Title: Recreational Drugs
Author: Julian Heicklen
Date: June 1997
SOC Publication Number: 004

Abstract 

A. Legal Status

B. Usage 

C. Medical Effects 

D. Criminogenic Effects 

E. Criminal Sanctions 

F. Costs

G. Conclusions

H. Recommendations 

References 

  Abstract

Agitation against the use of drugs in the United States started in the middle of the 19th century with the movement to prohibit the use and sale of alcohol. Legislation against the opiates followed at the end of the nineteenth century. In 1914, the Harrison Act started the war against narcotics. Finally marijuana was included in 1937. All of these efforts were spurred in part through racial fear. In the last generation, hallucinogens, the synthetic drugs, and tobacco have come under attack.

This report is concerned mainly with alcohol, tobacco, marijuana, cocaine, and heroin. These drugs are listed in decreasing order of usage. With the exception of heroin, the use of all of these drugs declined in the 1980s when the current "War on Drugs" began in earnest. A minimum in usage was reached in the early 1990s. Since then there has been a modest, but noticeable rise in drug usage, except for cocaine. Heroin usage, at least among high-school seniors, remained nearly constant throughout this period.

Of the five drugs mentioned, only marijuana has no serious medical effects on the user and is non-addictive. In addition to the harm tobacco causes to the smoker, it also harms others that are exposed to tobacco smoke. Tobacco (and possibly marijuana) does not impair motor coordination, whereas the other drugs do. Both alcohol and cocaine are criminogenic. They induce violent and criminal acts. Marijuana, tobacco, and the opiates are not criminogenic.

The number of people arrested, convicted, and incarcerated for drug offenses has increased dramatically since 1980. In addition prison sentences became longer. In 1995, about 1/3 of all new incarcerations in the United States were for non-violent drug offenses. Consequently the costs of law enforcement were enhanced accordingly. Currently the national cost for drug crime control is about $100 billion.

There are two types of drug useage:1) An elastic usage that can be altered by legal sanctions, law enforcement, and education, and 2) An inelastic usage that is unaffected by any of those factors, but may be subjected to alteration by medical or rehabilitative programs.

Because of its harmful effects, tobacco should be heavily regulated. Advertisements must clearly delineate the harmful health effects. Tobacco should be sold only by licensed dealers, and detailed records of sales should be kept. Sales taxes should cover the expected societal costs. The sale of tobacco products can be controlled to some extent by limiting the number of licensed distributors.

Because of its harmful effect to others through secondary smoke, tobacco use should be illegal in public facilities, especially in those serving food or drink. Violation of this prohibition should be a misdemeanor for the proprietors of the facilities. The proprietors should be fined heavily for a first offense and the facility closed for a subsequent offense within a specified time period. Individual violators should receive fines.

Criminalization of marijuana sale and use is unwarranted, except for use in operating a motor vehicle or performing a public safety function. Under these conditions, we recommend that marijuana be treated identically with alcohol, which likewise is a depressant. Otherwise marijuana sale and use should be legal. Depriving people in medical need of marijuana is immoral. Decriminalization of marijuana would diminish the prison population, and help reduce prison overcrowding.

Cocaine is addictive, ciminogenic, and may be harmful at high doses. Therefore we are making no suggestions for law enforcement changes at this time. We do suggest that the legal sanctions gainst crack cocaine be made the same as for other forms of cocaine.

Heroin usage over the past 15 years is of the inelastic type. Therefore some decrease in legal sanctions and law enforcement should not lead to increased usage, but would save a considerable amount of money. Up to 64 % of property crime and up to 33% of violent crime might be eliminated if heroin were available legally. Availability of heroin and clean needles would reduce the transmission of AIDs. Our proposal is that Pennsylvania establish two legal distribution centers for heroin, one in Philadelphia and one in Pittsburgh. Any competent adult should be permitted to buy heroin from these legal centers, but only enough to supply himself. Careful records of all sales should be made. Heroin-related crimes and hospital admissions in Philadelphia and Allegheny Counties should be monitored and recorded.

 
Recreational drugs can be classified by their effects. These are listed in Table 1.

Our discussion will include many of these drugs to some extent. However most of the discussion will relate to the five most commonly used "troublesome" recreational drugs: alcohol, nicotine, marijuana, cocaine, and the opiates (opium and heroin).

