Tobacco as a model for illegal drugs

Two opinions that we should look to tobacco policy as a model for drug policy.

The first is from the Victoria Times Colonist:

We could have made tobacco illegal 20 years ago. But we chose a different approach — managed use, with education and financial penalties to decrease smoking. And it’s worked quite well.

So why not try the same approach with illicit drugs, or at least some of them? What if we say heroin and cocaine are like tobacco — things we really wish people wouldn’t use, but that we still accept some probably will.

Under that approach we would commit a lot of resources to making sure people didn’t start, as we did with smoking. We’d target kids, but also vulnerable adults.

We’d make a big effort to help people quit, something we don’t do today. And for people who wanted to keep using, we would prescribe heroin or cocaine or working substitutes. (The current half-hearted, restrictive methadone program really doesn’t count.)

What are the downsides? It simply seems wrong to provide a drug like cocaine to people, for one thing. You could argue that others — young people — might see the practice as condoning drug use. (Though we’ve managed to allow controlled sale of tobacco products while condemning their use.)

Against those negatives, look at what we would gain. The people being prescribed the drugs wouldn’t be stealing to get the money to buy them. Figure a 75-per-cent drop in property crime, conservatively, since Victoria police estimate up to 90 per cent of break-ins and thefts are drug-related. Police would be free to work on other problems and jails would be less crowded.

Organized criminals would lose a huge market. There would still be demand, but not enough to make the business attractive. Instead of spending their days and nights scrambling for money and drugs, users would have time to think about work and developing more stable lives.

Based on similar efforts in other countries, a significant number would seek treatment.

During a prescribed heroin trial in Switzerland, not only did crime by users plummet but about seven per cent quit during their time in the program.

Since people wouldn’t be using drugs in alleys and dodgy settings, we’d save a fortune in health costs. Fewer overdoses, abscesses and infections. People with both mental health problems and addictions would get a chance to reduce the chaos in their lives and deal with their mental illness.

And all the while we’d be pushing for the same shift in attitudes toward drugs as we have achieved on smoking. It should be much easier. About 55 per cent of adults smoked in 1965, compared with 15 per cent in B.C. today. Only about two per cent of Canadians are heroin and cocaine users; if we can make the same relative gains, using the lessons from smoking, the number of addicts would be tiny.

That seems like a long list of benefits, with few costs. Yet instead, we push on with tactics and strategies that have failed to deal with prohibited substances for almost a century. We fight to reduce supply, unsuccessfully, and create crime and chaos and costs.

For whatever reason, we tried something different with tobacco. Maybe the big companies had too much clout, or there were just too many smokers. We didn’t ban cigarettes or arrest people. We worked on reducing demand. And it worked.

Why not for other drugs?

I have a few reactions. First, I don’t think his arguments are without any merit. As some states and other countries experiment with decriminalization, it will be worth watching which harms are reduced, which harms increase and what strategies are most effective in mitigating the undesirable effects of decriminalization. I’ve said several times in this blog that there is no such thing as a problem free drug policy. All of them will have problems associated with them, the question is this — which problems are we willing to live with?

Second, I have concerns about the legalization and the combination of legal capitalism and addictive drugs. Marketing is a concern and lobbying power. Consider that tobacco is still not regulated by the FDA.

Third, in Michigan 23% of adults are regular smokers, and 52% of youth report having tried smoking with 16% of them before the age of 13. While tobacco policy has been successful in many ways, these numbers are still to high to offer comfort in moving towards tobacco as a model.

Fourth tobacco policy is in a state of rapid change. Who knows where it will be 5, 10 or 25 years from now? Is it inconceivable that some states or countries could be moving toward making tobacco sales illegal?

Finally, “During a prescribed heroin trial in Switzerland…about seven per cent quit during their time in the program.” Talk about the soft bigotry of low expectations. The only kind of person who would point to this as an argument in favor of this policy is a person who believes that heroin addicts can’t get well.

Another column from Newsday, “In the war on drugs, a tax plan that makes sense”, raises inconsistencies in drug harms and their legality while arguing for higher tobacco taxes. He stops short of calling for any other drug policy change but he begs the question:

Will higher prices really push smokers to stop? Will $7 packs persuade kids not to start? Or is the lure of smoking and grip of addiction so all-powerful, the customers will pay whatever it costs?

Most of the research says that higher prices have the most impact on teenagers. They have less money in their pockets, even in the affluent ‘burbs. At the same time, tax opponents warn about a rise in tax cheating, counterfeiting and illicit sales from Indian reservations, should higher taxes come in.

Only one thing is certain: This debate will never be settled on the facts. Addiction issues almost never are, and that certainly applies to the new suburban cigarette-tax debate.

Why is tobacco legal and marijuana not? Why is alcohol taxed, while cocaine and heroin are just available? Is it because some of these substances are more dangerous than others?

Of course not. We’ve never had a War on Drugs in America. We’ve always had a War on Some Drugs. And the teams were never chosen rationally.

The prestigious British medical journal The Lancet published a fascinating study last month.

Researchers from Oxford and Bristol universities set a straightforward challenge for themselves: Make a science-based assessment of the harm caused by various drugs, legal and illegal.

The researchers relied on three scales: the physical harm to the user, the drug’s addictiveness, and its impact on the user’s family and community.

Their data are hard to argue with: Alcohol and tobacco are more harmful than marijuana or ecstasy. Heroin and cocaine topped the list as most harmful. But there was hardly any connection at all, the scientists pointed out, between the harm a drug does and how the law has chosen to treat it.

Otherwise, pot would be legal. Tobacco and alcohol would not.

No one in the New York area yesterday was calling to make cigarettes illegal, even if they have now been banned from offices, restaurants, sports arenas and bars. (Suozzi did mention adding public parks to the no-smoking list.)

No one likes to pay more, even in a sin tax.

But if an extra $2 a pack will make some adults smoke less and persuade a few kids not to start, at least the change is connected to some kind of reality.

In this war, at this time, with these drugs, that’s actually
saying something.