because when I think about Oregon, when I think about San Francisco, when I think about Washington State, I mean, you’re talking about places with very broken housing markets. We’ll talk I’m sure more about the Tenderloin.

But the Tenderloin is dystopic in the way the Tenderloin is dystopic because it is a giant homeless encampment. And that was true well before the current wave of drug policy liberalization. And so one argument here is that the drug system is being blamed for policymakers’ inability to solve these other problems. Is there something to that?

There’s an intense argument out here in the Bay Area between people who say, look, the homeless crisis is just a side effect of addiction. And people say, look, the addiction crisis is just a side effect of homelessness. And I would say they’re both wrong in that, even within my personal group of acquaintances, I know people who lost their home because of an addiction. And it’s not that the housing market discharged them, they had an empty property. But they were out on the streets. And then there are people who lost their housing and then were living next to drug markets on the streets and developed an addiction there.

So I don’t think we can separate that Gordian knot. And I don’t know if in policy terms we have to. I mean, I think we should be able to pursue policies that increase the access to housing and still work on policies that reduce the damage from addiction.

So to go back to Oregon and one of the theories that was operating there was that we’re going to move more money into treatment. We’re going to make it easier and safer in the sense that you will not be arrested for seeking treatment. We’re going to make it easier and safer for you to seek treatment. We’re going to make it cheap to seek treatment. Why didn’t more people seek treatment?

That theory reflects a misunderstanding about the nature of addiction, which is that it is like, say, chronic pain or depression, conditions that feel lousy for the person who has them all day long, and they will do anything to get rid of them. Drug addiction is not like that. It has many painful experiences. It destroys people’s lives.

But drug use feels in the short term incredibly good. That is why people do it. They’re getting intense reward. So they are ambivalent about giving that up in a way no one with chronic pain is ambivalent about giving up chronic pain and no one with depression is ambivalent about giving up depression.

The other point about it is a huge number of the problems from drug use and addiction fall on other people rather than the person concerned. And so people like me who work in this field, we get calls and calls and calls from mothers, fathers, brothers, sisters, children concerned about their loved ones. But it’s very rare we get a call from somebody concerned about their own use.

Take the law out of it and look at a drug that is legal and widely accepted. Studies of people who seek treatment for an alcohol problem, slightly over 9 in 10 of those people say they were pressured to come. And the pressure might be family pressure, mom and dad said or my spouse said, this keeps up, I’m moving out. The boss said, one more day drunk at work, and you’re fired. Doctor said, you keep doing this, you will be dead in six months. It could be this is your fourth or fifth arrest for drunk driving, and your lawyer says, you better get into treatment because the judge otherwise might throw you in the penitentiary. That is overwhelmingly the situation of people seeking treatment — pressure from outside.

So let’s just remove all pressure. No legal pressure, no disapproval. Then people will spontaneously say, OK, I really want to make a change, and I’ll come in. Look, those of us who do this for a living, we pray for patients like that. It’s great when they come in, but that is just a very rare person.

Let me ask about this from the other direction, which is maybe this all just wasn’t nearly liberal enough because one of the arguments made — and I do think there’s evidence behind it — is people are getting stuff they don’t know. And the reason people die from fentanyl laced heroin or simply fentanyl that they thought was heroin is because they don’t have a source they can trust. Part of the difficulty here is, yes, people end up addicted. We don’t have really good treatments for addiction that we can come back to whether you think that is a true claim.

And then we also make it very difficult for people and dangerous for people to get what they need to avoid withdrawal to keep feeling normal. And if we made that easier on them, if we made it so they didn’t have to go to a place like the Tenderloin and instead get something safe, they would not die from overdose. They would not die from fentanyl laced heroin. Is there validity to that?

Yeah, well, certainly using fentanyl in an illicit market is extraordinarily dangerous. And my colleagues and I are trying to figure out the death rate per year of a regular user. It might be as high as 5 percent. So that is an extraordinarily dangerous thing to do.

And the arguments you’re making have been influential in this region to the point that if you go up slightly even further in the Pacific Northwest into Canada and British Columbia, they’ve gone so far to say it’s the government’s job to supply these drugs because prohibition makes things more dangerous, so we have a positive obligation to do this. But the problem with that reasoning is we did flood communities with legally made, consistent quality, clearly labeled opioids for years. And the net effect was millions of people getting addicted and hundreds of thousands of people dying.

That’s, in fact, how we got here. I think everyone knows what OxyContin is, all the other opioids that were really pushed out there. So it’s just really hard to sustain that argument that at a population level, huge access to addictive drugs is not going to cause a lot of addiction and overdose as long as they’re clearly labeled and of consistent quality. If that were true, we would never had an opioid crisis.

So Measure 110 passes in 2020. It goes into effect in 2021. What happens to it in 2023?

At that point, overdoses were way up. And popular sentiment has shifted pretty dramatically. I think quite a few people felt burned. They hadn’t gotten what they’d been promised. And that included people who, for example, had relatives who were addicted who they assume would be getting into treatment and recovery and then weren’t able to get services.

Neighborhoods are decaying. Polling showed that about two thirds of the Oregon population wanted Measure 110 repealed in part or in whole. And interestingly, those sentiments were even stronger among Black and Hispanic Oregon residents.

In response to all this, both Houses by very large margins replaced Measure 110 with a different approach to drug policy. It restored the ability to impose criminal penalties, to use those penalties particularly to leverage people to change their behavior — for example, by restoring drug courts and other kinds of diversion and monitoring programs. It is definitely not correct to say they reinstated the war on drugs because, it has to be remembered, Oregon never really had a war on drugs policy. They were the first state in the nation to decriminalize marijuana over 50 years ago, in fact. They decriminalized marijuana. They had a very low rate of putting nonviolent criminals into prisons.

So it was more a restoration of that progressive, liberty loving approach that they’d had before but supplemented with a lot more funding for treatment, which is something they’ve had a lot of problems standing up for years, which had nothing to do with Measure 110. The treatment system was in very bad shape before Measure 110. And it still is.

If you’ve been around drug policy conversations for a long time, you’ll have heard a lot, I have heard a lot, about Portugal. And Portugal is a place where they decriminalized drugs. And it has been a much more sustainable, solid policy. So what is different about Portugal?

Portugal is different in policy and different in culture. So they definitely don’t throw people in prison, and it’s decriminalized. But they do have what are called dissuasion commissions that do assessments of people, say, who arrested in the street for using drugs. And you have to show up to this assessment. And they can push and nudge people to seek care.

And they can also apply penalties if they want to. They can say, you’re a cab driver. You’ve been caught using cocaine. And we’re going to take your cab license away until you seek treatment and stop using cocaine. Things like that. It is not a war on drugs approach, but it is a push in the policy. And that has never been taken on seriously by American advocates who cite Portugal.

Portugal also has a universal health care. We do not have that. We are the only developed Western country that doesn’t have that. So that makes it easier to get help irrespective of what the laws are. And Portugal had at least at the time of their decriminalization a very nice network of treatment services and harm reduction services for people. And all that together worked in the policy mix.

The other point is the culture of Portugal is much more family oriented. It’s much more communitarian than American general and certainly much more true than our freedom loving Libertarian Pacific Coast. If you spend time in Lisbon, you have a common experience of running into people and say, where are you born? And they’ll say, well, Lisbon. And where were your parents born? Lisbon. And they still live in my neighborhood. And my grandparents live in my neighborhood, too. You never hear this in San Francisco or Portland. Everybody is from somewhere else. And many people actually moved to the West to get away from everybody else, to get away from social constraints. I want to be my own person. Well, Portugal is the opposite of that.

So there’s a lot of constraint on behavior. It’s loving constraint, but it is constraint, those boundaries around people’s behavior that don’t exist out in the West with the exception of recent immigrant communities, which, by the way, have very low rates of drug problems.

This is something that I always think people underestimate at least about San Francisco, which is one of these cities under the best, which is that it is a culture of enormous tolerance. And that is a lot of what makes San Francisco remarkable, what has made it a home for L.G.B.T.Q. people when that was a very rare thing to be, what has made it open to all these weird ideas from computer scientists and strange nerds who came around with their thoughts about AI and their thoughts about visual operating systems.

And people don’t like necessarily the dark side of this open, tolerant, nonjudgmental way of looking at the world. There’s a bit of a divided soul, a difficulty judging, a discomfort with paternalism, and a kind of optimism that if you let subcultures have their freedom and grapple their way forward, they’ll find their way to an equilibrium and that we should be very, very, very skeptical of heavy handed particularly law enforcement as a way of changing culture.

That is a very nice description of the city we both love. And we’d be much poorer without San Francisco’s embrace of individual freedom and all the great things that it gives, which you just articulated. To me, the resolution here is taking addiction seriously as a problem.

So if you look at somebody who is using methamphetamine five times a day, you could say, well, that is really an expression of their individual freedom. I need to respect that. But if you recognize the likelihood that they are not particularly free because they are addicted, the inconsistency disappears. And so I feel personally no contradiction between saying the state should intervene with pressure — for example, mandating people into treatment. For me, that doesn’t conflict with individual freedom at all. So when I talked to somebody who said, look, you need to just let people do what they want, I say, look. I volunteer in the Tenderloin. And I carry naloxone, the overdose rescue medication, with me. If someone were in front of me in overdose and dying, should I administer naloxone even though the person can’t consent, they’re unconscious?

And I’ve never had anyone say, you’re right. You should just respect their right to die. They say, well, no, of course, you should do that, conceding the principle that there are times that the thing we can do the most to help other people is take care of them when they were not in a fit state to take care of themselves.

Is that a straw man, though? I can’t really think of people at least that I have heard arguing that somebody under the throes of heroin addiction is free and is choosing the life they live, that they’re likely to be happy with the world they now exist in.

One of the really striking things about this new rhetoric about drug policy out here is how rarely addiction is even mentioned. The fact that there’s so much focus on drug overdose, which is, of course, terrible, but that is treated as the only index and not addiction reflects a viewpoint that that’s not either an important thing or not that real a thing. Because if it were, you would note that in the heyday of wild opioid prescribing, there were fewer overdoses, but there were far more people who were addicted to those substances. And that made their lives dramatically worse.

I also see the lack of attention to addiction in the investment in harm reduction without the idea of using it as a springboard into treatment, which to me is a very novel idea that’s only become more powerful in the last couple of years where people feel like that in itself is the goal versus trying to eliminate addiction and get somebody into recovery.

So this is complicated, I think, because there’s this interaction in this period between what you might call elite and mass drug culture. In this period, you have the rise of a lot of super popular podcasters like Joe Rogan and Tim Ferriss, who are very open about their psychedelic use. You have Michael Pollan’s great book on psychedelics, “How to Change Your Mind.” I do a bunch of podcasts about psychedelics. You have a book by Carl Hart, who’s a well-known drug researcher at Columbia, called “Drug Use for Grownups” where he talks openly about using heroin to relax at the end of the day. Ketamine use rises in a very public way.

And so you have this change in drug culture among elites. It becomes much more acceptable to talk about how you use drugs to improve your life that I think also makes it look hypocritical to have a punitive approach not just legally but culturally towards other kinds of drug use. Do you think there’s something to that?

Yeah. I’ve seen that very much, too. And people with a platform, they’ve got a hearing. One of the most important things to understand about Measure 110, for example, is it passed easily. It was not that controversial as people thought it would be. And that elite change, I think, was part of the dynamic.

And definitely, you could see that in psychedelics in Oregon, which, as you know, has set up an entire system to administer psychedelics as a healing force. At least that’s the theory. These are transformative medicines often, by the way, in advance of evidence. But put that aside for a minute. And that is a remarkable change.

I think the criticism you could make of people who are well off and well resourced and have a lot of social capital and have access to treatment and health care whenever they need it is that they could be overgeneralizing what it’s like to use drugs in that situation versus the situation most people find themselves in with a lot less resources and a lot fewer things to catch them if they develop a problem. Now, some would say, well, the real problem is the law, and it’s the punishment you get and all that. And that can absolutely ruin people’s lives. There’s no question to that.

But there’s also quite a few people whose lives are ruined by drugs, including cannabis. There’s some people whose lives have been ruined by psychedelics and certainly people’s lives ruined by cocaine and fentanyl and so on. You don’t think about that much maybe when you are in a really comfy, well-resourced environment. But the average person who lives in a more typical environment does think about it, does have to worry about it. And that gives them a different understanding of what drugs are, how risky they are, and what they want their government to do about them.