The "War on Drugs" has occupied the American scene for at least 150 years. It has resulted in considerable expenditure of effort, grief, and financial costs. It started with the attempts to outlaw alcohol consumption and has continued uninterrupted ever since. The current illicit drugs of the five mentioned above are marijuana, cocaine, and the opiates. Alcohol is regulated, and its use is illegal in some contexts. Nicotine currently is being regulated to some extent and is under pressure for more regulation.

Hopefully we should not make the same mistakes in our policy with other drugs that we made with alcohol prohibition. The purpose of this report is to examine the facts related to the five common recreational drugs in order to recommend a rational policy toward drug use for the future. Such an analysis is necessary not only for future policy on currently illicit drugs, but also because the "War on Nicotine" is about to erupt. Since nicotine is used much more widely than current illicit drugs, errors in nicotine policy could be devastating.

We are not advocating increased drug use. Our basic thrust is to advocate a more efficient, less costly, more humane way of dealing with the drug problem. We seek to reduce the many harms associated with drug use and the current policies and practices in dealing with drugsÑlicit and illicit.
 

  A. Legal Status

The use of drugs was first addressed at the national level in the Pure Food and Drug Act of 1906. The act prohibited misbranding of pharmaceuticals. Patent medicines containing heroin, cocaine, opium or marijuana could still be sold, but the medicines had to list these ingredients by name. This tended to reduce sales, and patent medicine producers generally eliminated the use of opiates and other narcotics (Meier, 1994, p. 23). In 1915, the number of drug addicts in the United States was reliably estimated to be between 200,000 and 275,000 with a concentration in the South and in the upper and middle classes (Meier, 1994, p. 23).

1. Alcohol

The drive to outlaw alcohol in the United States started in the nineteenth century. After the Civil War, the Women's Christian Temperance Union (WCTU) and the Prohibition Party led the struggle. The movement had little success; the peak vote garnered by the Prohibition Party was 2.3% of the vote for president in 1892. The movement became effective with the founding of the Anti-Saloon league in 1893. The movement was effective because of its racial overtones. It pitted the native-born middle-class rural Protestants (for prohibition) against the immigrant, urban working-class Catholics (against prohibition). The Anti-Saloon League was closely tied to the Protestant churches and billed itself as the "Church in Action" (Meier, 1994, p. 137). Major political candidates ran against "Rum, Romanism, and Rebellion." (Statement of October 29, 1984, by Samuel D. Burchard on a visit to James G. Blaine, the Republican candidate for President in 1984).

The Anti-Saloon League was instrumental in passing prohibition laws in several states. By 1906, three states were "dry." Six more went "dry" by 1909. Nine more accepted prohibition in 1913, and there were 23 "dry" states by 1916 (Meier, 1994, p. 137). In 1913 Congress passed the Webb-Kenyon Act prohibiting the transport of alcoholic beverages into "dry" states. In 1917, both the Senate and House of Representatives approved the prohibition amendment to the U. S. Constitution, and it was soon ratified by 3/4 of the states. It became the 18th Amendment to the U. S. Constitution and took effect on January 17, 1920. The Volstead Act was passed as a rigid enforcement law. In 1929 Congress passed the Jones Act, amending the Volstead Act to provide a $10,000 fine and a 5-year jail term for first-time offenders of the law. Enforcement action activity is summarized in Table 2 for the years that prohibition was in effect (1920­33).

Prohibition was very successful in achieving its stated aim, reducing the consumption of alcohol and the attendant medical and social problems. Hospital admission rates for alcoholism, arrest rates for drunkenness, and cirrhosis of liver all declined (Meier, 1994, p. 148). Per capita consumption of alcohol dropped to 0.75 gallons in 1921­22, the lowest level in history. Even per capita consumption rates of 1.1 gallons in the later days of prohibition, when bootlegging was in full force, were well below the pre-prohibition level of 1.7 gallons per year.

