Ditching Drug Prohibition: A Dissent

Continuing from my initial post, the second main argument in favor of the legalization of drugs whose consumption (or at least possession) is presently prohibited is that the harms associated with drug-taking are caused more by their illegality than by their pharmacological or other effects. Their illegality means that their production and distribution are necessarily criminal activities; while the artificial expense of obtaining supplies that results from criminalization leads consumers, particularly addicts, into criminality in order to obtain sufficient money to buy them.

These arguments are either half-true or wholly false. The considerable harms caused by a psychoactive substance with which most of us are familiar, alcohol, are certainly not caused by its illegality or by the restrictions placed upon its sale. No one ever died of alcoholic liver disease because alcohol was prohibited. The same is true of tobacco: no one ever died of lung cancer because he couldn’t buy cigarettes. Since on most calculations tobacco is one of the biggest causes of preventable disease in the world, this is not an entirely trivial matter. It is wishful thinking to suppose that harm may be done by psychoactive substances only, or principally, if they are made illegal.

More to the point, the current epidemic of opioid-associated deaths in the United States, 16,000 a year (four times more than heroin), has been caused by perfectly legal, if often careless, corrupt or irresponsible prescribing by doctors. Since the turn of the century, more than 100,000 Americans have in effect been killed by legal prescriptions (even if the prescription drugs have often been diverted from their intended use—intended by the prescribing doctor, that is).

This is important to stress, because it is sometimes alleged that deaths from heroin are caused not so much by the heroin itself as by variations in its strength that are the result of fluctuating legal pressures on producers and distributors. A sudden increase in the purity of black market heroin after a period of greater impurity may result in the deaths of heroin addicts who think they are taking the same dose as before. And it is certainly true, therefore, that heroin addicts whose drug is pure and whose dose they know can continue to inject for many years in perfect safety. But the doses of prescription opioids are also perfectly known to those who take them, but still they die in considerable numbers.

It is worth considering for a moment the origins of this epidemic of death by legal prescription. There was a general feeling in the medical profession that it was so afraid of causing addiction to analgesics that it stinted pain relief even to those who were clearly dying. From this apprehension it was a short step to believing that there were vast numbers of patients whose chronic pain was being inadequately treated. A small study showed that patients given strong analgesics in hospital or for medical reasons almost never became addicted to or abused them, so it was wrongly concluded that patients outside hospital with chronic pain (or alleged chronic pain) could similarly be treated without the development of addiction or abuse.

By an unhappy synergy that often occurs in human affairs, pharmaceutical companies began at the same time vigorously to market synthetic opioids. Doctors, whether from a genuine desire to help their patients, a desire to deal with them in the quickest way possible, a desire to please or a fear of displeasing them, or, in some cases, commercial greed, began to prescribe these drugs in ever-larger quantities. But illegality—except, perhaps, for those doctors who in effect sold prescriptions—had nothing to do with the development of the problem.

More recently, medical problems have arisen in the case of so-called “legal highs,” that is to say synthetic cannabinoids that are produced, distributed, purchased, and taken with perfect legality. (As soon as one substance is prohibited by law, chemists, mostly in laboratories in China, produce another that is similar but not identical, which remains legal until it is prohibited. This is in itself a tribute to human ingenuity, irrespective of whether it is being used to a good end.)

Ever since synthetic cannabinoids first became popular about five years ago, the hospital in which I used to work has treated every week several cases of intoxication with them. Assuming the experience of my former hospital to be more or less average for Britain, this means that tens of thousands of such cases are now being treated annually in the country as a whole. This does not in itself tell us how dangerous synthetic cannabinoids actually are, of course, because we have only a vague numerator and not a denominator. But if having to be treated in hospital (always at someone else’s expense, of course) is a harm, sometimes for serious complications such as renal failure caused by rhabdomyolysis, then these legally produced, legally distributed, legally consumed drugs, taken for their pleasurable effects, do harm on some considerable scale.

In other words, it is not true that problems with drugs arise only when or because they are prohibited.