That all makes sense to me. But something else I would say was here was that I would have described the consensus for a very long time as drug use is bad, and policing is good. And to some degree, by the time of 110 and some other reforms we were seeing in other states, I think that there was — and you can tell me if this tracks for you — a belief that drug use is somewhere between neutral and good depending on the drug, and policing is bad.

Yeah. There’s no way to separate what happened in Oregon from the murder of George Floyd and from Black Lives Matter. I mean, the protests against police were as intense in Oregon as anywhere they were in the United States and indeed throughout the region and a lot of concern — and it’s got to be said — a lot of justifiable concern about racism and policing. And a huge portion of that was focused on drug enforcement. And that flip was clearly part of why the bill passed.

In terms of drug use, I think there’s a split. I mean, so there are people who accept it’s a health matter. So let’s move to that part of the population, some of whom will say, it’s not a good idea, but we should add health services, and I certainly wouldn’t punish anybody for it, to people would say, no, it is good. In fact, it is actively good. Drug use is good. Drug use should be accepted and maybe even promoted or celebrated. And the debate has been, I think, between those two strands, whereas in the ‘80s, it was more between “drugs are bad — period” and “they should be legal even if they’re good or bad.”

You’ve written about billboards that I used to see and always thought were somewhat strange around fentanyl use and showing happy people — and these were in San Francisco — showing happy people and suggesting if you’re going to use this stuff, use it with friends. Use it around others. Make sure you’re not doing it alone.

One way of looking at them was as a destigmatization of this. It’s totally fine. Just be safe. And another way of looking at it was a total last gasp, but we don’t know what to do. We’re going to try this approach to everything else is failing. Maybe if we completely turn around our approach and just try to change the social dynamics in which people use, that might have an effect on the margin.

So several things there you’re saying, I think they’re important. One is, absolutely. In the face of all this death and all this suffering, we’re all desperate for solutions. And I think it is good that we are thinking in very fundamental ways about what the solutions are. That should be the case when you have this much suffering.

I think it is not irrelevant that these changes have unfolded during a pandemic where, let’s face it, we all went a little crazy. It was very stressful. It was emotional. Many policy debates took on a very personal cast. And we did rock between different extremes in our politics.

With the billboards — and just to describe these billboards, what to me is interesting about them is that the public health department signed off on these. And if they had been promoting beer, they would’ve been outraged by them because they would’ve said, well, you’re making it look like this is something young, attractive, successful people do. And it’s a lot of fun. And you’re understanding all the risk. And you’re going to be tempting kids. You’re basically giving people really bad information. But it wasn’t alcohol. It was fentanyl.

And so I guess they felt it was reasonable on the idea that this will destigmatize. And then people will be comfortable talking about it and using fentanyl together. And they would show people in the apartment having a nice party. Then they could take care of each other in the event of an overdose. It would be a social event, and then you could be there. To me, it’s an extraordinary chain of reasoning. But that’s where San Francisco got in 2021.

I lived in San Francisco during this period. It also had a highly liberalizing attitude on drugs. It had significant open air drug markets, particularly in the Tenderloin.

But what I always saw as the core thing that was infuriating people because I lived in places like D.C. that had a much higher murder rate but where crime was much less of an angry political issue was a feeling that the government was tolerating disorder, that it wasn’t fighting it and failing or fighting it and failing to triumph over what’s a very hard problem, but that the government was allowing it, that they were allowing these open air drug markets, that they were allowing people to shoot up on the street, and that it turned out the politics of permitting disorder were really, really, really bad.

Yes, they are. And I volunteer in the Tenderloin. So I’ve spent a lot of time in those neighborhoods and definitely pick up that sense. And, say, for a number of people would express it in an even harsher way, which is the government is tolerating it where I live in a way they would never tolerate it in a wealthier neighborhood. That could be coupled also with a sense of some of those people in the wealthier neighborhoods say this should be tolerated, but they’re not having to tolerate it. I am. And that generates understandable anger.

And this has had an interesting racial dimension in my observation of it is that a lot of this tolerance has been pushed in the name of racial justice often by white college educated progressives but is unpopular with many, many people of color who live in low income neighborhoods because they’re paying the cost of it while it’s being advocated for for people who they don’t even know who live in neighborhoods that don’t have these kinds of problems.

I was reading recently a lawsuit filed by residents of the Tenderloin against San Francisco. And it was saying in a way that is illegal and unconstitutional, it was alleging that San Francisco — and everybody knows this to be true — was not enforcing laws in the Tenderloin the way it was in other parts of the city, that it had settled on a containment strategy in the Tenderloin. And the Tenderloin is really rough for people who have not walked around there. I mean, the disorder, the despair, the difficulty’s incredibly visible. And one of the things that was noted in the lawsuit was that the Tenderloin has a much higher ratio of children than most parts of San Francisco. It has a lot of immigrant families, a lot of poor families. And so this is being tolerated where really a lot of kids were.

And the argument was that this was not allowed where richer people lived in San Francisco, and it was where these poorer people lived. And even knowing that, it was striking to see it laid out and to see these experiences of people who were living amidst it laid out and their fury that containment was being done on their backs.

Why are there hundreds of dealers standing on street corners in the Tenderloin and in the south of Market? They are not there to service the neighborhood. Because if you live in a neighborhood and your dealer lives in the neighborhood, your dealer doesn’t have to stand on a corner. You know each other. You can text. You can just stop by and make your transactions.

Open air markets are there to service strangers. They’re so that buyers and sellers can find each other really fast. And in an open air market, it’s serving people who don’t live in the neighborhood. There’s no reason there’d be that many dealers. The Tenderloin doesn’t need that many dealers to pay for its own drug use.

So it’s a legitimate gripe if you live in a neighborhood and you’re trying to raise a family in a neighborhood that is taken over by an open air market to say, we’re taking all the harms of all the drug use of the other neighborhoods where they don’t allow open air dealing. But people know they can just drive from there to here pick up their drugs and then go off about their way. And that’s unfair. And so I sympathize with the residents of the Tenderloin who are raising that very legitimate gripe about not getting equal protection under the law.

One question I’ve had about all this is how much of it is a set of policies that might’ve worked or certainly worked better than they did, but fentanyl rolled a grenade underneath this? I mean, a lot of this thinking was happening years before fentanyl just completely invaded America.

The emergence and dominance of powerful synthetic drugs like fentanyl among the opioids or super strong methamphetamine that is now a larger share of the market than cocaine has, I think, undermined basic assumptions about drug policy across the world. When a kind of person who might come into, say, a methadone clinic addicted to heroin, their heroin use might be once a day or maybe twice a day, including people who were holding jobs, people who still were in touch with their families. Not that life was going well, but there was some level of manageability. We now have people with fentanyl using 10, 20, 30 times a day. Their entire existence is — because fentanyl has a very short cycle of action.

So you wake up. You’re in withdrawal. Withdrawal is incredibly unpleasant. You may smoke fentanyl, smoke, smoke, smoke. Maybe it takes 10 minutes, 20 minutes, 30 minutes. Your withdrawal finally stops. You smoke some more till you get high. You fall asleep. You wake up, and you’re in withdrawal. And you’re just really stuck like that.

And I see people like that. I mean, I’m very optimistic about the potential of recovery for addiction. Those are what I’ve seen. And those are also my values. I try to approach everybody that way.

And I also sometimes am frightened that it’s just much, much harder to help people in this state when their life is that consumed by drugs even relative to how consumed their lives were by drugs like heroin and OxyContin. It’s really pretty frightening. And we are getting it first. The United States and Canada too are being exposed to these drugs.

It’s interesting to note in Europe, they’re just starting to get these drugs. And whether they’ll keep with their same policy mix is a really interesting question. It isn’t entirely sure. I have a colleague who says fentanyl is like an antibiotic resistant infection. The stuff we always done that used to work doesn’t work anymore. And that’s terrifying.

How good now is our best gold standard addiction treatment?

So this varies a lot by drug. I’m going to start with the bad news first, which is the stimulants. So the biggest disappointment of my career is about cocaine and methamphetamine. I started my career in the late 1980s. And the care that people got for those drugs then is almost the same as what they get now. There’s been very little progress.

Billions have been spent. Brilliant people have tried to develop, for example, pharmacological treatments for them. Nothing has panned out yet. Most of the behavioral treatments don’t work. We have one thing that seems to work, which is contingency management, a particular way of structuring and giving rewards to help people make changes in their behavior. But we’ve had that for a very long time. So the news there is kind of disappointing.

For alcohol, funnily enough, one of the best things we have has been around forever, which is Alcoholics Anonymous. And for a long time, people in my field looked down on it as too folky and not medical enough. And yet there’s now tremendous evidence that myself and some colleagues assembled in what’s called a Cochrane Collaboration showing that does work, that people do, in fact, as well or better in Alcoholics Anonymous as they do coming to see people like myself.

There’s also some medications available. Acamprosate is one. Naltrexone is another. Some people benefit from those.

On the opioids, we have multiple approved FDA medications. Methadone has been around a very long time. It’s a substitute medication. It is effective for many people. Buprenorphine is another substitute medication, slightly different pharmacologically, but also effective for a great many people. And we have naltrexone, which is it works differently. It’s a blocking agent. And there are people who do very well on that.

So those things are all good. That’s considered the front line. You offer people medication first. And people also can benefit from other kinds of things — therapies and from residential care. And if somebody is out on the street with an addiction, it’s not believable that they are going to check in once a week for an hour with a therapist because their lives aren’t that organized. They usually need a safe substance free environment in which to stay. And those are often in short supply. So we sometimes don’t have success there not because we don’t know what to do, but because we haven’t allocated the resources to do it.

But how good are any of these? I mean, let’s zoom in on alcohol for a minute. I’ve known a lot of people — people I’ve loved — who have had very severe alcohol addictions. And you can’t be near that and not realize how differently different drugs act on different people. If I am drinking, just at some point, my body is like, that’s good. We’re done.

And there are people I know who they have burnt their life down around them. And they’ve been in and out of residential treatment. They’ve gone to A.A. Some people recover. Often they really don’t. How likely is it if you go into A.A. or some of these other things that you’ll recover?

People who seek for alcohol treatment or Alcoholics Anonymous can fall into three bins. If you look at them about 6 or 12 months later, somewhere between 40 percent, 50 percent are dramatically better off. Their lives are dramatically better. And that could be the completely abstinent, or they’re much more abstinent, but their lives are dramatically better.

Then there’s another group of people who seem to be somewhat better. That might be 20 percent, 25 percent. They’re still having significant problems. But maybe they make some things like, at least I’m not drinking and driving at the same time, or at least my spouse and I are making some progress in our marital communication. And then the remaining people unfortunately look exactly the same as the day they came into treatment. They either made no progress, or they made some slight progress and then relapsed.

The perception that we have of it tends to be driven by that last group. That’s because when people get better, they disappear into the woodwork. So when I worked in the White House, I used to think when I walked by somebody getting out of the metro who’s actively using drugs or alcohol, I’m very aware. That’s so visible to me.

And yet I know every day people walk by me in suits or in recovery, and I don’t notice them at all. Just looks like another Washington lawyer or civil servant or politician. So the cognitive effects of people who are doing the worst or the most vivid give us, I think, a more despairing view than we ought to have.

How much is the risk of developing an addiction genetic?

Genes affect us a lot. Studies across addictions show a genetic contribution. It varies by the substance, but at least 30 percent, sometimes even 50 percent. How much control people have just in general — some people are more impulsive than others, have a harder time thinking about the future than others from their first day on this Earth. And that will increase your risk for addiction.

If you’re very, very risk averse person who thinks a lot about the future, drug use looks differently to you than if you’re someone who wants to feel good today and is a happy go lucky person. Some of why we get addicted has to do with things that nobody can really control. And those can be things like liking. Even for the first time we use them, we like drugs differently.

When my boys were little, they were in the backyard, and they were climbing a tree. And I said, ah, that’s not how to climb a tree. I’ll show you how to climb a tree. So when I got to the emergency room, I said, this bone is broken. And I know it because I can see the way it’s knocked off my wrist.

And they nicely patched it for me. And they sent me home with Vicodin, the opioid Vicodin, bottle of 30, and said, it’s going to hurt. So you’re going to want to take these.