Meier (1994, pp. 187­189) analyzed the effect of prohibition, taxation, and enforcement on legal alcohol consumption, as computed from federal tax data. The analysis covered 71 years for federal policies and 57 years for state policies. Each dry state reduced legal alcohol consumption in the United States by 0.010­0.020 gallons per year. Meier's analysis also concluded that increased enforcement had little, if any, effect on legal alcohol consumption. Increasing state taxes decreased alcohol consumption, but federal taxation rates did not affect alcohol consumption. Furthermore state arrest rates for alcohol-related crimes were unrelated to alcohol consumption.

However prohibition was a colossal failure in reaching its real aim, the repression of immigrant, working-class, urban, and Catholic populations. These groups coalesced into the modern Democratic Party, and, under the leadership of Franklin Roosevelt, revolutionized the country. Ironically, Roosevelt was the archtypical native-born, upper-class Protestant. From 1861 until 1933, the Republican Party occupied the U. S. Presidency for all but 16 of the 72 years. From 1933­2001, the Republican Party occupied the Presidency for only 28 of the 68 years. From 1933 to 1995, the Republicans had a majority in the U. S. House of Representatives for only 4 of the 62 years.

An unintended side effect of prohibition was the increase in crime and corruption. From January 1920 to February 1, 1926, 752 prohibition agents were discharged for delinquency or misconduct (approximately 1 in 12 employees). During this period 141 agents were convicted of taking bribes, participating in bootlegging, or committing some other crime (Meier, 1994, pp. 144­145). The Wickersham Commission of 1931 reported that the number of employees dismissed for cause reached 1,600 by 1930. Along with corruption came abuse of power. Evidence was illegally seized. Random searches without warrants became common. Entrapment was a standard operating procedure. Allegations of excessive force were made.

Prohibition brought with it the introduction of organized crime into the United States. Crime rates, in addition to bootlegging, soared. There is no accurate account of the actual crime rates for most crimes, because many of them were associated with alcohol consumption, and thus went unreported. However we do have data for homicide, almost all of which was reported (Zawitz, 1988, p. 15). The homicide rate rose from 1.1 per 100,000 residents in 1903 to 9.7 per 100,000 residents in 1933, the year that prohibition was repealed. It then dropped steadily for a number of years, but never returned to the levels before prohibition. It reached a local minimum of 4.5 per 100,000 residents in 1958, and then started to climb again as drug-law enforcement increased, reaching an all-time high of 11 per 100,000 in 1980. Since 1980 the murder and manslaughter rate has decreased to 7.9 per 100,000 in 1984­85, then rose to 9.8 per 100,000 in 1991 and has fallen again to 7.9 in 1995 (Heicklen, 1997).

Meier's analysis (1994, p. 231) found that drunk driving laws are not significantly related to nighttime traffic fatalities. This is consistent with the findings of Ross (1982, pp. 102­103) that increasing the severity or swiftness of punishment has no known impact on drunk driving. Increasing the certainty of punishment has a modest short-term deterrent effect. Of all the alcohol policies, only the number of retail outlets for alcohol sales is related to the prison population. None of the other factors, in particular alcohol consumption or the alcohol crimes arrest rate, is related to the prison population.
 

2. Opiates and Cocaine

A history of drug enforcement in the United States was given by Hamowy (1987). Until late in the 19th century, there were no restrictions on the sale or use of narcotics. Drugs were sold over-the-counter by pharmacies and were available from general stores, groceries, and through mail-order houses. Patent medicine manufacturers regularly used opiates or cocaine in their remedies. Many drinks, including Coca-Cola, contained cocaine.

The movement to restrict the use of opium was aimed at protecting white people from the influence of the Chinese immigrants that were entering the western part of the United States in large numbers. The first ordinance was passed by the city of San Francisco in 1875. It made it unlawful to keep or frequent an opium den. Between 1877 and 1896, 22 states and territories enacted legislation relating to opium dens. That the laws were racist in origin is clear from the Idaho law, which explicitly referred to "any white person."

The first state to prohibit the sale of drugs except by prescription was Montana in 1889. The law pertained to the sale of opium, cocaine, heroin, and morphine. The first federal law to control the production or distribution of opium, cocaine, heroin, and morphine was the Harrison Narcotic Act of 1914. It was used as the basis for prohibiting physicians from prescribing narcotics to any addict.

