2. Ethan A. Nadelmann

We turned to Mr. Nadelmann to pursue the inquiry. Formerly in the Political Science Department at Princeton, he is now the director of the Lindesmith Center, a drug-policy research institute in New York City. He is the author of Cops across Borders: The Internationalization of U.S. Criminal Law Enforcement.

THE essayists assembled here do not agree exactly on which aspect of the war on drugs is most disgraceful, or on which alternative to our current policies is most desirable, but we do agree, as Mr. Buckley expected, on the following: The ``war on drugs'' has failed to accomplish its stated objectives, and it cannot succeed so long as we remain a free society, bound by our Constitution. Our prohibitionist approach to drug control is responsible for most of the ills commonly associated with America's ``drug problem.'' And some measure of legal availability and regulation is essential if we are to reduce significantly the negative consequences of both drug use and our drug-control policies.

Proponents of the war on drugs focus on one apparent success: The substantial decline during the 1980s in the number of Americans who consumed marijuana and cocaine. Yet that decline began well before the Federal Government intensified its ``war on drugs'' in 1986, and it succeeded principally in reducing illicit drug use among middle-class Americans, who were least likely to develop drug-related problems.

Far more significant were the dramatic increases in drug- and prohibition-related disease, death, and crime. Crack cocaine -- as much a creature of prohibition as 180-proof moonshine during alcohol prohibition -- became the drug of choice in most inner cities. AIDS spread rapidly among injecting drug addicts, their lovers, and their children, while government policies restricted the availability of clean syringes that might have stemmed the epidemic. And prohibition-related violence reached unprecedented levels as a new generation of Al Capones competed for turf, killing not just one another but innocent bystanders, witnesses, and law-enforcement officials.

There are several basic truths about drugs and drug policy which a growing number of Americans have come to acknowledge.

1. Most people can use most drugs without doing much harm to themselves or anyone else, as Mr. Buckley reminds us, citing Professor Duke. Only a tiny percentage of the 70 million Americans who have tried marijuana have gone on to have problems with that or any other drug. The same is true of the tens of millions of Americans who have used cocaine or hallucinogens. Most of those who did have a problem at one time or another don't any more. That a few million Americans have serious problems with illicit drugs today is an issue meriting responsible national attention, but it is no reason to demonize those drugs and the people who use them.

We're unlikely to evolve toward a more effective and humane drug policy unless we begin to change the ways we think about drugs and drug control.

Perspective can be had from what is truly the most pervasive drug scandal in the United States: the epidemic of undertreatment of pain. ``Addiction'' to (i.e., dependence on) opiates among the terminally ill is the appropriate course of medical treatment. The only reason for the failure to prescribe adequate doses of pain-relieving opiates is the ``opiaphobia'' that causes doctors to ignore the medical evidence, nurses to turn away from their patients' cries of pain, and some patients themselves to elect to suffer debilitating and demoralizing pain rather than submit to a proper dose of drugs.

The tendency to put anti-drug ideology ahead of compassionate treatment of pain is apparent in another area. Thousands of Americans now smoke marijuana for purely medical reasons: among others, to ease the nausea of chemotherapy; to reduce the pain of multiple sclerosis; to alleviate the symptoms of glaucoma; to improve appetite dangerously reduced from AIDS. They use it as an effective medicine, yet they are technically regarded as criminals, and every year many are jailed. Although more than 75 per cent of Americans believe that marijuana should be available legally for medical purposes, the Federal Government refuses to legalize access or even to sponsor research.

2. Drugs are here to stay. The time has come to abandon the concept of a ``drug-free society.'' We need to focus on learning to live with drugs in such a way that they do the least possible harm. So far as I can ascertain, the societies that have proved most successful in minimizing drug-related harm aren't those that have sought to banish drugs, but those that have figured out how to control and manage drug use through community discipline, including the establishment of powerful social norms. That is precisely the challenge now confronting American society regarding alcohol: How do we live with a very powerful and dangerous drug -- more powerful and dangerous than many illicit drugs -- that, we have learned, cannot be effectively prohibited?

Virtually all Americans have used some psychoactive substance, whether caffeine or nicotine or marijuana. In many cases, the use of cocaine and heroin represents a form of self-medication against physical and emotional pain among people who do not have access to psychotherapy or Prozac. The market in illicit drugs is as great as it is in the inner cities because palliatives for pain and depression are harder to come by and because there are fewer economic opportunities that can compete with the profits of violating prohibition.