The relationship between crime and drug prohibition is also much more complex than the legalizers would have us believe. It is certainly true that gangs quickly form that try to control drug distribution in certain areas, and that conflict between the aspirant gangs leads to violence. I once walked into the intensive care unit of my hospital to find two young men of Jamaican descent lying opposite one another, who had shot (but not killed) one another in a turf war over drugs. But here I would point out two things: first that the violence of such criminal gangs was largely confined to the subculture from which they emerged, so that other people were not much endangered by it; and second that, in my dealings with such people, I did not form the impression that, were it not for the illegality of drugs, they would otherwise be pursuing perfectly respectable careers. If my impression is correct, then the illegality of drugs might protect the rest of society from their criminality: the illegal drug trade being the occasion, but not the cause, of their violence. Rebel Without a Cause was the title of a famous book about psychopathy; without the illegality of drugs, the gangs would be criminals without a cause. But they would soon find one.

What about Prohibition?, is the natural reply. It is true that the homicide rate in the United States fell dramatically in the wake of repeal. By the 1960s, however, when alcohol was not banned, it had climbed higher than during Prohibition, and the consumption of drugs was much less prevalent than it was to become. Moreover, what is less often appreciated, the homicide rate in the United States rose faster in the 13 years before than in the 13 years during Prohibition. (In other respects, Prohibition was not as much of a failure as is often suggested: alcohol-related problems such as liver disease declined during it considerably. But no consequences by themselves can justify a policy, otherwise the amputation of thieves’ hands would be universal.) Al Capone was not a fine, upstanding citizen before Prohibition turned him into a gangster.

As for Mexico, the horrors perpetrated by the drug cartels are well-known. They make certain areas of Mexico dangerous in the extreme. They corrupt officialdom. They replace, destroy, or make difficult legitimate economic activity.

But, without wishing to denigrate Mexicans, Mexico has never been known for the honesty of its administration. Its current homicide rate, even with the drug cartels in full cry, is about a third of what it was in the 1940s, though it is 10 or 15 times higher than the current homicide rate in countries like Britain or France. Part of the decline of homicides in Mexico may be due to improvements in medical treatment. (It was once estimated that, if the resuscitation and surgical techniques used today were those used in 1960, the U.S. homicide rate would be five times higher than it is, which, if true, is alarming; it would probably mean that the potential homicidal attack rate in the United States is 50 to 100 times what it was in 1900, or even higher if adjusted for age.) But, notwithstanding the cartels, most of Mexico is safer than it was 60 or 70 years ago, before the cartels were dreamed of.

It is therefore possible—though I do not positively assert that it is or must be so—that the violence of the cartels in Mexico would attach itself to something other than drug-dealing in the event that the drugs in which they deal became items of normal commerce such as flowers or strawberries. The immensity of the profits of the illegal drug trade make it a natural magnet for criminals, it is true; but human ingenuity is without limit, including to bad ends.

So much for large-scale or organized crime. What of the pettier kind, of which I saw so much close-up in my medical career as a doctor in a prison? I will turn to this next.

Reader Discussion

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on July 23, 2015 at 12:18:24 pm

As this particularly informative piece discloses, it appears the doctor is using a graphic example to demonstrate that as we search for and select means for ends; that we consider: what (or which) ends we seek (by priorities or purposes - the "why"); what we can observe ("know") of what ends particular means produce; and how the ends produced will conform to our objectives in attempting to deal with circumstances.

That should be simple [?].

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R Richard Schweitzer
on July 23, 2015 at 16:56:17 pm

You cant just look at the number of deaths. We had 32,719 deaths from cars in 2013. Should we ban cars under your argument? Opioids is a very broad category. It includes morphine, codeine, oxycodone, Hydrocodone, fentanyl, methadone, and many others (heroin is also an opioids). There were about 219 million prescriptions for opioid painkillers. It is a very large category of some of the most dangerous drugs that are very useful. Look at the odds that a given prescriptions will cause a person to die, and you will see that it is a VERY tiny chance (and even then it usually depends on someone who doesn't know what they are doing or mixes opioids with alcohol or other dangerous situations).