Opiates were legal and commonly used in the United States in the nineteenth century. One of the uses was to quiet crying babies (Duke and Gross, 1993, p. 55). The first law against these drugs was to outlaw the smoking of opium in California in 1909 (Falco, 1992, p.19). The first federal law controlling drugs was the Harrison Narcotic Act of 1914. Until then all drugs were legal in the United States. Race played a role in the adoption of the Harrison Act (Meier, 1994, p. 25). There were law enforcement claims that cocaine gave Blacks superhuman strength and contributed to assaults on whites. The Harrison Act regulated narcotics and cocaine, but did not outlaw them. Sellers had to register with the federal government, pay a tax, and keep records of sales. The U. S. Government improperly used this law to prohibit drug addict maintenance (Meier, 1994, p. 25). Growing opium poppies was not illegal in the United States until 1942 (Brecher et. al., 1972, pp.3­4).

The increased interest in the drug problem in the 1960s resulted from the war in Vietnam. Thousands of our military personnel returned from that war as drug addicts. In 1970, the Drug Abuse Prevention and Control Act of 1970 was passed. This act established five separate "schedules" for classifying drugs. These are:

Schedule I. Drugs with no accepted medical use in the United States and having high probability for abuse: heroin, LSD, marijuana, peyote, mescaline, psylocibin, methaqualone, cocaine. For a first offense, possession of 10 grams of LSD or 50 grams of cocaine with intent to distribute can produce sentences of 20 years to life and fines of one to five million dollars.

Schedule II. Drugs with a high probability of abuse and causative of severe dependence: opium, morphine, codeine, methadone, methamphetamine. These have medicinal use under close supervision. Penalties for violation are the same as for Schedule I drugs.

Schedule III. Drugs with lesser probability for abuse, such as paregoric (containing opium), and available only by prescription.

Schedule IV. Drugs with lesser probability of abuse than those in Schedule III, such as barbiturates, diazepam (Valium), and sleeping pills, available by prescription.

Schedule V. Drugs with still less likelihood of abuse, containing minute amounts of opium or codeine, such as cough medicines or compounds to control diarrhea. Illegal trafficking in these can bring fines of $100,000 to $250,000 and prison terms of up to a year.

The latest classification of drugs was reported by the Food and Drug Administration (1996). The illicit drugs that will be discussed here and their classification are listed in Table 3:

The Posse Comitus Act was revised in 1982 to permit military interdiction of inward-bound drugs (Public Law 97­86) and again in 1986 to provide for emergency assistance to civilian law enforcement agencies (Public Law 99­570). We now had the military acting as police, a dangerous situation for any nation.

Also in 1986, a new Anti-Drug Abuse Act was passed. It provided a mandatory minimum $1000 fine for a first offense of possessing any amount of an illegal drug, and 15 days in jail and a $2500 fine for a second offense.

 
3. Marijuana

The first states to regulate marijuana were Maine, Indiana, and Wyoming in 1913. Other states followed soon thereafter. By 1937, only Tennessee and South Carolina had no laws against marijuana. In 1937 the federal government passed the Marijuana Tax Act that imposed a tax on the medical distribution of Marijuana and made criminal the non-medical sale or possession of marijuana. In 1941, the medicinal uses of marijuana stopped, and research on possible medical uses came to an abrupt halt. There is some indication that the impetus to outlaw marijuana was directed against Mexican immigrants, who were significant users of this drug, though the evidence is less conclusive for racial bias than in the case of opium. There certainly were no medical or social reasons for outlawing marijuana, as the government research studies showed that it was harmless and non-addictive.

In 1930, the Federal Bureau of Narcotics was established in the Treasury Department with an anti-drug activist, Harry J. Anslinger, as the first Director. He served until 1962. During his tenure, the Marijuana Tax Act of 1937 was passed. It restricted marijuana use to a very few medical processes, imposed taxes on its importation, and made unauthorized possession a criminal act (Vallance, 1993).

In the 1970s, some states reduced penalties for marijuana usage, but these laws were nullified by subsequent federal laws. The resurgence of states to legalize marijuana use occurred again in 1996, when both Arizona and California passed referenda legalizing marijuana use. However its use is still illegal under federal law.
 

4. Tobacco

In 1964, the Surgeon General of the United States (Terry, 1964) issued a report that tobacco smoking was injurious to health and caused lung and laryngeal cancer in men and probably lung cancer in women. Since then there have been attempts to regulate tobacco usage. This is a drug regulation movement that appears to have no racial motivation.