3. Prohibition is no way to run a drug policy. We learned that with alcohol during the first third of this century and we're probably wise enough as a society not to try to repeat the mistake with nicotine. Prohibitions for kids make sense. It's reasonable to prohibit drug-related misbehavior that endangers others, such as driving under the influence of alcohol and other drugs, or smoking in enclosed spaces. But whatever its benefits in deterring some Americans from becoming drug abusers, America's indiscriminate drug prohibition is responsible for too much crime, disease, and death to qualify as sensible policy.

4. There is a wide range of choice in drug-policy options between the free-market approach favored by Milton Friedman and Thomas Szasz, and the zero-tolerance approach of William Bennett. These options fall under the concept of harm reduction. That concept holds that drug policies need to focus on reducing crime, whether engendered by drugs or by the prohibition of drugs. And it holds that disease and death can be diminished even among people who can't, or won't, stop taking drugs. This pragmatic approach is followed in the Netherlands, Switzerland, Australia, and parts of Germany, Austria, Britain, and a growing number of other countries.

American drug warriors like to denigrate the Dutch, but the fact remains that Dutch drug policy has been dramatically more successful than U.S. drug policy. The average age of heroin addicts in the Netherlands has been increasing for almost a decade; HIV rates among addicts are dramatically lower than in the United States; police don't waste resources on non-disruptive drug users but, rather, focus on major dealers or petty dealers who create public nuisances. The decriminalized cannabis markets are regulated in a quasi-legal fashion far more effective and inexpensive than the U.S. equivalent.

The Swiss have embarked on a national experiment of prescribing heroin to addicts. The two-year-old plan, begun in Zurich, is designed to determine whether they can reduce drug- and prohibition-related crime, disease, and death by making pharmaceutical heroin legally available to addicts at regulated clinics. The results of the experiment have been sufficiently encouraging that it is being extended to over a dozen Swiss cities. Similar experiments are being initiated by the Dutch and Australians. There are no good scientific or ethical reasons not to try a heroin-prescription experiment in the United States.

Our Federal Government puts politics over science by ignoring extensive scientific evidence that sterile syringes can reduce the spread of AIDS. Connecticut permitted needle sales in drugstores in 1992, and the policy resulted in a 40 per cent decrease in needle sharing among injecting drug users, at no cost to taxpayers.

We see similar foolishness when it comes to methadone. Methadone is to street heroin more or less what nicotine chewing-gum and skin patches are to cigarettes. Hundreds of studies, as well as a National Academy of Sciences report last year, have concluded that methadone is more effective than any other treatment in reducing heroin-related crime, disease, and death. In Australia and much of Europe, addicts who want to reduce or quit their heroin use can obtain a prescription for methadone from a GP and fill the prescription at a local pharmacy. In the United States, by contrast, methadone is available only at highly regulated and expensive clinics.

A WARNING of the prohibitionists is that there's no going back once we reverse course and legalize drugs. But what the reforms in Europe and Australia demonstrate is that our choices are not all or nothing. Virtually all the steps described above represent modest and relatively low-risk initiatives to reduce drug and prohibition-related harms within our current prohibition regime. At the same time, these steps are helpful in thinking through the consequences of more far-reaching drug-policy reform. You don't need to go for formal legalization to embark on numerous reforms that would yield great dividends. But these run into opiaphobia.

The blame is widespread. Cowardly Presidents, unwilling to assume leadership for reform. A Congress so concerned with appearing tough on crime that it is unwilling to analyze alternative approaches. A drug czar who debases public debate by equating legalization with genocide. A drug enforcement/treatment complex so hooked on government dollars that the anti-drug crusade has become a vested interest.

But perhaps the worst offender is the U.S. Drug Enforcement Administration -- not so much the agents who risk their lives trying to apprehend major drug traffickers as the ideologically driven bureaucrats who intimidate and persecute doctors for prescribing pain medication in medically appropriate (but legally suspicious) doses, who hobble methadone programs with their overregulation, who acknowledge that law enforcement alone cannot solve the drug problem but then proceed to undermine innovative public-health initiatives.

I am often baffled by the resistance of conservatives to drug-policy reform, but encouraged by the willingness of many to reassess their views once they have heard the evidence. Conservatives who oppose the expansion of federal power cannot look approvingly on the growth of the federal drug-enforcement bureaucracy and federal efforts to coerce states into adopting federally formulated drug policies. Those who focus on the victimization of Americans by predatory criminals can hardly support our massive diversion of law-enforcement resources to apprehending and imprisoning nonviolent vice merchants and consumers. Those concerned with overregulation can hardly countenance our current handling of methadone, our refusal to allow over-the-counter sale of sterile syringes, our prohibition of medical marijuana. And conservatives who turn to the Bible for guidance on current affairs can find little justification there for our war on drugs and the people who use and sell them.