I take one. And I feel terrible. Stomach all feels bound up. I feel just really groggy. I don’t like this. For me, it was very easy to say pain is better than taking even one more of these pills. Meanwhile, I’ve treated people who say, the first time I had an opioid, it was like a hole that had been in my heart my whole life filled up for the first time.

Now, both those experiences are real. You cannot attribute them to, well, Keith must be a real solid and moral person, and that’s an immoral person, or Keith must have made good choices, and that person made bad choices, because we had no learning history at all. It was just the kismet of genetics that drugs feel differently to different people from the very first time, not just learning history.

And so I find it very easy to be sympathetic to someone who’s addicted to opioids because I think the reason I’m not going to do that is not because I’m a better person. It’s because they just don’t feel good to me. And to you, they felt fantastic. And so you were willing to keep on using them.

It’s not just that I find it easy to be sympathetic. But I find it hard to know how to think about it because, to be blunt, I’ve had very positive personal experiences with certain drugs. And at the same time, I’m somebody who is extremely nonaddictive in this area of my life. I have never wanted more puffs on a cigarette than I had. I’ve never smoked a cigarette and been like, I need another one. Obviously, other people I knew when I was in college, that was not how that went for them.

There is something here where, on the one hand, I worry that a fair amount of the discourse around drugs comes from people for whom maybe it actually is positive for them. There are people who have real positive relationships with different kinds of substances both legal and illegal. Adderall can be amazing for somebody with A.D.H.D., and it can be very destructive for somebody who ends up using it recreationally. I mean, you were talking about methamphetamines. And it’s not all that different.

And it becomes, I think, almost philosophically hard to know how to think about these substances that really can range. How to think about something where for some people it can be a very good part of their life, either pleasurable or even very profound. For other people, it can be a complete disaster that will actually ruin their life. And who are you making policy for and how feels like something that this conversation gets caught on a lot.

I agree, yeah, because drugs aren’t good, and drugs aren’t bad. They are good and bad. And sometimes I envy colleagues who work in areas like cholera prevention. If there’s a cholera outbreak, and you get rid of it, you’re a hero. Everybody loves you. Nobody says, but I was having a party. I need a little cholera. Can’t you keep a little cholera for special occasions? It’s like, no, everyone just hates cholera. Drugs are absolutely not like that. People have great experiences with drugs. I drink wine, by the way. That’s a drug. Or ethanol is a drug.

So we can’t resolve it that simply. And so we have to get into these questions of, well, when is it good? And when is it bad? And for whom is it good? And for whom is it bad?

And then there’s a question that is to me a philosophical question, in fact, religions grapple with, which is should I give something up for the benefit of others? Perhaps I can use fentanyl freely and enjoy it. But should I still say it shouldn’t be in recreational market because I’m aware enough of my fellow people would find it life ruining? And so the moral thing is for me to give it up so the sense that all of us can live together in a spirit of common humanity. And there’s always going to be tougher discussions, things that are good and bad versus things that are just clearly good, and we should just embrace them, and clearly bad and just reject them.

I wonder about this with the rollout of legal cannabis across a lot of the country. So this is something that I occasionally take. I’ll sometimes have a 5 milligram edible to help me sleep or to relax at the end of the night. It isn’t something I want all that often. And when I go into these stores, and I look in them, and I see the way they’re popping up in New York the way they popped up in California, it’s pretty clear this market is not catering to me.

And I think a lot about something that, as you mentioned, our mutual late friend Mark Kleiman, who was one of the great drug researchers and crime researchers, used to say to me, which is that alcohol companies do not make their money on people who drink a beer or two a week. They make their money on people who drink a case. And when I go into these stores, what I see are the rise of super high potency products that I wouldn’t touch. And clearly the money is being made given how many of the stores there are on people taking a lot more than I am a lot more often. When you look at what is going on with legal cannabis, how do you feel about it?

So start at the question of should we ever throw people in a cell for cannabis? Oh, so that was a terrible idea. So let’s take that off the table and just say if we’re going to have a legal industry, have we regulated it well? And I think it’s absolutely clear we have not.

And this is something we’re generally I’d say bad at relative to other countries of constraining profit when the profit damages public health. And so we have an industry with hardly any constraints on their products, not a very good record with even labeling their products accurately, very poor enforcement of even keeping the legal regime in place. And the pot shops in New York are a good example of that. A huge number of them are unlicensed and just doing whatever they want. And they’re being allowed to do that.

So I think we’ve done a really bad job with cannabis and in part driven by this phenomenon of not being willing to admit that cannabis isn’t good or bad, but it is both. And so when Mark Kleiman and I worked with Washington state, who was one of the first states to legalize, and we said, you still need to have some enforcement to make a licensing system work, I remember people literally either laughing or getting angry at us saying, the war on drugs is over. No more enforcement ever.

It’s like, actually, no. Why would you have a license and do the right thing and not hire minors? And why would you be sure to card? And why would you sell clean and safe products when you do that because you get a market advantage in a licensed market? And so if we just allow anybody to do anything, well, then there’s really no point in getting licensed, no point in paying your taxes, no point in being a good citizen, no point in not in hawking dangerous products.

And that’s the situation that we have. And we’re going to be really sorry for it. The distribution of consumption is also really important to think about. It’s not quite half, but it’s certainly a plurality of cannabis users today are using it every single day, usually a high strength product.

Wow, really? Almost half?

Yeah. I’d say about 40 percent are daily or near daily users. And so that’s where the money is if you’re running an industry. And so you want to produce cheap high-strength product that that population will use and use and use and use. And I just think we’re really going to regret that.

My friends over at “Search Engine,” which is a great podcast, just did this two part series on the New York cannabis market. And I had not really understood that while New York is now completely full of what appeared to me to be legal cannabis stores, virtually none of them are legal cannabis stores. There’s a very small number of legal ones and then a huge number of illegal ones.

And you might say, well, how are there all these illegal stores? And the answer is that nobody wants to send the police to bust people for cannabis. And so much of the theory of legalization as I understood it for years was that we will legalize and then be able to regulate the market. But if what we’ve done is legalized, but we’re not willing to use law enforcement, and so we cannot regulate the market, that’s actually a dramatically different policy equilibrium than I feel like I was promised.

Yeah, the experience you’re having — I think people have had across a lot of drug policy — is expecting one thing and then getting another and underestimating the ideological commitments of the people who designed it. So there are people who say, we’re going to have this legal market, and we’ll get rid of the illegal sellers and all that. But that isn’t what necessarily they wanted. They just thought, look, this should not be restricted at all. And you should just be able to deal with it and sell it and have a classic Libertarian understanding of it as opposed to a more progressive understanding of what we expect from industries. And this problem is replicated all over the country.

There’s also something that’s happened in policing, which is there’s always more to do for police than they have to do. So they’re not super interested in getting involved. Even with some of the massive problems we have, for example, here in California, we have huge illicit groves, some of them staffed by people who have literally been human trafficked. But it hasn’t really risen up as an enforcement priority because, cannabis, we don’t do that anymore.

You said this about cannabis, and I found it really striking. Quote, “The newly legal industry looks a lot like the tobacco industry — an under-regulated, under-taxed, politically connected, white dominated corporate entity that generates its profits mainly by addicting lower income people to a drug. 85 percent of Colorado’s cannabis, for example, is consumed by people who did not graduate from college.” Can you say a bit more about that socioeconomic breakdown?

Yeah. So I think that in middle upper class society, that figure’s really shocking. And the idea is, oh, cannabis user is, oh, someone like you, someone who has a good job, went to college, and maybe uses occasionally. No. I say if you want to think of the typical user, think of somebody who works in a gas station who gets high on all their breaks. That’s much more the sociodemographic breakdown of it.

And by the way, that’s what you see with tobacco as well. In my professional middle class life, it is so rare for me to see somebody smoking a cigarette. But if you go into a poor neighborhood, there’s still a lot of people who smoke cigarettes.

And so we’ve won the war on smoking I guess, middle class and well off. But it’s far less the case as you move into people who have much more challenging lives. And this comes back to the point that you raised and I think is really important one is that since that professional class makes the policies, it’s really important for them to remember that their lives are different than the people whose lives will be most profoundly affected by those policies.

One thing that a lot of drugs, cannabis being one of them, do is allow you to escape from a life that doesn’t feel good to you. If I had a job that bored the hell out of me, it might be more appealing to use something like cannabis more often. I really like my job. And I definitely cannot do it high, so I don’t. But there’s both a question of how does this affect you as a person but also how much might you want it, need it, need the escape?

I think this gets down to one of the most important questions to ask, which is, why don’t more people use drugs? People say, why does anybody use drugs? And it’s like, well, do you ask me why anybody has sex? That’s a really strange question. It feels good. We don’t need an explanation why people use them.

It’s actually far more interesting to think, why aren’t we all using them? Why aren’t you and I using drugs right now? And big reasons why are, well, we have other rewards in our lives. And we have a lot of other stuff that we want to do that is rewarding.

So in the absence of those things, the why not question, the answer seems to be, well, I can’t think of a reason why not. I might as well. Well, you won’t live as long. Well, I don’t expect to live that long. You won’t do well in your brilliant career. I don’t have a brilliant career. You won’t enjoy your fabulous house. I don’t have a fabulous house.

And that’s a reason I think it’s easy or it should be easy to have some sympathy. We all don’t have the same set of rewards to choose from. Rewards any neuroscientists would tell you are judged relative to each other. We don’t just make judgments over good, bad, but we do a lot of this is better than that. So as you pull rewards out of an environment, yeah, drugs become relatively more appealing.

It feels to me across this conversation that we’re talking about two eras that didn’t really work. I think a lot of people are worried about just a pendulum swinging between extremes. I’m curious if to you there is a synthesis out there either in a place or in a theory that feels like it balances these different realities, that people will use drugs? They are good for some people and terrible for others, that we don’t want to be throwing adults constantly into jail because they did something with their own bodies. We don’t want tons of people to get addicted because we decided not to throw anybody in jail. Is there something that feels to you like it strikes a balance here?

So years ago, when I worked for President Obama, we cited Washington’s example because they had taken a couple of hundred million dollars, spent it on mental health and substance use treatment, and showed within 12 months they’d actually made all their money back because of less crime, because of less disability, because of less trips to the emergency room. And importantly, they had gathered data to show that. And that was one of the things we used when the Affordable Care Act was being done to explain why covering substance use in that package would be a good deal for the taxpayer in addition to, of course, being a good deal to any person who had that problem.

There’s also certain issues where people with very different views and feelings about drugs can agree. So I’ve been working with a lot of people around the country on building Medicaid into the correctional system starting in California. It was pushed by a fabulous assembly member named Marie Waldron. We turn Medicaid on before people leave. And that gets them typically on some type of medication. And that can pull people together because it makes it far less likely for them to die of an overdose or to have other health problems. And it also makes them much less likely to commit crimes. And so you can get people like, well, I’m not very sympathetic. I don’t want to spend money on the health of some drug user. But if it makes them less likely to commit more crime, I like that. And other people say, well, this is a health matter. It’s like, well, then they like it too.

And that approach, which now multiple states have been approved for and the Biden administration C.M.S. has said, you can all have this Medicaid waiver — I don’t know the current number. I think it’s about 14 or 15 other states are applying. And as an example of something where you don’t necessarily have to resolve all the disagreements, but you can find a policy that maximizes multiple outcomes that a broad section of people care about.

Something I’ve seen you talk about and write about is this idea that the way that policing should work here is it should be very, very predictable, very certain you will get picked up, and very modest. It’s sort of almost like it operates as a constant annoyance. You end up in jail for 24 hours and are let loose. And there was some evidence that definitely did decrease repeat offending not among everybody but among enough people to really matter in the study. Do you still think that’s a good idea?

Absolutely. It’s a good principle for enforcement and for deterrence to have it be predictable, responsive, and fair. There’s been a lot of success with drink driving and alcohol through the program 24/7 Sobriety, which started in South Dakota and has now spread to about 15, 20 states and is also now in other countries.

It’s all across England, all across Wales where I was just last week actually working on that, which is a model whereby people are sentenced after their second, third, fourth, fifth alcohol related arrest to not be allowed to drink. They aren’t sent to jail. They aren’t fine. Their cars aren’t taken away. But their alcohol use is monitored literally every single day with swift and certain but modest consequences if they drink.

And that program has reduced incarceration. It has reduced crime. It has reduced domestic violence. And it strikes a good balance between using the criminal justice system to protect and put some constraints on people but not in a way that ends up being carceral.