The movement against tobacco usage started with research and educational programs. This led to the ban of some cigarette advertising, and the requirement that cigarette advertisements carry a message warning of the health dangers.

Later prohibitions against smoking in designated areas became popular. It is now illegal to smoke in airplanes on U. S. domestic flights. A number of public facilities prohibit tobacco smoking. Most restaurants provide a smoking and a non-smoking section.

In 1996, President Clinton placed nicotine and tobacco under the jurisdiction of the Federal Drug Administration. This is sure to lead to further restrictions on tobacco usage.
 

5. Other Factors
 
Vallance (1993) reports that since 1961, at least 82 federal laws have been enacted that relate to the drug problem. Some of these are described in appendix A of Vallance. In 1968, the Federal Bureau of Narcotics was merged with the Bureau of Drug Abuse Control from the Department of Health, Education, and Welfare into a new Bureau of Narcotics and Dangerous Drugs in the Department of Justice. Thus drugs officially left the purview of health and became primarily criminal in nature. In 1982 a further reorganization established the Drug Enforcement Administration. In 1993, it had over 5,000 employees and an appropriation of $748 million. (Vallance, 1993).

In addition to federal laws, there are a multitude of state laws regulating drugs. In Pennsylvania (Pennsylvania Commission on Sentencing, 1994) there are 1 crime relating to cigarettes, 6 crimes relating to alcohol, and 81 crimes relating to other drugs. Of these, 12 are specific to marijuana. The recommended minimum prison sentences can be as high as 10 years, with maximum sentences of 20 years. For marijuana abuse, the recommended minimum prison sentence can be as high as 5 years, with a maximum of 10 years.

A final comment on drug law enforcement is the unintended effect it has on unrelated crime. In Florida, arrests for interdiction of drugs have become so numerous that perpetrators of other crimes have to be released from prison in order to accommodate the drug offenders. In Philadelphia a similar situation has occurred. Dilulio (1996) writes: "Norma Shapiro imposed an arbitrary population cap on the city's jails. In one 18-month-period alone, Philadelphia police rearrested 9,700 of these released criminals, charging them with 79 murders, 90 rapes, and thousands of other serious offenses." This information has been verified by Lynne Abrahamson, the District Attorney of Philadelphia County (Abrahamson, 1997).

B. Usage

The Office of National Drug Control Policy (Drugs and Crime Data, 1996) recently has issued a report on drug use trends in the United States. Its findings are summarized in Figure 1. The percentage of persons aged 12 and older that have ever used drugs increased from 33.1% in 1979 to 36.7% in 1985. From 1985 through 1994, the percentage has remained nearly constant at about 37%. For those that used drugs in the past year, the percentage dropped slightly from 19.6 in 1979 to 18.6 in 1985. A more dramatic decrease from 18.6% to 11.1 % occurred from 1985 through 1992. From 1992 through 1994, drug use in the previous year increased somewhat from 11.1% to 12.4%. Drug use in the previous 30 days has followed the trend for drug use in the last year. The percentages were 13.7, 11.6, 5.5, and 5.8, respectively, for 1979, 1985, 1992, and 1994. Former users increased from 13.5% in 1979 to 25.2% in 1994. Casual users remained nearly constant at about 6% over this time period. Illicit drug use dropped noticeably in the 1980s. This was a period of significant law enforcement coupled with educational programs.
  Figure 1: Percentage of Persons Ages 12 and Older Reporting Illicit Drug Use. Casual users are defined as the difference between last-year users and last 30-day users. Former users are defined as the difference between those that ever used drugs and last-year users. Data from Drugs and Crime Data (1996).

 
Similar data are shown for high-school seniors in Figure 2. Here the trends for those that ever used drugs, those that used drugs in the last year, and those that used drugs in the last 30 days are all the same. They show a decrease through the 1980s, but they reach a minimum in 1992, and then start to climb. The number of former and casual users remains fairly constant at about 5­7 % for casual users and about 8% for former users. Figure 2: Illicit Drug Use by High School Seniors. Casual users are defined as the difference between last-year users and last 30-day users. Former users are defined as the difference between those that ever used drugs and last-year users. Data for Figure 3 of Drugs and Crime Data (1996).

