Why the war on drugs should take cues from our battle against smoking

A cigarette butt. (istockphoto)

 

By Danielle Allen 

It was the best of times, it was the worst of times. In January 1964, the Beatles first broke onto the Billboard chart with “I Want to Hold Your Hand”; by June, Ringo Starr had collapsed from tonsillitis and pharyngitis. 

In January , the surgeon general announced that scientists had found conclusive evidence linking smoking to cancer and thus launched our highly successful 50-year public- health fight against tobacco. In August, the North Vietnamese fired on a U.S. naval ship in the Gulf of Tonkin, which led to the Gulf of Tonkin R esolution and the public phase of the Vietnam War. Alongside an accelerating deployment of conventional troops would come their widespread use of marijuana and heroin.

By 1971, cigarette ads had been banned from radio and television, the surgeon general had called for regulation of tobacco, and cigarette smoking had begun its long decline. T he impact of drug use among troops and returning veterans provoked President Richard M. Nixon to declare a war on drugs.

This was followed, of course, by the 1973 passage of the Rockefeller Drug Laws in New York. These set the model for criminalization and increasing penalties for the country as a whole, especially regarding drugs.

In the contrast between what has happened since 1964 with tobacco, on the one hand, and marijuana, cocaine, heroin and other banned substances, on the other, we have an instructive lesson in the comparative effects of choosing a public-health or a criminalization paradigm for dealing with addictive substances.

The approach to tobacco has worked. Between 1964 and 2014, smoking rates declined by half; between 1996 and 2013, the number of eighth-graders who had smoked within the past 30 days fell from 21 percent to 4.5 percent. The progress against smoking has been steady and impressive.

It’s an altogether different tale with banned substances. While levels of illegal drug use have risen and fallen since 1971, current levels are equivalent to those we had in the mid-1970s. According to the Monitoring the Future r eport, daily use of marijuana by 12th- graders was at 6 percent in 1975; in 2014, it was 5.8 percent. The picture with heroin has shown similar stability. In 1975, 1 percent of 12th-graders had used heroin within the year. In 2000 that figure was 1.5 percent. In 2014 it was down to 0.6 percent, but it may be climbing again.

And for every year of the past decade, Americans have spent $100 billion to buy banned substances.

There is an even starker contrast in how perceptions of the risks of smoking and of illegal drugs have changed. In 1975, 51.3 percent of 12th-graders thought that smoking one or more packs of cigarettes a day posed great risk; by 1991 that number was 69.4 percent, by 2014 it was 78 percent. With illegal drugs, arrows move the opposite direction or stay essentially flat. In 1975, 43.3 percent of 12th-graders thought smoking marijuana regularly involved great risk; by 2014 , that number had declined to 36.1 percent. In 1975, 60.1 percent of 12th-graders thought trying heroin once or twice posed great risk; in 2014, 62.8 percent did.

In other words, for all the money spent and lives ruined through violence and criminalization, we have made zero headway against illegal drugs.

So what did we do about smoking? Tobacco control has focused on prevention and cessation.

Beginning in 1964, public- health campaigns worked toward the “denormalization” of smoking, in the words of the 2014 Report of the Surgeon General, “The Health Consequences of Smoking — 50 Years of Progress.” Although 800 private lawsuits were brought against tobacco companies without success between 1950 and 1984, in 1977 Berkeley, Calif., banned smoking in public places, and by the end of 1985, 89 cities and counties had followed suit. 

In 1986, Congress doubled the excise tax on a pack of cigarettes, and by 1988, about 400 municipalities had passed ordinances restricting public smoking. The tobacco industry began to lose lawsuits in 1995, and in 1998, the attorneys general of 46 states entered into the Tobacco Master Settlement Agreement with the largest tobacco companies in the country. 

By 2014, states had received $99.5 billion in payments from those companies, and some of these resources had funded the highly effective American Legacy Foundation, now known as the Truth Initiative, which maintains ongoing anti-smoking campaigns directed to youth and young adults. In addition, the requirement to pay out these resources forced tobacco companies to raise prices, leading to additional reductions in youth smoking.

What we have done with marijuana and the other illegal drugs is, of course, invest heavily in criminal justice.
According to a 2011 Justice Department report, addressing illegal drugs cost the nation $193 billion in 2007. The crime-related portion was $113 billion. This expenditure can lead to high-profile drug busts, as with the splashy recent raid on the Tijuana-San Diego drug-running train tunnel. But this criminalization means a massive overload on the judicial system.

According to federal judicial caseload statistics, in U.S. district courts, in 2013, 32 percent of all defendant filings were for drug-related cases, making this the biggest category of filings.

We ought to admit that we got tobacco right but drugs wrong.

As with tobacco, there are real public health risks associated with drugs, not only heroin and opiates but even marijuana. We lack good research on the long-term effects of marijuana use, but some are clear.

According to the Monitoring the Future r eport, “Frequent marijuana use predicts a lower likelihood of post-secondary educational attainment.” Early marijuana use seems to increase the risk of schizophrenia for those who are at risk for that disease for genetic reasons, and experts estimate that roughly 9 percent of marijuana users are likely to become addicted to it.

Rather than using the FBI to bust up fancy tunnel networks, we should legalize marijuana and decriminalize other drugs, and then tax and sue drug producers to generate revenue to support public health campaigns against their products, agencies to regulate them and treatment for those who suffer from addiction.

Legalizing and decriminalizing drugs doesn’t mean giving up on the fight against them, and we have the lesson about what works right in front of our eyes.