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Part II Continued

The Costs of Prohibition

Prohibition Threatens Public Health

Spread of Disease

Sharing Needles

Because the possession of hypodermic needles is generally illegal, users of injectable drugs routinely share needles and syringes with one another, often in "shooting galleries" where dozens of addicts may line up to use a single needle rented out by the dealers and not sterilized between uses. This sharing of needles has become a major source of transmission of blood-borne diseases such as acquired immune deficiency syndrome ("AIDS") and hepatitis. According to a recent national review, "more than 33% of new AIDS cases occur among injecting drug users or people having sexual contact with them." In New York State, the majority of new AIDS cases since 1988 have been reported among users of injectable drugs and their sexual partners. Both the Centers for Disease Control and the New York State Department of Health have estimated that more than 75% of pediatric AIDS cases are children whose mothers either injected drugs or were the sexual partners of persons who injected drugs. The data suggest, at the very least, that sterile hypodermic needles should be readily and freely available to drug users. So long as drug use remains unlawful, however, free needle distribution is not likely to attract a substantial portion of the user population. In response, some courts have circumscribed laws dealing with the unlawful possession of hypodermic needles by applying defenses of medical necessity.

Trading Sex for Drugs

Because illicit drugs are expensive, many addicts turn to prostitution to make money to support their habits, or exchange sexual services directly for drugs. Prostitute drug addicts often do not protect themselves from contracting sexually transmitted diseases carried by their customers, and they pass such diseases on to other customers, their lovers, and their children. The crack epidemic, in particular, has been blamed for the recently noted resurgence of syphilis and other sexually transmitted diseases. Dr. Robert Rolfs of the Centers for Disease Control placed the blame squarely on cocaine and its high cost:

People---especially women---have high-risk sex and practice prostitution to support their habits. And it is occurring in a relatively poor population where people have a lot of things that prevent their access to treatment. Therefore, they stay infected longer and are more likely to pass their infections on to others. [133].

Fewer addicts would be forced to resort to prostitution if the current prohibitions against drugs were lifted.

Neglect of Health

Because of addicts' preoccupation with obtaining and using drugs, and the debilitating effects of some of the drugs themselves, many addicts are in very poor health. Malnutrition is a frequent problem and, in turn, contributes to many others. Addicts' poor health makes them especially susceptible to diseases ranging from scurvy and shingles to tuberculosis and the flu. Addicts are also more likely to contract communicable diseases and therefore more likely to spread them. The interrelated urban problems of homelessness and illegal drug abuse have contributed to the development of multi-drug-resistant strains of diseases such as tuberculosis, which was once thought to be on the verge of eradication. These more virulent diseases know few geographical limitations and pose risks to the general population.

Avoidance of the Health-Care System

Individuals who use illegal drugs often put off addressing their health problems for fear of prosecution or other adverse consequences (e.g., rebuffs by doctors, loss of job). This reluctance to seek medical care is compounded by the fact that many drug addicts have no private physicians and rely instead on public hospitals or clinics for any care they might get.

Prohibition, therefore, has perverse results on health; drug abusers tend to enter the health-care system only if and when their need for care is acute, which is also when care is most costly to deliver. If, for example, a woman avoids pre-natal care, she may give birth to a baby with low birth weight and other medical difficulties. If a drug abuser puts off seeking treatment for illnesses and injuries, he or she may end up in the emergency room and the intensive care ward.

Mothers and pregnant women face the additional and justifiable fear that any detectable drug use may be reported as a possible indication of child abuse or neglect. In many large city hospitals, the urine of newborn babies is tested for prohibited drugs, and mothers whose babies test positive for pre-natal exposure are reported to the child abuse authorities. Until recently, in New York City, such babies were routinely kept from their mothers pending investigations that often lasted many months, interfering with normal bonding and necessarily adversely affecting the infant's development and relationship with the parent. Moreover, these women have, in some jurisdictions, been prosecuted for pre-partum distribution of prohibited drugs.

In addition to the obvious costs to the individuals who become infected with catastrophic illnesses directly through drug use, and the high costs to the health care system of treating them, prohibition contributes to the spread of such diseases throughout society, particularly to the sexual partners and children of infected drug users. Left untreated, users and addicts are more likely to give birth to unhealthy children, to abuse or neglect their children after they are born, or to have their children placed in foster care.

Lack of Information and Quality Control

Adulterated Drugs, Designer Drugs, and Drugs of Unknown Potency

Because drugs are manufactured and distributed in secret, it is impossible for users to guard against adulteration or to determine the purity and potency of the drugs they use. The problem is compounded by drug growers, manufacturers, and distributors who, to minimize the risks of apprehension, develop and purvey the drug varieties that pack the most intoxicating effect into the smallest package. According to an experienced New York City researcher,

The fact that cocaine, heroin and related drugs are illegal encourages the use of injection. Severe statutory restrictions greatly increase the cost of illicit substances to nonmedical users. Injecting provides a way to economize. Injectable forms of opiates and coca are much more concentrated than traditional forms, such as opium or coca tea. Injection provides an intense and economical effect by maximizing the amount of drug that reaches the brain. People who sniff or smoke drugs say that if they inject they need only one third of the amount of the drug to maintain a habit.