And the place where we can really make a huge impact on that in the United States is the million people we’re already supervising on probation and parole who have substance use problems. And we need to roll those out more broadly. For example, Oregon’s new policy mix if implemented properly, which will be a challenge, I think it would be a very good one. They do put pressure on people to seek treatment. But they say literally, no one is going to be put into a prison in Oregon simply because they used a drug. And now they’re building up the other part you got to have, which is have to have the health system and the services that keep people alive while they use and then help them get into recovery. That, I think, is a very appealing mix of things.

We have a really hard time, I think, in the U.S. and lots of policy issues of realizing that it’s not a series of on/off switches. It’s a series of dials. And you can adjust things and find sensible, nuanced approaches that are more effective than what fits on a bumper sticker.

And I feel like that’s what my job is. And people like me who do not have to take the great risk to stand up and people and say, please vote for me. And then that means I have to explain something simply. It can’t be any other way but are next to it and are very fortunate to have the time to sift through evidence in a calm environment before they venture out with some suggestions about what we might do better.

I think that’s a good place to end. So then as a final question, what are three books you would recommend to the audience?

So there’s so many good books written about in this area. It’s hard to pick. So I decided to prioritize personal relationship starting with your late friend of mine Mark Kleiman, who wrote a book called “Drugs and Drug Policy: What Everyone Needs to Know,” coauthored with Jonathan Caulkins and Angela Hawken.

And it is exactly what the title promises. It’s accessible. It’s something you can dip into and out of and answer any question you want. And I also point to it as just a model of how academics in any area can write in such a fashion that a broad audience can engage their work and learn from it.

The second book I would suggest, again, from a friend who’s someone I’ve known since she was a psychiatric resident and I was an assistant professor. And that’s Dr. Anna Lembke here at Stanford. And the book is called “Dopamine Nation,” which was a deserved bestseller around the world.

But that gives you much more of the human experience describing, what is it like to be addicted, to not be able to stop doing something even though you know it’s destructive? How does it feel? How do you try to overcome it? And what is going on in that person neurologically that makes it so hard? And then the book also talks about just the seeking of reward in a reward saturated society and how we all are chasing all these things, whether it’s on our cell phones or with drugs and so on.

And then the last one — maybe a more eccentric choice, but it’s such a good book — is by Thomas De Quincey. And it’s called “Confessions of an English Opium Eater.” So De Quincey was a hangers on of the romantic poet set about 200 years ago in England. And he wrote at the time a very scandalous account. But, of course, also scandalous things in Britain are often very popular things.

So it became a bestseller about his experience of long time opium use. And he talks about the pains of opium and the pleasures of opium and a bit about how it affects social relationships, how it affects human psychology. And what I like about is, first off, it has a wonderfully florid over the top poetic style. And the other thing is almost everything you and I have talked about today is touched on in that book. And that shows that while we do learn things and we go forward with science, with policy, it is also true that the human relationship with drugs has had the same benefits and challenges in it for time immemorial. And so that’s a reminder of that when you read a book written that long ago and can resonate with so much of what’s going on today.

Keith Humphreys, thank you very much.

This episode of “The Ezra Klein Show” was produced by Annie Galvin. Fact-checking by Michelle Harris, with Kate Sinclair and Mary Marge Locker. Our senior engineer is Jeff Geld, with additional mixing by Aman Sahota. Our senior editor is Claire Gordon.

The show’s production team also includes Rollin Hu and Kristin Lin. Original music by Isaac Jones. Audience strategy by Kristina Samulewski and Shannon Busta. The executive producer of New York Times Opinion Audio is Annie-Rose Strasser. Special thanks to Sonia Herrero.

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Produced by ‘The Ezra Klein Show’

Drug policy feels very unsettled right now. The war on drugs was a failure. But so far, the war on the war on drugs hasn’t entirely been a success, either.

Take Oregon. In 2020, it became the first state in the nation to decriminalize hard drugs. It was a paradigm shift — treating drug-users as patients rather than criminals — and advocates hoped it would be a model for the nation. But then there was a surge in overdoses and public backlash over open-air drug use. And last month, Oregon’s governor signed a law restoring criminal penalties for drug possession, ending that short-lived experiment.

Other states and cities have also tipped toward backlash. And there are a lot of concerns about how cannabis legalization and commercialization is working out around the country. So what did the supporters of these measures fail to foresee? And where do we go from here?

[You can listen to this episode of “The Ezra Klein Show” on the NYT Audio App , Apple , Spotify , Amazon Music , YouTube or wherever you get your podcasts .]

Keith Humphreys is a professor of psychiatry at Stanford University who specializes in addiction and its treatment. He also served as a senior policy adviser in the Obama administration. I asked him to walk me through why Oregon’s policy didn’t work out; what policymakers sometimes misunderstand about addiction; the gap between “elite” drug cultures and how drugs are actually consumed by most people; and what better drug policies might look like.

You can listen to our whole conversation by following “The Ezra Klein Show” on the NYT Audio App , Apple , Spotify , Google or wherever you get your podcasts . View a list of book recommendations from our guests here .

(A full transcript of this episode is available here .)

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Why all drugs should be legal. (Yes, even heroin.)

Prohibition has huge costs

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We've come a long way since Reefer Madness . Over the past two decades, 16 states have de-criminalized possession of small amounts of marijuana, and 22 have legalized it for medical purposes. In November 2012, Colorado and Washington went further, legalizing marijuana under state law for recreational purposes. Public attitudes toward marijuana have also changed; in a November 2013 Gallup Poll , 58 percent of Americans supported marijuana legalization.

Yet amidst these cultural and political shifts, American attitudes and U.S. policy toward other drugs have remained static. No state has decriminalized, medicalized, or legalized cocaine, heroin, or methamphetamine. And a recent poll suggests only about 10 percent of Americans favor legalization of cocaine or heroin. Many who advocate marijuana legalization draw a sharp distinction between marijuana and "hard drugs."

That's understandable: Different drugs do carry different risks, and the potential for serious harm from marijuana is less than for cocaine, heroin, or methamphetamine. Marijuana, for example, appears incapable of causing a lethal overdose, but cocaine, heroin, and methamphetamine can kill if taken in excess or under the wrong circumstances.

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But if the goal is to minimize harm — to people here and abroad — the right policy is to legalize all drugs, not just marijuana.

In fact, many legal goods cause serious harm, including death. In recent years, about 40 people per year have died from skiing or snowboarding accidents ; almost 800 from bicycle accidents; several thousand from drowning in swimming pools ; more than 20,000 per year from pharmaceuticals ; more than 30,000 annually from auto accidents ; and at least 38,000 from excessive alcohol use .

Few people want to ban these goods, mainly because while harmful when misused, they provide substantial benefit to most people in most circumstances.

The same condition holds for hard drugs. Media accounts focus on users who experience bad outcomes, since these are dramatic or newsworthy. Yet millions risk arrest, elevated prices, impurities, and the vagaries of black markets to purchase these goods, suggesting people do derive benefits from use.

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That means even if prohibition could eliminate drug use, at no cost, it would probably do more harm than good. Numerous moderate and responsible drug users would be worse off, while only a few abusive users would be better off.

And prohibition does, in fact, have huge costs, regardless of how harmful drugs might be.

First, a few Economics 101 basics: Prohibiting a good does not eliminate the market for that good. Prohibition may shrink the market, by raising costs and therefore price, but even under strongly enforced prohibitions, a substantial black market emerges in which production and use continue. And black markets generate numerous unwanted side effects.

Black markets increase violence because buyers and sellers can't resolve disputes with courts, lawyers, or arbitration, so they turn to guns instead. Black markets generate corruption, too, since participants have a greater incentive to bribe police, prosecutors, judges, and prison guards. They also inhibit quality control, which causes more accidental poisonings and overdoses.

What's more, prohibition creates health risks that wouldn't exist in a legal market. Because prohibition raises heroin prices, users have a greater incentive to inject because this offers a bigger bang for the buck. Plus, prohibition generates restrictions on the sale of clean needles (because this might "send the wrong message"). Many users therefore share contaminated needles, which transmit HIV, Hepatitis C, and other blood-borne diseases. In 2010, 8 percent of new HIV cases in the United States were attributed to IV drug use.

Prohibition enforcement also encourages infringements on civil liberties, such as no-knock warrants (which have killed dozens of innocent bystanders) and racial profiling (which generates much higher arrest rates for blacks than whites despite similar drug use rates). It also costs a lot to enforce prohibition, and it means we can't collect taxes on drugs; my estimates suggest U.S. governments could improve their budgets by at least $85 billion annually by legalizing — and taxing — all drugs. U.S. insistence that source countries outlaw drugs means increased violence and corruption there as well (think Columbia, Mexico, or Afghanistan).

The bottom line: Even if hard drugs carry greater health risks than marijuana, rationally, we can't ban them without comparing the harm from prohibition against the harms from drugs themselves. In a society that legalizes drugs, users face only the negatives of use. Under prohibition, they also risk arrest, fines, loss of professional licenses, and more. So prohibition unambiguously harms those who use despite prohibition.

It's also critical to analyze whether prohibition actually reduces drug use; if the effects are small, then prohibition is virtually all cost and no benefit.

On that question, available evidence is far from ideal, but none of it suggests that prohibition has a substantial impact on drug use. States and countries that decriminalize or medicalize see little or no increase in drug use. And differences in enforcement across time or place bear little correlation with uses. This evidence does not bear directly on what would occur under full legalization, since that might allow advertising and more efficient, large-scale production. But data on cirrhosis from repeal of U.S. Alcohol Prohibition suggest only a modest increase in alcohol consumption.

To the extent prohibition does reduce use drug use, the effect is likely smaller for hard drugs than for marijuana. That's because the demands for cocaine and heroin appear less responsive to price. From this perspective, the case is even stronger for legalizing cocaine or heroin than marijuana; for hard drugs, prohibition mainly raises the price, which increases the resources devoted to the black market while having minimal impact on use.

But perhaps the best reason to legalize hard drugs is that people who wish to consume them have the same liberty to determine their own well-being as those who consume alcohol, or marijuana, or anything else. In a free society, the presumption must always be that individuals, not government, get to decide what is in their own best interest.

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The Spotlight on Steroids and Sports

Should we accept steroid use in sports.

Jeffrey Katz

The Edited Broadcast of the Debate

Fans hold up a sign during a 2004 game between the New York Mets and the San Francisco Giants. Giants slugger Barry Bonds has long been accused of steroid use. Al Bello/Getty Images hide caption

Fans hold up a sign during a 2004 game between the New York Mets and the San Francisco Giants. Giants slugger Barry Bonds has long been accused of steroid use.

Hear the Full Debate

The unedited debate (1 hour, 52 minutes), read bios of the debate panelists.

Produced for broadcast by WNYC, New York.

The next debate , on the proposition "America Should Be the World's Policeman," takes place Feb. 12.

The debate over athletes' use of steroids and other performance-enhancing drugs has taken on newfound urgency in recent months.

A report by former Sen. George Mitchell, released in December, mentioned dozens of baseball players as having used steroids and described their use as "widespread." Track star Marion Jones pleaded guilty to lying to investigators about steroid use in October. And last summer, several riders were dismissed from the Tour de France on charges of using banned substances.

Those who oppose the use of steroids and other performance-enhancing drugs say that the athletes who use them are breaking the rules and getting an unfair advantage over others. Opponents of the drugs say the athletes are endangering not only their own health, but also indirectly encouraging youngsters to do the same.

Others maintain that it is hypocritical for society to encourage consumers to seek drugs to treat all sorts of ailments and conditions but to disdain drug use for sports. They say the risk to athletes has been overstated and that the effort to keep them from using performance-enhancing drugs is bound to fail.

Six experts on steroids and other performance-enhancing drugs recently took on the issue in an Oxford-style debate, part of the series Intelligence Squared U.S. The debates are modeled on a program begun in London in 2002: Three experts argue in favor of a proposition and three argue against.

In the latest debate, held on Jan. 15, the formal proposition was, "We should accept performance-enhancing drugs in competitive sports."

As the debate began, it was announced that former Olympics sprinter Ben Johnson, who was scheduled to argue in favor of allowing drugs, had pulled out on the advice of his lawyer because of his involvement in a lawsuit. Johnson was stripped of his gold medal in the 1988 Olympics after testing positive for steroids.

