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Legalization Would Be the Wrong Direction

Hiding just beneath the theory of harm reduction is a whole other agenda in dealing with substance abuse.

July 27, 1998|BARRY R. McCAFFREY | Barry R. McCaffrey is director of the Office of National Drug Control Policy

The so-called harm-reduction approach to drugs confuses people with terminology. All drug policies claim to reduce harm. No reasonable person advocates a position consciously designed to be harmful. The real question is which policies actually decrease harm and increase good. The approach advocated by people who say they favor harm reduction would in fact harm Americans.

The theory behind what they call harm reduction is that illegal drugs cannot be controlled by law enforcement, education and other methods; therefore, proponents say, harm should be reduced by needle exchange, decriminalization of drugs, heroin maintenance and other measures. But the real intent of many harm reduction advocates is the legalization of drugs, which would be a mistake.

Lest anyone question whether harm reductionists favor drug legalization, let me quote some articles written by supporters of this position. Ethan Nadelmann, director of the Lindesmith Center, a Manhattan-based drug research institute, wrote in American Heritage (March, 1993): "Should we legalize drugs? History answers 'yes.' " In Issues in Science and Technology (June, 1990), Nadelmann aligns his own opinion with history's supposed verdict: "Personally, when I talk about legalization, I mean three things: The first is to make drugs such as marijuana, cocaine and heroin legal." With regard to labels, Nadelmann wrote: "I much prefer the term 'decriminalization' or 'normalization.' "

People who advocate legalization can call themselves anything they like, but deceptive terms should not obscure a position so that it can't be debated coherently. Changing the name of a plan doesn't constitute a new solution or alter the nature of the problem.

The plain fact is that drug abuse wrecks lives. It is criminal that more money is spent on illegal drugs than on art or higher education, that crack babies are born addicted and in pain and that thousands of adolescents lose their health and future to drugs.

Addictive drugs were criminalized because they are harmful; they are not harmful because they were criminalized. The more a product is available and legitimized, the greater will be its use. If drugs were legalized in the U.S., the cost to the individual and society would grow astronomically. In the Netherlands when coffee shops started selling marijuana in small quantities, use of this drug doubled between 1984 and 1992. A 1997 study by Robert MacCoun and Peter Reuter from the University of Maryland notes that the percentage of Dutch 18-year-olds who tried pot rose from 15% to 34% from 1984 to 1992, a time when the numbers weren't climbing in other European nations. By contrast, in 1992 teenage use of marijuana in the United States was estimated at 10.6%.

Many advocates of harm reduction consider drug use a part of the human condition that will always be with us. While we agree that murder, pedophilia and child prostitution can never be eliminated entirely, no one is arguing that we legalize these activities.

Some measures proposed by activist harm reductionists, like heroin maintenance, veer toward the absurd. The Lindesmith Center convened a meeting in June to discuss a multicity heroin maintenance study, and a test program for heroin maintenance may be launched in Baltimore. Arnold Trebach argues for heroin maintenance in his book "Legalize It? Debating American Drug Policy": "Under the legalization plan I propose here, addicts . . . would be able to purchase the heroin and needles they need at reasonable prices from a nonmedical drugstore."

Why would anyone choose to maintain addicts on heroin as opposed to oral methadone, which eliminates the injection route associated with HIV and other diseases? Research from the National Institute for Drug Abuse shows that untreated addicts die at a rate seven to eight times higher than similar patients in methadone-based treatment programs.

Dr. Avram Goldstein, in his book "Addiction: From Biology to Drug Policy," explains that when individuals switch from heroin to methadone, general health improves and abnormalities of body systems (such as the hormones) normalize. Unlike heroin maintenance, methadone maintenance has no adverse effects on cognitive or psychomotor function, performance of skilled tasks or memory, he said. This research indicates that the choice of heroin maintenance over methadone maintenance doesn't even meet the criteria of harm reduction that advocates claim to apply.

Treatment must differ significantly from the disease it seeks to cure. Otherwise, the solution resembles the circular reasoning spoofed in Saint-Exupery's "The Little Prince" by the character who drinks because he has a terrible problem, namely, that he is a drunk. Just as alcohol is no help for alcoholism, heroin is no cure for heroin addiction.

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