1. Marijuana

Let us examine the use of specific drugs over the past 20 years. The data for marijuana usage are given in Figure 3, broken down by age groups. The peak years for the percentage of marijuana users were 1979­1982. Then use declined noticeably until about 1990 when it leveled off. For all years the use was highest in the 18­25 year old group and lowest in the over 26 age group. During the 1980s, federal anti-marijuana laws and enforcement were strengthened. This led to the criminalization of marijuana in some states where it use had been non-criminal. In addition there was a considerable public relations effort, spearheaded by Nancy Reagan, against drug use. However, in the 1990s about 23% of 18­25 year olds and 10­15% of high-school students were marijuana users.

The past-year use of marijuana reported by high-school seniors rose from 40.0% in 1975 to a maximum of 50.8% in 1979 according to Drugs and Crime Data (1996). It then dropped to a minimum of 21.9% in 1992, after which it rose again to 34.7% in 1995. The use of marijuana by high-school seniors is analyzed in more detail by Maguire and Pastore (1996) in Figure 4. This figure shows usage in the past year, in the past 30 days, and by casual users (the difference between past year and past 30-day users). For all 3 groups, usage dropped during the 1980s, reached minima in 1992, and then rose again. The percentage of high-school seniors using marijuana in 1994 was (Maguire and Pastore, 1996, p. 282): 19.0% for current users (within the last 30 days), 11.7% for casual users (within the last year, but not the last 30 days), 7.5% for former users (not within the last year), and 61.9% that never used marijuana.

  Figure 3: Past Year Use of Marijuana. Data for Figure 2 of Drugs and Crime Data (1996).

  Figure 4: Marijuana/Hashish Use Among High-School Seniors. Casual users are defined as the difference between last-year users and last 30-day users. Data from Tables 3.62 and 3.63.of McGuire and Pastore (1996).
 

2. Cocaine

An ordinary dose of cocaine is 1/8­1/4 grain (Inciardi et. al., 1996, p. 22). Grinspoon and Bakalar (1985, pp. 87­88) reported that coca leaf chewers consume 50­100 grams daily, with some avid chewers consuming as much as 250 grams per day. In each cocada, 34 grams of leaves were chewed, with 180 mg of alkaloids including 112 mg of cocaine; coca chewers ingest 200­500 mg of cocaine daily.

The data for cocaine use are given in Figure 5, broken down by age groups. The peak year for the percentage of cocaine use among 18­25 year olds was 1979. Nearly 20% of people in that age group used cocaine that year. Since then the percentage of usage has dropped steadily to the 1994 value of just above 4%. For the other age groups, cocaine usage was less prevalent, never exceeding 4% of the population in those groups. The peak years were 1979­1985 for the high-school group and 1982-1985 for the over 26 year olds. Cocaine use trends followed those for marijuana, probably for the same reasons.

  Figure 5: Past Year Use of Cocaine. Data for Figure 1 from Drugs and Crime Data (1996).

The past year use of cocaine reported by high-school seniors rose from 5.6% in 1975 to a maximum of 13.1% in 1985, dropped to a minimum of 3.1% in 1992 and then rose to 4.0% in 1995 according to Drugs and Crime Data (1996). The use of cocaine by high-school seniors is analyzed in more detail by Maguire and Pastore (1996) in Figure 6. This figure shows usage in the past year, in the past 30 days, and by casual users (the difference between past year and past 30-day users). For all 3 groups, usage dropped during the 1980s, reached minima in 1992, and then rose again. The percentage of high-school seniors using cocaine in 1994 was (Maguire and Pastore, 1996, p. 282): 1.5% for current users (within the last 30 days), 2.1% for casual users (within the last year, but not the last 30 days), 2.3% for former users (not within the last year), and 94.1% that never used cocaine.

  Figure 6: Cocaine (including Crack) Use Among High-School Seniors. Casual users are defined as the difference between last-year users and last 30-day users. Data from Tables 3.62 and 3.63 of McGuire and Pastore (1996).

3. Opiates

The use of opiates is highly correlated with poverty, unemployment, illegitimacy, financial assistance, and delinquency (Inciardi et. al., 1996, p. 16). Opiate use does not cause these problems, but exists side-by-side with them. An ordinary dose of morphine is 1/5 of a grain; of heroin, 1/16-1/8 of a grain (Inciardi et. al., 1996, p. 22).