In a vote before the debate, 18 percent of audience members supported the motion to accept performance-enhancing drugs in competitive sports, and 63 percent opposed it. Nineteen percent were undecided. After the debate, 37 percent of audience members agreed with the proposition. Fifty-nine percent opposed it, and 4 percent remained undecided.

The event was held at the Asia Society and Museum in New York City and moderated by longtime sportscaster Bob Costas, who hosts NBCs Football Night in America and HBOs Inside the NFL.

Highlights from the debate:

FOR THE MOTION

Radley Balko , a senior editor and investigative journalist for Reason magazine, says: "So what is this debate really all about? I'd suggest it's about paternalism, and it's about control. We have a full-blown moral panic on our hands here, and it's over a set of substances that, for whatever reason, has attracted the ire of the people who have made it their job to tell us what is and isn't good for us. Our society has an oddly schizophrenic relationship with pharmaceuticals and medical technology. If something could be said to be natural, we tend to be OK with it. If it's lab-made or synthetic, we tend to be leery. But even synthetic drugs and man-made technology seem to be OK if the aim is to make sick people better or broken people whole again."

Excerpt of Balko's argument.

Norman Fost , professor of pediatrics and bioethics at the University of Wisconsin, says: "I ask you in the audience to quickly name, in your own minds, a single elite athlete who's had a stroke or a heart attack while playing sports. It's hard to come up with one. Anabolic steroids do have undesirable side effects: acne, baldness, voice changes ... infertility. But sport itself is far more dangerous, and we don't prohibit it. The number of deaths from playing professional football and college football are 50 to 100 times higher than even the wild exaggerations about steroids. More people have died playing baseball than have died of steroid use."

Excerpts of Fost's argument

Julian Savulescu , professor of practical ethics at the University of Oxford, says: "To say that we should reduce drugs in sport or eliminate them because they increase performance, is simply like saying that we should eliminate alcohol from parties because it increases sociability. So our proposal is that we allow a modest approach. ... Our proposal is enforceable, it frees up the limited resources to focus on drugs that may be affecting children, which we grant should not have access to drugs ... As we've argued, performance enhancement is not against the spirit of sport, it's been a part of sport through its whole history, and to be human is to be better, or at least to try to be better."

Excerpts of Savulescu's argument

Against the motion.

George Michael , a sportscaster and creator of the program Sports Machine , says: "I am not willing to pay the price for legalizing steroids and performance-enhancing drugs, because I've seen too often what it can do. I don't want to go to the cemetery and tell all the athletes who are dead there, 'Hey guys, soon you'll have a lot more of your friends coming, because we're going to legalize this stuff.' The only good news out of it? They wouldn't hear the news. Because they're all dead."

Excerpts of Michael's argument

Dale Murphy , a former Major League Baseball outfielder who started the iWon't Cheat Foundation to help rid sports of drugs, says: "We need better testing, harsher punishments and people will decide not to get involved with performance-enhancing drugs. Gambling in baseball is the perfect example. The culture of professional baseball players is the one thing they know, and one thing they learn from the minute they sign a professional contract, is that if you gamble on the game in any way, shape or form, your career will be over."

Excerpts of Murphy's argument.

Richard Pound , chairman of the World Anti-Doping Agency and a partner in the Canadian law firm Stikeman Elliott, says: "The use of performance-enhancing drugs is not accidental; it is planned and deliberate with the sole objective of getting an unfair advantage. I don't want my kids, or your kids, or anybody's kids to have to turn themselves into chemical stockpiles just because there are cheaters out there who don't care what they promised when they started to participate. I don't want my kids in the hands of a coach who would encourage, condone or allow the use of drugs among his or her athletes."

Excerpts of Pound's argument.

The Intelligence Squared U.S. series is produced in New York City by The Rosenkranz Foundation and for broadcast by WNYC.

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More Reasons States Should Not Legalize Marijuana: Medical and Recreational Marijuana: Commentary and Review of the Literature

Recent years have seen substantial shifts in cultural attitudes towards marijuana for medical and recreational use. Potential problems with the approval, production, dispensation, route of administration, and negative health effects of medical and recreational marijuana are reviewed. Medical marijuana should be subject to the same rigorous approval process as other medications prescribed by physicians. Legalizing recreational marijuana may have negative public health effects.

Introduction

Recent years have seen a cultural shift in attitudes towards marijuana. At the time of this writing, medical marijuana is legal in 20 states and the District of Columbia; recreational marijuana is now legal in Washington and Colorado. A substantial and growing literature documents legalized marijuana may have adverse effects on individual and public health.

Medical Use of Marijuana

The term ‘medical marijuana’ implies that marijuana is like any other medication prescribed by a physician. Yet the ways in which medical marijuana has been approved, prescribed, and made available to the public are very different from other commercially available prescription drugs. These differences pose problems unrecognized by the public and by many physicians.

Lack of Evidence for Therapeutic Benefit

In the United States, commercially available drugs are subject to rigorous clinical trials to evaluate safety and efficacy. Data appraising the effectiveness of marijuana in conditions such as HIV/AIDS, epilepsy, and chemotherapy-associated vomiting is limited and often only anecdotal. 1 , 2 To date, there has been only one randomized, double-blind, placebo- and active-controlled trial evaluating the efficacy of smoked marijuana for any of its potential indications, which showed that marijuana was superior to placebo but inferior to Ondansetron in treating nausea. 3 Recent reviews by the Cochrane Collaboration find insufficient evidence to support the use of smoked marijuana for a number of potential indications, including pain related to rheumatoid arthritis, 4 dementia, 5 ataxia or tremor in multiple sclerosis, 6 and cachexia and other symptoms in HIV/AIDS. 2 This does not mean, of course, that components of marijuana do not have potential therapeutic effects to alleviate onerous symptoms of these diseases; but, given the unfavorable side effect profile of marijuana, the evidence to justify use in these conditions is still lacking.

Contamination, Concentration & Route of Administration

Unlike any other prescription drug used for medical purposes, marijuana is not subject to central regulatory oversight. It is grown in dispensaries, which, depending on the state, have regulatory standards ranging from strict to almost non-existent. The crude marijuana plant and its products may be contaminated with fungus or mold. 7 This is especially problematic for immunocompromised patients, 8 including those with HIV/AIDS or cancer. 9 Furthermore, crude marijuana contains over 60 active cannabinoids, 10 few of which are well studied. Marijuana growers often breed their plants to alter the concentrations of different chemicals compounds. For instance, the concentration of tetrahydrocannabinol (THC), the principal psychoactive ingredient, is more than 20-fold more than in marijuana products used several decades ago. Without rigorous clinical trials, we have no way of knowing which combinations of cannabinoids may be therapeutic and which may be deleterious. As marijuana dispensaries experiment by breeding out different cannabinoids in order to increase the potency of THC, there may be unanticipated negative and lasting effects for individuals who smoke these strains.

Marijuana is the only ‘medication’ that is smoked, and, while still incompletely understood, there are legitimate concerns about long-term effects of marijuana smoke on the lungs. 11 , 12 Compared with cigarette smoke, marijuana smoke can result in three times the amount of inhaled tar and four times the amount of inhaled carbon-monoxide. 13 Further, smoking marijuana has been shown to be a risk factor for lung cancer in many 14 , 15 but not all 16 studies.

High Potential for Diversion

In some states, patients are permitted to grow their own marijuana. In addition to contributing to problems such as contamination and concentration as discussed above, this practice also invites drug diversion. Patients seeking to benefit financially may bypass local regulations of production and sell home-grown marijuana at prices lower than dispensaries. We do not allow patient to grow their own opium for treatment of chronic pain; the derivatives of opium, like marijuana, are highly addictive and thus stringently regulated.

Widespread “Off-label” Use

FDA-approved forms of THC (Dronabinol) and a THC-analog (Nabilone), both available orally, already exist. Indications for these drugs are HIV/AIDS cachexia and chemotherapy-associated nausea and vomiting. Unlike smoked, crude marijuana, these medications have been subject to randomized, placebo-controlled, clinical trials. Yet despite these limited indications where marijuana compounds have a proven but modest effect in high-quality clinical trials, medical marijuana is used overwhelmingly for non-specific pain or muscle spasms. Recent data from Colorado show that 94% of patients with medical marijuana cards received them for treatment of “severe pain.” 17 Similar trends are evident in California. 18 Evidence for the benefit of marijuana in neuropathic pain is seen in many 19 - 21 but not all 22 clinical trials. There is no high-quality evidence, however, that the drug reduces non-neuropathic pain; this remains an indication for which data sufficient to justify the risks of medical marijuana is lacking. 4 , 23 – 25

If marijuana is to be ‘prescribed’ by physicians and used as a medication, it should be subject to the same rigorous approval process that other commercially available drugs undergo. Potentially therapeutic components of marijuana should be investigated, but they should only be made available to the public after adequately powered, double-blind, placebo-controlled trials have demonstrated efficacy and acceptable safety profiles. Furthermore, these compounds should be administered in a way that poses less risk than smoking and dispensed via standardized and FDA-regulated pharmacies to ensure purity and concentration. Bypassing the FDA and approving ‘medicine’ at the ballot box sets a dangerous precedent. Physicians should be discouraged from recommending medical marijuana. Alternatively, consideration can be given to prescribing FDA-approved medicines (Dronabinol or Cesamet) as the purity and concentration of these drugs are assured and their efficacy and side effect profiles have been well documented in rigorous clinical trials.

Recreational Marijuana

The question of recreational marijuana is a broader social policy consideration involving implications of the effects of legalization on international drug cartels, domestic criminal justice policy, and federal and state tax revenue in addition to public health. Yet physicians, with a responsibility for public health, are experts with a vested interest in this issue. Recent legislation, reflecting changes in the public’s attitudes towards marijuana, has permitted the recreational use of marijuana in Colorado and Washington. Unfortunately, the negative health consequences of the drug are not prominent in the debate over legalizing marijuana for recreational use. In many cases, these negative effects are more pronounced in adolescents. A compelling argument, based on these negative health effects in both adolescents and adults, can be made to abort the direction society is moving with regards to the legalization of recreational marijuana.

Myth: Marijuana is Not Addictive

A growing myth among the public is that marijuana is not an addictive substance. Data clearly show that about 10% of those who use cannabis become addicted; this number is higher among adolescents. 26 Users who seek treatment for marijuana addiction average 10 years of daily use. 27 A withdrawal syndrome has been described, consisting of anxiety, restlessness, insomnia, depression, and changes in appetite 28 and affects as many as 44% of frequent users, 29 contributing to the addictive potential of the drug. This addictive potential may be less than that of opiates; but the belief, especially among adolescents, that the drug is not addictive is misguided.

Schizophrenia and Other Psychotic Disorders

Marijuana has been consistently shown to be a risk factor for schizophrenia and other psychotic disorders. 30 – 32 The association between marijuana and schizophrenia fulfills many, but not all, of the standard criteria for the epidemiological establishment of causation, including experimental evidence, 33 , 34 temporal relationship, 35 – 38 biological gradient, 30 , 31 , 39 and biological plausibility. 40 Genetic variation may explain why marijuana use does not strongly fulfill remaining criteria, such as strength of association and specificity. 41 , 42 As these genetic variants are explored and further characterized, marijuana use may be shown to cause or precipitate schizophrenia in a genetically vulnerable population. The risk of psychotic disorder is more pronounced when marijuana is used at an earlier age. 32 , 43

There is some evidence that compounds naturally found in marijuana have therapeutic benefit for symptoms of diseases such as HIV/AIDS, multiple sclerosis, and cancer. If these compounds are to be used under the auspices of ‘medical marijuana,’ they should undergo the same rigorous approval process that other medications prescribed by physicians, including randomized, placebo- and active-controlled trials to evaluate safety and efficacy, not by popular vote or state legislature.