Because the injection forms of illicit drugs are concentrated, they are [also] relatively easier to ship. [140].

It has been demonstrated that, as law enforcement and criminal penalties intensify, dealers also find other ways to economize by inventing new drugs---so-called "designer drugs"---that are not yet prohibited. This places the ill-informed consumers of such drugs at greater risk of overdose and other health problems. Illnesses and deaths have resulted from (1) the introduction of dangerous substances into drugs that could otherwise have been used with greater safety, (2) inadvertent overdoses due to variations in potency, and (3) the development of "designer drugs" intended to give the effect of familiar intoxicants with new chemical compositions that put them beyond the reach of current laws. Just as the prohibition against alcohol led to sales of poisonous wood alcohol and the prohibition against abortion led to coat-hanger abortions, the prohibition against drug manufacture, sale, and possession results in unnecessary deaths due to adulteration, variable purity, and "designer drugs." This contrasts sharply with the government's current regulation of alcoholic beverages, which ensures that the beverages are pure and that buyers know how strong they are and what some of their health effects may be. Experts have noted that heightened efforts to enforce drug laws and amend them to encompass new formulations or ban precursor substances may only push dealers to take greater risks, selling ever more potentially dangerous substances.

Lack of Knowledge About Safer Use

Because many drugs are outlawed, individuals considering drug use rarely have access to accurate information about the effects of drugs. While a cautious user may err on the side of avoiding certain activities while under the use of drugs, he or she may have no way of knowing, beyond trial and error, the possible adverse health consequences of certain combinations of drugs and his or her individual tolerance for particular substances. Because of its penchant for exaggeration and cartoonish treatment of the issues, most current education about drugs is not taken seriously by young people. As a result, it is far less effective than other health education (e.g., about nutrition, fitness, and smoking cigarettes).

Using Alcohol and Tobacco Instead of "Soft Drugs"

Alcohol and tobacco are completely legal yet do much more harm, statistically speaking, than illegal drug use. It is also generally recognized that alcohol, at least when used to excess, can cause aggressive, anti-social behavior. The current prohibitionist laws against marijuana, generally considered an "a-motivational" drug, and other so-called "soft drugs" have the effect of influencing some people to choose alcohol over these "soft drugs." Peter Reuter, an economist at the Rand Corporation, concludes that "If marijuana is a substitute for alcohol..., alcohol is, by definition, a substitute for marijuana. Thus tough marijuana enforcement must increase drinking." Similarly, Frank Chaloupka, an economist at the University of Illinois, found through statistical analysis "that states without criminal sanctions against marijuana possession suffered fewer auto fatalities." Finally, Karen Model, a Ph.D. candidate at Harvard, found that "states decriminalizing marijuana reported lower overall rates of drug- and alcohol-related emergencies." To the extent that users are choosing alcohol rather than marijuana or other "soft drugs," the overall public health effects are probably worse than they would be otherwise.

Injuries Due to Violence

The high prices commanded by prohibited drugs create competition among groups and individuals willing to break the law to supply drugs to consumers. Their competition often becomes violent and has contributed to the build-up of arms and the pervasiveness of violence in many areas. Gunshot wounds and other traumas due to the illegal drug business have become commonplace in big-city hospital emergency rooms. Not only traffickers, but also law enforcement officers and innocent bystanders are often the victims. Mayor Rudolph Giuliani recently noted:

The victims of the [ ] gun battles [of street-level drug dealers] are innocent bystanders---and often young children. Last year alone, about 500 New York City children were shot; of these, 89 were innocent bystanders hit by crossfire. [151].

The cost of prohibiting drugs must be measured in terms of lost lives and expensive medical care and include the hidden costs of lost productivity and the psychological damage to individuals and entire communities living in fear, helpless and hopeless.

With the possible exceptions of cocaine and PCP, drugs themselves do not generally cause violent behavior. It is, instead, turf wars for the control of black markets and the drug users' need for money to purchase such substances that leads to violence. Indeed, marijuana and heroin have been shown to render their users disinclined to violence or incapable of violence while under the influence. These substances are much less dangerous in this regard than alcohol.

Diversion of Resources from Treatment and Prevention

Prohibition diverts money that could otherwise be used for preventing and treating drug abuse. Federal anti-drug legislation provides a single budget for "supply reduction" and "demand reduction" efforts. Law enforcement agencies have always received much more than prevention, treatment, and research programs combined. The ABA recently reported that "[s]ince the early 1980s, treatment has been a declining priority. In 1991, treatment received 14% of the $10.5 billion federal drug budget compared to 25% ten years earlier." During the same period, "federal spending on law enforcement increased 737%, with interdiction efforts leading the increase." Ending drug prohibition would, by definition, eliminate the need for any special law enforcement funds for drug interdiction. It would also allow for the redirection of law enforcement resources to concentrate on violent crime and quality of life issues.


A Wiser Course: Ending Drug Prohibition
A Report of The Special Committee on Drugs and the Law
of the Association of the Bar of the City of New York
June 14, 1994

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