The past year use of heroin reported by high-school seniors dropped from 1.0% in 1975 to 0.5% in 1979 according to Drugs and Crime Data (1996). It then remained constant through 1994 and rose again to 1.1% in 1995. The trends reported by Maguire and Pastore (1996) are the same, but their percentage values are lower. Their data are shown in detail in Figure 7. This figure shows usage in the past year, in the past 30 days, and by casual users (the difference between past year and past 30-day users). Contrary to the situation with marijuana and cocaine, heroin usage in all three groups remained nearly constant from 1983­1994. Then it rose dramatically in 1995. In fact the rise in 1995 is so dramatic that the data may be suspect. The percentage of high-school seniors using heroin in 1994 was (Maguire and Pastore, 1996, p. 282): 0.3% for current users (within the last 30 days), 0.3% for casual users (within the last year, but not the last 30 days), 0.6% for former users (not within the last year), and 98.8% that never used heroin.

  Figure 7: Heroin Use Among High-School Seniors. Casual users are defined as the difference between last-year users and last 30-day users. Data from Tables 3.62 and 3.63 of McGuire and Pastore (1996).

The use of opiates other than heroin by high-school seniors is analyzed in detail in Figure 8. This figure shows usage in the past year, in the past 30 days, and by casual users (the difference between past year and past 30-day users). Contrary to the situation with heroin, usage of opiates other than heroin follow trends similar to those for marijuana and cocaine. The peak use was in 1985 for all three groups. It declined to minima in 1991 or 1992, and then rose again. The percentage of high-school seniors using opiates other than heroin in 1994 was: 1.5% for current users (within the last 30 days), 2.3% for casual users (within the last year, but not the last 30 days), and 3.8% for users within the last year.

  Figure 8: Use of Opiates other than Heroin by High-School Seniors. Casual users are defined as the difference between last-year users and last 30-day users. Data from Tables 3.62 and 3.63 of Maguire and Pastore (1996).

4. Hallucinogens

The use of hallucinogens by high-school seniors is analyzed in detail in Figure 9. This figure shows usage in the past year, in the past 30 days, and by casual users (the difference between past year and past 30-day users). The usage of hallucinogens follows trends similar to those for marijuana and cocaine. Hallucinogen usage among high-school seniors declined to minima 1989 or 1990, and then rose again, reaching peak usage in all three groups in 1995. The percentage of high-school seniors using hallucinogens in 1994 was: 3.2% for current users (within the last 30 days), 4.6% for casual users (within the last year, but not the last 30 days), adding up to 7.8% for users within the last year. The current use of hallucinogens among high-school seniors is higher than that for cocaine or for all the opiates combined.

  Figure 9: Use of Hallucinogens by High-School Seniors. Casual users are defined as the difference between last-year users and last 30-day users. Hallucinogens include LSD and PCP. Data from Tables 3.62 and 3.63 of Maguire and Pastore (1996).

5. Alcohol

According to Kleiman (1992, p. 204), about 2/3 of Americans use alcohol, at least occasionally, and about 1/3 drink regularly (at least weekly). Americans spend approximately $90 billion per year on alcoholic beverages, more than twice as much as they spend on all illicit drugs combined. About 16% of all drinkers (10% of all Americans) have a "drinking problem."

The total number of Americans that have used alcohol is 172 million, compared to 68 million that have reported using marijuana (Falco, 1992, p. 183). Cocaine, the second-most popular illicit drug (after marijuana) has been tried by 24 million Americans.

The reported use of alcohol by Americans is shown in Figure 10. It was 58% in 1939, rose to a maximum of 67% in 1945­1946, dropped to about 60% in the 1950s and early 1960s. Then it rose to a peak value of 71% 1976­1978. After that it declined steadily to a minimum of 56% in 1989 and has risen slightly since then.

  Figure 10: Respondents Reporting Alcohol Use. Data from Table 3.87 of Maguire and Pastore (1996).