Lastly, even if it was dangerous, that doesn’t mean we should ban it. People should have the right to choose for themselves what risks they are willing to take for the benefits. They shouldn’t be able to harm others, but they should be able to choose the risk they wish to take.

Your arguments about designer drugs are mostly specious (at least in the united states). All drugs must be approved by the FDA before being sold. And this is an argument that they shouldn’t illegal so it doesn’t matter if they can slightly change it or not if it is legal.

Many additional problems are caused by the prohibition on drugs. Is it not an argument that those problems are greater then the benefits of prohibition? Just because legal drugs cause problems doesn’t eliminate the problems of prohibition.

If a drug user cannot manage their drugs to not cause harm to others (such as a hospital visit because they are in serious medical trouble), then the government should step in. First they should be a debt created to pay back the costs they create (something that maybe shouldn’t be removable in bankruptcy). Secondly, the government can do a variety of things (like forced rehab) when such a thing occurs. No one supports people pushing harm on others.

Everyone else has to pay for the courts, police, and jails to enforce these drug laws.

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Devin Watkins
on July 25, 2015 at 12:23:59 pm

Maybe I didn't read properly, I thought this "This is important to stress, because it is sometimes alleged that deaths from heroin are caused not so much by the heroin itself as by variations in its strength that are the result of fluctuating legal pressures on producers and distributors."
Was the point, the main point anyway, of Dalrymple's use of death statistics.

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Image of Kiljoy
on July 25, 2015 at 12:32:30 pm

Oh, and regarding a supposed ban on cars... could you imagine why Dalrymple would consider that not merely a disingenuous, but actually wicked, comparison?

Fact is, liberty ( not the *civil* liberty that Edmund Burke spoke of), but the licentious kind, has meant that bad faith has been allowed to flourish. Of moral chains, the less that come from within, the more that must come from without; except the external chains won't be moral, they'll be totalitarian.

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on July 27, 2015 at 19:51:55 pm

[…] Al Capone was not a fine upstanding citizen before Prohibition turned him into a gangster. [“Ditching Drug Prohibition: A Dissent,” Library of Law and Liberty, July 23, […]

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Not-So-Random Thoughts (XVI) | POLITICS & PROSPERITY
on July 31, 2015 at 20:33:40 pm

...and yet, a great deal of the danger of drugs is, in fact, same as it was for alcohol during Prohibition: contamination from dirty, inappropriate tools and other shortcuts in fabrication. Strength is only part of the argument that illegality causes the hazards. Yet the contamination factor is barely acknowledged. Contamination, Theodore!

Even deaths and other harms from opioids have a factor in the illegality of drugs: manufactured opioids--opioids being the chemically produced laboratory bastardization--are not proper opiates. Some of their toxicity--and ineffectuality--is because of this. Thus, even more factoring from illegality: empowering and enriching pharma giants by making consumption of a plant illegal is a notable part of "legal" (albeit controlled to death) substance harms.

Prohibition... fewer liver disease cases, but ... how many lead poisoning cases? Sheesh.

I've never seen a proponent of legalization suggest that the drugs of choice--natural ones like hemp, opiates and coca derivatives--have no dangers. Hinting that one might have so done is once more a straw man. Yes, living will kill us, Theodore. But I'd rather see people high on cocaine than on methamphetamine. Meth is so incredibly toxic, and it exists because whereas cocaine is illegal and impenetrably expensive, there needed to be a cheaper option. Are both dangerous? Of course! Do I want to be around the user of either? HELL no! But if I had to choose between the cokehead and the methhead, cokehead it is.

Another straw man: no one ever said there was no crime before prohibition. However, prohibition of such things that should not be prohibited creates an immense opportunity for the criminal class. It makes criminals of mere possessors or users who have done nothing else, nothing that is inherently criminal.

Murder rates... and under what conditions do all those new murders and attempted murders occur? Ah yes, rarely among upstanding folks. Of course, thanks to prohibitions, we have a massively huge criminal class, who identify as criminal, who are used to be outlaw... and who fall all the way into that trap set by prohibitionists who, delusorily or otherwise, think they know what's good for you better than you could know.

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