Effects on Cognition

Early studies suggested cognitive declines associated with marijuana (especially early and heavy use); these declines persisted long after the period of acute cannabis intoxication. 44 – 46 Recently, Meier and colleagues analyzed data from a prospective study which followed subjects from birth to age 38; their findings yielded supportive evidence that cannabis use, when begun during adolescence, was associated with cognitive impairment in multiple areas, including executive functioning, processing speed, memory, perceptual reasoning, and verbal comprehension. 47 Rogeberg 48 criticized the study’s methodology, claiming that the results were confounded by differences in socioeconomic status; this claim, however, was based on sub-analyses that used very small numbers. Additional sub-analyses 49 of the original study cohort showed that marijuana was just as prevalent in populations of higher socioeconomic status, suggesting that socioeconomic status was not a confounding variable. Any epidemiological study is subject to confounding biases and future research will be needed to clarify and quantify the relationship between cognitive decline and adolescent marijuana use. However, the findings of the original study by Meier et al show there is indeed an independent relationship between loss of intelligence and adolescent marijuana use. This finding, moreover, is consistent with prior studies. 44

Other Negative Health Effects

Substantial evidence exists suggesting that marijuana is harmful to the respiratory system. It is associated with symptoms of obstructive and inflammatory lung disease, 11 , 50 an increased risk of lung cancer, 14 , 15 and it is suspected to be associated with reduced pulmonary function in heavy users. 51 Further, its use has been associated with harmful effects to other organ systems, including the reproductive, 52 gastrointestinal, 53 and immunologic 10 , 54 systems.

Social Safety Implications: Effects on Driving

Marijuana impairs the ability to judge time, distance, and speed; it slows reaction time and reduces ability to track moving objects. 55 , 56 In many studies of drug-related motor vehicle fatalities, marijuana is the most common drug detected except for alcohol. 57 , 58 Based on post-mortem studies, Couch et al determined that marijuana was likely an impairing factor in as many fatal accidents as alcohol. 59 One study showed that in motor vehicle accidents where the driver was killed, recent marijuana use was detected in 12% of cases. 57 Other research confirms a significantly increased risk of motor vehicle fatalities in association with acute cannabis intoxication. 60

Risk Perception and Use in Adolescents

Marijuana use among adolescents has been increasing. Data that has tracked risk perception and use of marijuana among adolescents over decades clearly shows an inverse relationship; as adolescent risk perception wanes, marijuana use increases. 61 As more states legalize medical and recreational marijuana, risk perception is expected to decrease, causing the prevalence of use among adolescent to continue to rise. This is among the most concerning of issues about the drug’s legalization because so many of the negative effects of marijuana—including cognitive impairment and risk for short- and long-term psychosis— are heightened when used during adolescence.

There is some evidence that compounds naturally found in marijuana have therapeutic benefit for symptoms of diseases such as HIV/AIDS, multiple sclerosis, and cancer. If these compounds are to be used under the auspices of ‘medical marijuana,’ they should undergo the same rigorous approval process that other medications prescribed by physicians, including randomized, placebo- and active-controlled trials to evaluate safety and efficacy, not by popular vote or state legislature. Furthermore, these therapeutic compounds should be administered via a route that minimizes long-term health risk (i.e., via oral pill) and should be dispensed by centrally regulated pharmacies to ensure the purity and concentration of the drug and allow for the recall of contaminated batches.

Marijuana for recreational use will have many adverse health effects. The drug is addictive, with mounting evidence for the existence of a withdrawal syndrome. Furthermore, it has been shown to have adverse effects on mental health, intelligence (including irreversible declines in cognition), and the respiratory system. Driving while acutely intoxicated with marijuana greatly increases the risk of fatal motor vehicle collision. Legalization for recreational use may have theoretical (but still unproven) beneficial social effects regarding issues such as domestic criminal justice policy, but these effects will not come without substantial public health and social costs. Currently there is a lack of resources devoted to educating physicians about this most commonly used illicit substance. The potential benefits and significant risks associated with marijuana use should be taught in medical schools and residency programs throughout the country.

Samuel T. Wilkinson, MD, is in the Department of Psychiatry at the Yale School of Medicine, New Haven, Ct.

Contact: [email protected]

None reported.

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Drug Legalization: Why drugs should be Illegal

16 Sep 2022

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The debate regarding whether drugs should be legalized or not has gained popularity over the past few decades. One of the reasons for this debate is because drugs have both negative and positive effects on our society. Legalization of drugs means that people can acquire, possess and even use drugs without any fear of criminal prosecution by the state government. With drugs being illegal, people find it difficult to access drugs and it can reduce the negative outcomes. Drugs should remain illegal in order to protect the health of people and prevent them from easily accessing drugs. 

Why drugs should be Illegal 

One of the strongest arguments for making drugs illegal is because illicit drugs have a negative effect on health. The health effects usually depend mainly on the type of drug used. Some of the short term effects are wakefulness, loss of appetite, overdose, heart attack and even death. However, long term effects can be cancer, lung diseases, mental illness and even HIV/AIDS. One of the drugs in marijuana is harmful to the respiratory organs and associated with lung diseases. This causes an increase in the risk of one getting lung cancer and also reduced pulmonary function to the heavy users. The indirect effect of drugs can affect the people using and also the ones around them. It can affect the unborn babies of pregnant women and affect their growth and health. 

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The legalization of drugs can jeopardize the safety of society. Most accidents are usually caused by divers who are under the influence of drugs. Drugs such as cocaine and marijuana diminish the ability to think and react quickly. Drug use has been estimated to be the leading cause of many accidnts. These drugs can impair the ability of one to correctly judge the time, distance and speed. These drugs also reduce the ability to track moving objects such as cars. 

The legalization of drugs can also send the wrong message to the society that drugs are safe to be used. This will lead to expanding the rise of peer pressure on the youth and expand drug-related problems like crime. Drug users commit crime in order to maintain and support the expensive drug habits because of addiction. Crimes that are committed by individuals using drugs will not reduce if the drugs are made legal. 

Why drugs should be legalized 

Drug legalization can also bring about benefits to society. One of the benefits of legalizing drugs is it will save tax money. The amount of cash set aside to interdict drug trafficking and drug-related crimes is usually very high and is continuing to grow everday. This crisis would disappear and save taxpayers the expenses of building more prisons. The efforts being used by the police in fighting drug-related crimes would be redirected towards other activities. 

The legalization of drugs would also make drugs safer for consumers. Since drugs are mainly illegal, they all lack the warning labels, instruction manuals, and product quality control. This makes the drugs very dangerous when compared to being manufactured by licensed companies. Most drugs being used like heroin are not all pure and they vary greatly with different dealers. When consumers know exactly what they are getting, they can easily adjust to the dosages and obtain the intended effect safely. This would generally promote consumer health and also safety. 

Some of the drugs like cannabis, heroin, marijuana, and cocaine can be used for medical purposes. Cannabis can be used as an oral spray to relief pain. Heroin, on the other hand, can be used by medical professionals as a diamorphine. This eases the pain of people who have only a few days or weeks to live. Cocaine in the medical world is used as an aesthetic by the dentists. Marijuana has certain natural components that have a therapeutic benefit for people with symptoms of HIV/AIDS and cancer. 

Conclusion 

The drugs that need to be legalized are the ones that are proven to help medical practitioners but still, they should be regulated. Not all drugs should be legalized since people might take advantage of it and use it for the wrong reasons and become addicts. I majorly stand on the side that drugs should not be legalized. Legalization would generally mean that drugs are safe to use, increase casual users and increase drug abuse leading to health problems. Legalization generally sends wrong messages to the youth today and people who do not take drugs. There have been legal drugs such as alcohol and opioid which have several problems for society today such as addiction. Making drugs legal would not solve any problem but would create several other problems. 

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The most convincing argument for legalizing LSD, shrooms, and other psychedelics

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I have a profound fear of death. It's not bad enough to cause serious depression or anxiety. But it is bad enough to make me avoid thinking about the possibility of dying — to avoid a mini existential crisis in my mind.

But it turns out there may be a better cure for this fear than simply not thinking about it. It's not yoga, a new therapy program, or a medicine currently on the (legal) market. It's psychedelic drugs — LSD, ibogaine, and psilocybin, which is found in magic mushrooms.

This is the case for legalizing hallucinogens. Although the drugs have gotten some media attention in recent years for helping cancer patients deal with their fear of death and helping people quit smoking, there's also a similar potential boon for the nonmedical, even recreational psychedelic user. As hallucinogens get a renewed look by researchers, they're finding that the substances may improve almost anyone's mood and quality of life — as long as they're taken in the right setting, typically a controlled environment.

This isn't something that even drug policy reformers are comfortable calling for yet. "There's not any political momentum for that right now," Jag Davies, who focuses on hallucinogen research at the Drug Policy Alliance, said, citing the general public's views of psychedelics as extremely dangerous — close to drugs like crack cocaine, heroin, and meth.

But it's an idea that experts and researchers are taking more seriously. And while the studies are new and ongoing, and a national regulatory model for legal hallucinogens is practically nonexistent, the available research is very promising — enough to reconsider the demonization and prohibition of these potentially amazing drugs.

Hallucinogens' potentially huge benefit: ego death

Mushroom, mushroom.

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The most remarkable potential benefit of hallucinogens is what's called "ego death," an experience in which people lose their sense of self-identity and, as a result, are able to detach themselves from worldly concerns like a fear of death, addiction, and anxiety over temporary — perhaps exaggerated — life events.

When people take a potent dose of a psychedelic, they can experience spiritual, hallucinogenic trips that can make them feel like they're transcending their own bodies and even time and space. This, in turn, gives people a lot of perspective — if they can see themselves as a small part of a much broader universe, it's a lot easier for them to discard personal, relatively insignificant and inconsequential concerns about their own lives and death.

That may sound like pseudoscience. And the research on hallucinogens is so early that scientists don't fully grasp how it works. But it's a concept that's been found in some medical trials, and something that many people who've tried hallucinogens can vouch for experiencing. It's one of the reasons why preliminary , small studies and  research from the 1950s and '60s found hallucinogens can treat — and maybe cure — addiction, anxiety, and obsessive-compulsive disorder.

Charles Grob, a UCLA professor of psychiatry and pediatrics who studies psychedelics, conducted a  study that gave psilocybin to late-stage cancer patients.  "The reports I got back from the subjects, from their partners, from their families were very positive — that the experience was of great value, and it helped them regain a sense of purpose, a sense of meaning to their life," he told me in 2014. "The quality of their lives notably improved."

In a fantastic look at the research, Michael Pollan at the New Yorker captured the phenomenon through the stories of cancer patients who participated in hallucinogen trials:

Death looms large in the journeys taken by the cancer patients. A woman I'll call Deborah Ames, a breast-cancer survivor in her sixties (she asked not to be identified), described zipping through space as if in a video game until she arrived at the wall of a crematorium and realized, with a fright, "I've died and now I'm going to be cremated. The next thing I know, I'm below the ground in this gorgeous forest, deep woods, loamy and brown. There are roots all around me and I'm seeing the trees growing, and I'm part of them. It didn't feel sad or happy, just natural, contented, peaceful. I wasn't gone. I was part of the earth." Several patients described edging up to the precipice of death and looking over to the other side. Tammy Burgess, given a diagnosis of ovarian cancer at fifty-five, found herself gazing across "the great plain of consciousness. It was very serene and beautiful. I felt alone but I could reach out and touch anyone I'd ever known. When my time came, that's where my life would go once it left me and that was O.K."

But Mark Kleiman, a drug policy expert at New York University's Marron Institute, noted that these benefits don't apply only to terminally ill patients. The studies conducted so far have found benefits that apply to anyone : a reduced fear of death, greater psychological openness, and increased life satisfaction.

"It's not required to have a disease to be afraid of dying," Kleiman said. "But it's probably an undesirable condition if you have the alternative available. And there's now some evidence that these experiences can make the person less afraid to die."

Kleiman added, "The obvious application is people who are currently dying with a terminal diagnosis. But being born is a terminal diagnosis. And people's lives might be better if they live out of the valley of the shadow of death."

Again, the current research on all of this is early, with much of the science still relying on studies from the '50s and '60s. But the most recent preliminary findings are promising enough that experts like Kleiman are cautiously considering how to build a model that would let people take these potentially beneficial drugs legally — while also acknowledging that psychedelics do pose some big risks.

The two big risks of hallucinogens: accidents and bad trips

Charles Grob, a UCLA professor of psychiatry and pediatrics, is leading the way in psychedelic research.

Mark Boster/Los Angeles Times via Getty Images

Hallucinogens aren't perfectly safe, but they're not dangerous in the way some people might think. As Grob previously  told me , there's little to no chance that someone will become addicted to psychedelics — they're not physically addictive like heroin or tobacco, and the experiences are so demanding and draining that a great majority of people simply won't be interested in constantly taking the drugs. He also said that hallucinogen persisting perception disorder, which can cause the disturbances widely known as "flashbacks," is "uncommon, but you will see it, particularly among someone who has taken hallucinogens a lot."

