It’s important when talking about opioids to remember what Dr. Hart stresses. The vast majority of people who use will not become addicted, so “it’s a waste of time and effort to offer them treatment.” Both he and Franklin would make these drugs available to the public and provide treatment to those who need it, “making sure that the unit dose enhances safety and minimizes toxicity.” They would also provide clear, honest, and thorough education about the risks and benefits of these and all drugs.
A legalization scheme for stimulants such as cocaine and methamphetamine is even more challenging to imagine than one for opioids, because stimulants are, next to alcohol, the drugs most commonly associated with antisocial behavior.*10 According to Dr. Hart, “Methamphetamine abuse is associated with multiple deleterious medical consequences, including paranoia mimicking full-blown psychosis.”*11 Adopting a purely market-based approach for drugs with such potential negative consequences made Gutwillig uncomfortable, though Franklin less so. Franklin can imagine a variety of possible regulatory schemes for cocaine, amphetamine, and methamphetamine, and pointed out that we currently have a medical model for the use of stimulants that, though hardly perfect, does function tolerably well. The millions of Americans who are prescribed Adderall, a stimulant in the same class of drugs as methamphetamine, fill their prescriptions legally at pharmacies. A similar system for cocaine, amphetamine, and methamphetamine might allow a patient or user to go to a pharmacy, present her ID to prove she is of legal age, and receive a dose of the drug appropriate to her size and experience.
“Treat methamphetamine like Adderall?” I asked. “Does that really make sense?”
In fact, it does. According to Dr. Hart, d-amphetamine, the main ingredient in Adderall, and methamphetamine, are chemically virtually identical.*12 They function in the same way in the brain. Like Adderall, methamphetamine improves focus and performance. The intensity of both drugs is enhanced when they are smoked or snorted, as is commonly the case in illicit use, as opposed to swallowed in pill form. Meth is a more problematic drug than Adderall because of how it’s ingested, and because it’s illegally obtained and thus often adulterated—not because of anything intrinsic to the drug itself. Individuals who are prescribed pharmaceutical methamphetamine in appropriate doses suffer no more harm than those prescribed Adderall. Because of this, and despite their concerns, all my experts agree that it would make sense to treat methamphetamine like Adderall and the other stimulants in its class.
I asked my experts if they would anticipate an increase in casual drug use were we to abolish prohibition. Most agreed that rates of use are likely to rise initially, before settling down to rates comparable to what we see now. However, increased use does not, according to Franklin, “necessarily equate with problematic use. Products would be safer to use, education would be robust, and thus use would be less problematic. If we move drug use to a place of health instead of criminal justice, then there would be quicker access to treatment. What we’re spending now for cops, courtrooms, and prisons would go instead to public health.” Less scare, more care.
Though imagining a more sane and sensible system with these experts was a fascinating exercise, I sympathize with Dr. Hart’s frustration when he told me, “I’m over the rethinking of drug policy. We need to actually just do it.” Fortunately, pressures to liberate us from the horrible damage caused by the War on Drugs have intensified internationally. In April 2016, the UN General Assembly held a special session on drugs, in anticipation of which former Secretary General Kofi Annan called for the decriminalization of all drugs for personal use, the increase in treatment options for drug abusers, the implementation of harm-reduction strategies such as needle exchange programs, and a focus on regulation and public education, rather than criminalization. In an op-ed in the Huffington Post, Annan wrote, “It is time to acknowledge that drugs are infinitely more dangerous if they are left solely in the hands of criminals who have no concerns about health and safety. Legal regulation protects health.”*13
This is remarkable, given that the slogan of the last UN General Assembly Special Session on Drugs in 1998 was “A Drug-Free World—We Can Do It!” It took nearly twenty years, but finally at least some in the international community have come to realize that we will never have a drug-free world. What we need to strive for is a world free of a drug market controlled by vicious criminal syndicates, where hundreds of thousands are murdered and hundreds of thousands more die of drug reactions and overdose, where millions are incarcerated, and where none can gain legal access to drugs that have the potential for markedly improving their lives.
I have worked on drug policy issues for over two decades. When I first began speaking about decriminalization, back in the 1990s, when politicians were inveighing against “super-predators” and calling for ever-more draconian penalties, people thought I was at best a na?ve dreamer, and at worst a dangerous drug advocate. And yet now here we are with the United Nations practicing radical sanity. It’s entirely possible that we may in fact one day see a system in which drug use is decriminalized, treatment is available to those who need it, and drugs like psilocybin and MDMA can be prescribed under certain limited conditions. I wonder what that brunch mom will say if this happens? Will we be having conversations about the age at which our children are allowed to smoke a doobie, and will that be before or after they’re allowed to cross the street?
* * *
*1 ?The Single Convention on Narcotic Drugs of 1961, the Convention on Psychotropic Substances of 1971, and the United Nations Convention Against Illicit Traffic in Narcotic Drugs and Psychotropic Substances of 1988.
*2 ?Richard A. Posner, “We Need a Strong Prison System.”
*3 ?Glenn Greenwald, Drug Decriminalization in Portugal, p. 28.
*4 ?We are actually well on our way to legalizing marijuana. In addition to Colorado, the states of Washington, Oregon, and Alaska and the District of Columbia have all recently legalized the possession and sale of small amounts of marijuana. Polls show that more than half the country favors this reform. Twenty-four states allow for the possession and distribution of medical marijuana, a policy supported by over 70 percent of the population. As people come to appreciate the tax revenues of legalized marijuana, and notice the few negative effects of these schemes, support is likely only to increase.
*5 ?I’m willing to bet that the average consumer of Jell-O shots is even younger than the average consumer of bubble tea.
*6 ?Tetrahydrocannabinol, the primary psychoactive substance in marijuana. There are over a hundred cannabinoids in marijuana, including cannabidiol (CBD), which is less intoxicating and has anxiolytic, antipsychotic, antiemetic, and anti-inflammatory properties. See, e.g., M. M. Bergamaschi et al., “Safety and Side Effects of Cannabidiol, a Cannabis Sativa Constituent.”
*7 ?Drugs such as 25I-NBOMe and 5-MeO-AMT, both synthetic hallucinogens.