Kleiman drew a comparison to marijuana to explain the risks. "The risk with cannabis is, primarily, that you lose control of your cannabis taking," he said. "The risk with LSD is primarily that you'll do something stupid to ruin the experience, or you'll have such a scary experience that it'll leave you damaged. But those are safety risks rather than addiction risks."

This gets to the two major dangers of hallucinogens: accidents and bad trips. The first risk is similar to what you'd expect from other drugs: When people are intoxicated in any way, they're more prone to doing bad, dumb things. As Kleiman explained, "People take LSD and think they can fly and jump off buildings. It's true that it's a drug warrior fairy tale, but it's also true in that it actually happens. People drop acid and run out in traffic. People do stupid shit under high doses of psychedelics."

Bad trips are also a concern. A bad psychedelic experience can result in psychotic episodes, a lost sense of reality, and even long-term psychological trauma in very rare situations, especially among people using other drugs or with a history of mental health issues. Just like psychedelics can lead to long-term psychological benefits, they can lead to long-term psychological pain.

These risks are why not many people are seriously discussing legalizing hallucinogens in the same way the US allows alcohol or is now beginning to allow marijuana. But the potential benefits of hallucinogens are leading some experts to consider how these drugs could be legalized in some capacity.

"I think it's a bad idea to treat hallucinogens like we treat cocaine or cannabis," Kleiman said. "They pose different risks and offer different benefits." He added, "But I don't think we're ever going to free these substances from careful legal control."

How hallucinogens can be legalized

Drop some LSD — but maybe only in a controlled environment.

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So how can you maximize the benefits and minimize the risks? The most convincing idea so far is letting people take psychedelics in a controlled setting, in which multiple participants can be watched over by trained supervisors who ensure the experience doesn't go poorly.

So far, this is what the medical side has focused on: The typical medical trial involves doctors watching over a deathly ill patient or someone dealing with addiction who takes psilocybin. But if the concept is expanded to allow nonmedical users, then perhaps professionals who aren't doctors but are trained in guiding someone through a trip could take up the role. "I imagine someone who has training in managing that experience, and a license, and liability insurance, and a facility," Kleiman said.

Here's how it would work: A psychedelic user would go through some sort of preparation period to make sure she knows what she's getting into. Then she could make an appointment at a place offering these services. She would show up at this appointment, take the drug of her choice (or whatever the facility provides), and wait to allow it to kick in. As the trip occurs, a supervisor would watch over the user — not being too pushy, but making sure he's available to guide her through any rough spots. In some studies, doctors have also prepared certain activities — a soundtrack or food, for example — that may help set the right mood and setting for someone on psychedelics. Different places will likely experiment with different approaches, including how many people can participate at once and how a room should look.

Kleiman also envisions a potential system in which people can eventually graduate to using the drug solo. "It's like Red Cross water safety instruction," he said. "You start out, you're a newbie. You don't go into the pool without a trained, certified person to watch you, guide you, and keep you safe. After a while, your teacher gives you a test to certify that you're safe to be in the water alone. And you might even get certified to become a trainer, so you can guide newbies yourself."

If pulled off correctly, this would maximize the best possible outcomes and minimize the worst. Supervisors could help prevent accidents, and they could walk people through good and bad trips, letting users relax and get something meaningful out of the experience.

There are risks to the controlled setting. If a supervisor is poorly trained or malicious, it could lead to a horrific trip that could actually worsen someone's mental state. This is why regulation and licensing will be crucial to getting the idea right.

Ethan Nadelmann, executive director of the Drug Policy Alliance, argued for a looser model that could, for example, allow psychedelics to be sold over the counter. "You dramatically decrease the black market. So long as you have people who have to go through some sort of gatekeeper, or who can be denied, you're going to continue to have a black market," Nadelmann said. "Secondly, this means the percent of consumers who got a product of known potency and purity from a reliable source would increase."

But the black market demand for psychedelics is very small, with only 0.5 percent of Americans 12 and older in 2013 saying they used hallucinogens in the past month. So allowing over-the-counter sales would likely have a tiny benefit at best on public health and criminal groups' profits from the black market.

The debate about which model works best will likely go on for some time, especially if different places test different approaches. There's no doubt it will be tricky to hash out exactly how to legalize and regulate these drugs,  as some states are learning with marijuana .

But if we know the benefits to public health and well-being are real, it's irresponsible to let the potential go untapped. It may soon be time for America to seriously consider legalizing LSD, magic mushrooms, and other psychedelic drugs.

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The meaning, history and political rhetoric surrounding the term abortion ‘ban’

Experts say ‘ban’ has emerged as shorthand for nearly all abortion prohibitions. the blunt term often leaves room for political spin..

Ban: Merriam-Webster  defines  it as “a legal or formal prohibition.”

But in the 2024 election cycle — the first general election since Roe v. Wade, the landmark ruling that enshrined a constitutional right to an abortion, was  overturned  — the term has morphed into polarizing political rhetoric. “Ban” has become synonymous with abortion and the wave of anti-abortion laws enacted in states across the country.

For example, on President Joe Biden’s reelection campaign website, the  abortion policy page’s  title reads: “Donald Trump wants to ban abortion nationwide. Re-elect Joe Biden to stop him and protect reproductive freedom.”

Trump appointed three of the U.S. Supreme Court justices who voted to overturn Roe. After years of inconsistency, Trump  most recently  has said that laws on abortion should be left to the states and that he wouldn’t sign a national abortion ban.

Many Democrats and abortion rights activists have also zeroed in on down-ballot Republicans, accusing them of supporting abortion “bans,” even if their position allows for some access.

“Yesterday, we celebrated Mother’s Day. Today, I remind you that politicians like Bernie Moreno, who supports a national abortion ban, don’t want moms making their own healthcare decisions. Abortion rights are on Ohio’s ballot again in 2024,” Ohio Democrat Allison Russo wrote May 13  on X .

Moreno, who has Trump’s support, is a Republican running for Senate in Ohio against Democratic incumbent Sen. Sherrod Brown. Moreno  has said  that he would vote for a 15-week national abortion ban.

Political discourse experts say “ban” has emerged as shorthand for nearly all abortion prohibitions. The blunt term, nuanced in its myriad interpretations, often leaves room for political spin.

What exactly is a ban?

“Ban” is not a medical term; people across the political spectrum on abortion define it differently.

The word has two main rhetorical functions, political discourse experts said. When people talk to like-minded people about a particular issue, it can reinforce the group’s beliefs. Or, it can label opponents as “extreme.”

“For example, when Joe Biden talks about an assault weapon ban, he’s not trying to convert skeptics — he’s signaling to people who already agree with them that they’re on the same team,” said Ryan Skinnell, an associate professor of rhetoric and writing at San Jose State University. “But the other way ‘ban’ works is to identify someone you disagree with as extreme. Groups who want to keep certain books out of libraries, for instance, rarely describe themselves as in support of book banning. Their opponents adopt that language.”

This dual usage reflects in the abortion fight. Abortion-rights activists use “ban” to signal an infringement on personal freedom and autonomy over medical decisions. Anti-abortion proponents may use “ban” to signal a protection of fetal life. For example, when introducing legislation that ban abortion at various stages,  Republican   politicians  have often framed the bills as moral imperatives that protect unborn life.

Peter Loge, a George Washington University professor who directs the school’s Project on Ethics in Political Communication, said ban has historically meant “to eliminate” or “not have,” but politicians employ a strategic ambiguity that allows listeners to assign their own meaning. Loge, who served as a senior adviser in former President Barack Obama’s Food and Drug Administration, said Obama did this with one of his campaign slogans: “Change We Can Believe In.”

“Well, what does ‘change’ mean? Clearly, it means whatever he thinks it means, but as a listener you will ascribe it to mean whatever you think it means,” Loge said. “So, if I think most abortions should be illegal and in some cases it’s OK, I can support a ban, because it’s a ban with exceptions. The listener plugs in whatever caveats they prefer and ascribes them to the speaker. This is a technique as far back as Aristotle, who wrote that the listener provides the reasoning for themselves.”

Loge, like Skinnell, said “ban” is often used in politics to showcase extremism and the threat of something being taken away.

“It’s the rhetoric of anger. ‘They want to take your rights from you. … Now it’s an ideological divide and it works because we’re going to be more motivated to vote,” Loge said. “People are more concerned about losing something they have than they are interested in getting something new. We are risk-averse.”

Nathan Stormer, a rhetoric professor at the University of Maine and an expert in abortion rhetoric, said the term usually shows up when people refer to making abortion illegal in pregnancy’s earlier stages. But, he added, although common usage typically refers to a first trimester threshold, there is “no set of rules.”

“Because it is not a consistently used term, I think when people do not specify what they are referring to, others may take them to mean at conception or very early, but one has to inquire about context,” Stormer wrote in an email.

How abortion ban rhetoric evolved

Before the 1970s, there was little discussion about abortion bans.

Although legal abortion existed in various states at various stages before the  Supreme Court decided Roe v. Wade in 1973,  the ruling’s enshrinement of abortion rights across the country, helped galvanize opposition and mobilize anti-abortion groups.

“There were book bans, pornography bans, dancing bans, and so on. But even most conservative politicians and church groups weren’t especially concerned with abortion as an issue, and there was virtually no concerted political interest in bans,” Skinnell, from San Jose University, said. “That began to change with Richard Nixon.”

Skinnell said the former president’s advisers, in coordination with evangelical Christian church leaders, determined they could connect abortion to left-wing social movements, such as feminism, by linking them consistently in speeches and campaign materials.

“The idea of abortion bans came directly out of that partnership,” Skinnell said, “and it gathered steam in right-wing and conservative circles throughout the next few decades.”

Republicans further popularized the term in the mid-1990s, when they advocated for the Partial-Birth Abortion Ban Act, which President George W. Bush  signed into law  in 2003. The campaign to pass that legislation, experts said, introduced the term “ban” as the abortion restriction’s “stated intent.”

Political rhetoric experts said much of the medical literature and media coverage before Roe v. Wade often used terms such as “illegal” because abortion was considered a criminal act in most states.

“Even in the early stages of criminalizing abortion in the U.S., I don’t think ban was a common term,” Stormer said. “When a restriction is being put in place where before there was not one, people tend to resort to the word ban.”

Emily Winderman, a University of Minnesota professor specializing in the rhetorical study of health and medicine, said that over time abortion “bans” have manifested  as “incremental” restrictions throughout gestational development to the complete prohibitions seen in multiple states today.

For instance, she said, “heartbeat bills,” which typically refer to laws that make abortion illegal as early as six weeks of pregnancy, were controversial when they emerged around 2010, but have become more prevalent since the Trump administration and Roe’s overturning.

Winderman also said bans can appear via code and ordinance restrictions, such as banning  the type of use for a particular piece of real estate — making abortion clinics impossible to place.

“It’s important to understand bans as a complex strategy that includes gestational limits as well as limitations on who can provide care and where,” she said.

Shifting abortion laws across the U.S. have made “ban” an increasingly common term.  Forty-one states  now ban abortion at different points in pregnancy — 14 enforce total bans, three enforce six-week bans and others restrict abortion before fetal viability.

Stormer, from the University of Maine, pointed to Arizona’s Supreme Court reinstating an 1864 law that completely banned abortion. (It  has since been repealed. ) At the time the law was written, conception was not well understood, and there was no clear sense of fertilization or how it worked.

“Reinstating that law was a great example of how the conflict over abortion has remained steady and largely recognizable, but its terms and understandings have been constantly moving, which says something,” Stormer said. “So, specific words do important work, but they do not capture what is happening rhetorically, in my opinion. The moving terminologies are the waves crashing, but the tides are the thing.”

This fact check was originally published by PolitiFact , which is part of the Poynter Institute. See the sources for this fact check here .

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How bad is vaping and should it be banned?

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Nicole Lee works as a consultant in the health sector and a psychologist in private practice. She has previously received funding by Australian and state governments, NHMRC and other bodies for evaluation and research into alcohol and other drug prevention and treatment.

Brigid Clancy is an Associate at 360Edge, a drug and alcohol consultancy company.

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Vaping regularly makes headlines, with some campaigning to make e-cigarettes more available to help smokers quit, while others are keen to see vaping products banned, citing dangers, especially for teens.

So just how dangerous is it? We have undertaken an evidence check of vaping research . This included more than 100 sources on tobacco harm reduction, vaping prevalence and health effects, and what other countries are doing in response. Here’s what we found.

How does vaping compare to smoking?

Smoking is harmful. It’s the leading preventable cause of death in Australia. It causes 13% of all deaths , including from lung, mouth, throat and bladder cancer, emphysema, heart attack and stroke, to name just a few. People who smoke regularly and don’t quit lose about ten years of life compared with non-smokers.

Nicotine, a mild stimulant, is the active ingredient in both cigarettes and nicotine vaping products. It’s addictive but isn’t the cause of cancer or the other diseases related to smoking.

Ideally, people wouldn’t be addicted to nicotine, but having a safe supply without the deadly chemicals, for instance by using nicotine patches or gum, is safer than smoking. Making these other sources available is known as “harm reduction”.

Vaping is not risk-free, but several detailed reviews of the evidence plus a consensus of experts have all estimated it’s at least 95% safer to vape nicotine than to smoke tobacco. The risk of cancer from vaping, for example, has been estimated at less than 1%.

These reviews looked at the known dangerous chemicals in cigarettes, and found there were very few and in very small quantities in nicotine vapes. So the argument that we won’t see major health effects for a few more decades is causing more alarm than is necessary.

Is ‘everyone’ vaping these days?

Some are concerned about the use of vaping products by teens, but currently available statistics show very few teens vape regularly. Depending on the study, between 9.6% and 32% of 14-17-year-olds have tried vaping at some point in their lives.

But less than 2% of 14-17-year-olds say they have used vapes in the past year. This number doubled between 2016 and 2019, but is still much lower than the rates of teen smoking (3.2%) and teen alcohol use (32%).

It’s the same pattern we see with drugs other than alcohol: a proportion of people try them but only a very small proportion of those go on to use regularly or for a long time. Nearly 60% of people who try vaping only use once or twice .

Smoking rates in Australia have declined from 24% in 1991 to 11% in 2019 because we have introduced a number of very successful measures such as restricting sales and where people can smoke, putting up prices, introducing plain packaging, and improving education and access to treatment programs.

But it’s getting harder to encourage the remaining smokers to quit with the methods that have worked in the past. Those still smoking tend to be older , more socially disadvantaged , or have mental health problems.

Read more: My teen's vaping. What should I say? 3 expert tips on how to approach 'the talk'

Should we ban vapes?

So we have a bit of a dilemma. Vaping is much safer than smoking, so it would be helpful for adults to have access to it as an alternative to cigarettes. That means we need to make them more available and accessible.

But ideally we don’t want teens who don’t already smoke to start regular vaping. This has led some to call for a “ crackdown ” on vaping.

But we know from a long history of drug prohibition - like alcohol prohibition in the 1920s - that banning or restricting vaping could actually do more harm than good.

Banning drugs doesn’t stop people using them - more than 43% of Australians have tried an illicit drug at least once. And it has very little impact on the availability of drugs.

But prohibition does have a number of unintended consequences, including driving drugs underground and creating a black market or increasing harms as people switch to other drugs, which are often more dangerous.

The black market makes drugs more dangerous because there is no way to control quality. And it makes it easier, not harder, for teens to access them, because there are no restrictions on who can sell or buy them.

Read more: Learning about the health risks of vaping can encourage young vapers to rethink their habit

Are our current laws working?

In 2021, Australia made it illegal to possess and use nicotine vaping products without a prescription. We are the only country in the world to take this path.

The problem is even after more than a year of this law, only 8.6% of people vaping nicotine have a prescription, meaning more than 90% buy them illegally.

Anecdotal reports even suggest an increase in popularity of vaping among teens since these laws were introduced. At best, they are not helping.

It may seem counterintuitive, but the way to reduce the black market is to make quality-controlled vapes and liquids more widely available, but restricted to adults. If people could access vaping products legally they wouldn’t buy them on the black market and the black market would decline.

We also know from many studies on drug education in schools that when kids get accurate, non-sensationalised information about drugs they tend to make healthier decisions. Sensationalised information can have the opposite effect and increase interest in drugs . So better education in schools and for parents and teachers is also needed, so they know how to talk to kids about vaping and what to do if they know someone is vaping.

What have other countries done?

Other countries allow vapes to be legally sold without a prescription, but impose strict quality controls and do not allow the sale of products to people under a minimum age. This is similar to our regulation of cigarettes and alcohol.

The United Kingdom has minimum standards on manufacturing, as well as restrictions on purchase age and where people can vape.

Aotearoa New Zealand introduced a unique plan to reduce smoking rates by imposing a lifetime ban on buying cigarettes. Anyone born after January 1 2009 will never be able to buy cigarettes, so the minimum age you can legally smoke keeps increasing. At the same time, NZ increased access to vaping products under strict regulations on manufacture, purchase and use.

As of late last year, all US states require sellers to have a retail licence, and sales to people under 21 are banned. There are also restrictions on where people can vape.

A recent study modelled the impact of increasing access to nicotine vaping products in Australia. It found it’s likely there would be significant public health benefits by relaxing the current restrictive policies and increasing access to nicotine vaping products for adults.

The question is not whether we should discourage teens from using vaping products or whether we should allow wider accessibility to vaping products for adults as an alternative to smoking. The answer to both those questions is yes.

The key question is how do we do both effectively without one policy jeopardising the outcomes of the other?

If we took a pragmatic harm-reduction approach, as other countries have done, we could use our very successful model of regulation of tobacco products as a template to achieve both outcomes.

Read more: It's safest to avoid e-cigarettes altogether – unless vaping is helping you quit smoking

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Home — Essay Samples — Nursing & Health — Performance Enhancing Drugs — Why Performance Enhancing Drugs Must Be Banned

Why Performance Enhancing Drugs Must Be Banned

• Categories: Performance Enhancing Drugs

About this sample

Words: 1760 |

Published: Oct 25, 2021

Words: 1760 | Pages: 4 | 9 min read

Table of contents

Introduction, works cited.

• Bowers, M. B. (1998). Doping and performance-enhancing drugs. In B. R. Brown (Ed.), Ethical issues in sport (pp. 3-16). Sage Publications.
• Dixon, K. (2008). Steroid testing and legalising performance enhancing drugs: The moralisation of the anti-doping debate. International Journal of Sport Policy and Politics, 1(1), 29-40.
• Evans, N. A., & Parkinson, A. B. (2006). Anabolic androgenic steroids: A survey of 500 users. Medicine and Science in Sports and Exercise, 38(4), 644-651.
• Fost, N. (2005). The ethic of performance-enhancing substances in sports. In M. McNamee & J. M. Parry (Eds.), Ethics and sport (pp. 114-127). Routledge.
• Mayo Clinic. (2019, September 5). Performance-enhancing drugs: Know the risks. Mayo Clinic. https://www.mayoclinic.org/healthy-lifestyle/fitness/in-depth/performance-enhancing-drugs/art-20046134
• Mottram, D. R. (2010). Drugs in sport (5th ed.). Routledge.
• Navidinia, M., & Ebadi, A. (2017). Doping in sport: Effects, harm and misconceptions. Journal of Substance Use, 22(5), 521-526.
• Pound, R. (2008). The fight against doping: Why we must win. In M. McNamee & V. Møller (Eds.), Doping and anti-doping policy in sport: Ethical, legal and social perspectives (pp. 17-26). Routledge.
• Redwood, B. (1995). Anabolic steroids: Beyond the legal and health problems. British Journal of Sports Medicine, 29(4), 213-214.
• Schwab, D. E. (2002). Performance-enhancing drug use in college sports: Ethical considerations. Quest, 54(3), 215-226.

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5 Reasons Why Alcohol Should Be Illegal Or Banned

• 1. Addictive
• 2. Harmful To Health
• 3. Compromises Judgement
• 4. Gateway Drug
• 5. Doesn't Solve Anything
• Treatment For Alcohol Abuse

From 1920 to 1933, the manufacture, transportation, and sale of alcoholic beverages was illegal in the United States. 

The Prohibition movement ended in failure, and today there are a range of economic, social, and cultural reasons why alcohol remains available for adult purchase and consumption.

But, just because alcohol is legal, highly accessible, and celebrated does not mean that it cannot be harmful.

Here are five arguments that can be made for why alcohol should still be illegal in the United States.

1. Alcohol Is Addictive

Alcohol is a drug. It’s a central nervous system depressant with psychoactive properties, and it is addictive.

How addictive alcohol is depends on the individual, their genetics and upbringing, and other social and environmental factors. 

But, according to a 2015 study funded by the National Institutes of Health, 29.1% of Americans will meet the criteria for Alcohol Use Disorder at some point in their lives, and 13.9% met the criteria in the previous year.

Heavy drinkers may develop physical dependence, leading to potentially severe or even life-threatening withdrawal symptoms if you stop drinking all at once. These symptoms can include tremors, blood pressure changes, trouble sleeping, hallucinations, and seizures.

And for those who do stop, maintaining sobriety is often a lifelong struggle.

2. Alcohol Abuse Is Harmful To Your Health

Alcohol overdose ( alcohol poisoning ) can be fatal. If too much alcohol is absorbed from the digestive system into the bloodstream following binge drinking , heart rate, blood pressure, and body temperature can fall to dangerous levels, causing brain damage and organ failure.

But, this isn’t the only way that alcohol causes harm.

Long-term, excessive alcohol consumption can lead to serious health issues including high blood pressure , heart disease , liver disease , cancer , dementia , depression, and anxiety.

Alcohol also has devastating negative effects when consumed by pregnant mothers. Even drinking only a moderate amount of alcohol can lead to fetal alcohol syndrome or a greatly increased risk of miscarriage or serious developmental issues.  

3. Use Of Alcohol Compromises Judgement

Many of us have stories of the adventures and mistakes we’ve made under the influence of alcohol. But too often, given its ability to suppress one’s inhibitions, the over-consumption of alcohol ends in stark tragedy.

In particular, binge drinking is commonly associated with cases of:

• drunk driving and car accidents
• domestic violence
• financial imprudence
• violent crime
• other severe accidents

And in the long term, heavy drinking can erode your relationships with family members, deaden your ability to feel pleasure from natural sources, and steal your motivation to study, work, and prosper.

4. Alcohol Is A Gateway Drug

A gateway substance is one that leads to the abuse of harder/more harmful drugs.

According to a 2012 investigation, alcohol, not tobacco or marijuana, is the primary gateway drug leading to other substances and illegal drug use among underage Americans.

And, according to a study by the National Institutes of Health, 55.3% of high school seniors (all under legal drinking age) have used alcohol in the past year.

This figure is especially concerning because, as with cannabis, alcohol use is known to have harmful developmental effects on children and teenagers, negatively impacting problem solving and memory. 

5. Alcohol Does Not Solve The Real Issues In Your Life

Many who drink alcohol do so as an escape, to mask negative feelings of stress, depression, or anxiety with intoxication and artificial feelings of well-being.

But abusing alcohol only makes these issues worse in the long run. 

As alcohol use and dependence escalate, they can lead to a spiral of increasingly negative feelings and compulsive substance abuse with no easy way out. This may continue until you’re drinking alcohol because you feel like you have to, not because you want to.

Treatment For Alcohol Use Disorder

If you struggle with problematic drinking, help is available.  

Substance abuse treatment centers host programs that can help you:

• safely detox and manage alcohol withdrawal symptoms
• address co-occurring mental health disorders including anxiety and depression
• develop stress-management and coping mechanisms to help maintain your sobriety
• consider why you’ve had difficulties with drinking in the past and make helpful changes to those feelings and thought processes
• connect with others also working through the rehabilitation process, for mutual support and encouragement

For more information regarding inpatient or outpatient alcohol use disorder treatment programs , including medication-assisted treatment (MAT) , please contact us today.

Written by Ark Behavioral Health Editorial Team

©2024 ark national holdings, llc. | all rights reserved., this page does not provide medical advice..

Centers for Disease Control and Prevention (CDC) - Alcohol Use and Your Health National Institute on Alcohol Abuse and Alcoholism - NIH study finds alcohol use disorder on the increase National Institute on Alcohol Abuse and Alcoholism - What are symptoms of alcohol use disorder? PubMed - Alcohol as a gateway drug: a study of US 12th graders PubMed - Harmful Alcohol Use

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