The per capita consumption of alcohol in the United States by volume has been given by Trebach (Trebach and Inciardi, 1993, pp. 109­110). The data are in Table 4. An all time high of 7.10 gallons was reached in 1830, and an all-time low of 0.90 gallons was reached during prohibition (1920­1933). By 1989, per capita consumption had climbed back to 2.43 gallons.

The use of alcohol was declining prior to the onset of prohibition. Marshall (1988, p. 45) reports that in 1918­1919, per capita annual consumption had dropped to 0.98 gallons. After prohibition was enacted, per capita annual consumption fell further to 0.73 gallons in 1921­1922, and then started to rise, reaching 1.14 gallons just as prohibition was repealed in 1933.

The use of alcohol by high-school seniors is analyzed in detail in Figure 11. This figure shows usage in the past year, in the past 30 days, and by casual users (the difference between past year and past 30-day users). The usage of alcohol follows trends different to those for the illicit drugs. Alcohol usage among high-school seniors declined steadily from 1983 to 1995 for users in the past year or the past 30 days. However the percentage of casual users rose steadily over the same period. Thus regular users were converting to casual use. The percentage of high-school seniors using alcohol in 1994 was (Maguire and Pastore, 1996, p. 281): 50.1% for current users (within the last 30 days), 22.9% for casual users (within the last year, but not the last 30 days), 7.4% for former users (not within the last year), and 19.6% that never used alcohol. The current use of alcohol among high-school seniors is higher than that for marijuana, cocaine, the opiates, and the hallucinogens combined.

  Figure 11: Use of Alcohol by High-School Seniors. Casual users are defined as the difference between last-year users and last 30-day users. Data from Tables 3.62 and 3.63 of Maguire and Pastore (1996).

6. Tobacco

The percentage of cigarette smokers in the United States over age 18 dropped from 42.3 % in 1965 (the year after the Surgeon Generals' report [Terry, 1964] on the dangers of tobacco usage) to 32.2 % in 1983 to 25.4% (about 50 million) in 1990 (Trebach and Inciardi, 1993, p. 110). The use of cigarettes in the last year by high-school seniors is given in Figure 12. It has remained nearly constant at about 30% from 1983­1992. From 1992 to 1995, there has been about a 10% increase.

  Figure 12: Use of Cigarettes by High-School Seniors in the Past Year. Data from Table 3.63 of Maguire and Pastore (1996).

    C. Medical Effects

1. Mortality

Deaths do occur from drug use. Ostrowski (1990) summarized the death rate for users of various drugs. His results are listed in Table 5.

It can be seen from Table 5 that the death rates from the legal drugs tobacco and alcohol far exceed those from the illegal drugs heroin and cocaine. Ostrowski (1990, p. 655) also points out that there were at least 8,000 deaths per year directly related to prohibition. These included 1,200 murders incident to street crime, 825 black market murders, 3,500 drug-related AIDs deaths, 2,400 poisoned drugs (no quality control), plus an unestimated number of deaths caused by other diseases spread through dirty needles and loss of medical use of illegal drugs.

Trebach (Trebach and Inciardi, 1993, p. 116) claims that there were only 8 known child deaths from all forms of cocaine in 1984. During the summers of 1986 and 1992, he could not find one death that could be attributed to crack cocaine. The total of all cocaine deaths for children througýÿÿÿâ

Husak (1992, p. 95) reports that nicotine causes 83.3 deaths per 10,000 weekly users. About 25% of all adolescents that smoke a pack of cigarettes daily lose, on average, 10­15 years of life. No known fatalities have ever been attributed to marijuana, despite its use by 51 million Americans. Cocaine, even when smoked in the form of crack, was cited as the primary cause of death in only 2496 case in 1989, and there is reason to believe that this figure is exaggerated. Since 862,000 Americans reported using crack in 1989, this comes to 29 deaths per 10,000 weekly users. For alcohol the death rate is 20.6 per 10,000 weekly users.

Falco (1992, pp. 24) reports that an estimated 18 million Americans are alcoholics and 55 million are nicotine (cigarettes, cigars, pipes) smokers. In contrast, there are 5.5 million serious drug users. Each year alcohol causes 250,000 deaths, while more than 400,000 Americans die from smoking tobacco. The estimates for total illicit drug deaths range from 5,000 to 10,000 annually.

Meier (1994, p. 167) reports that 1.5 million persons are arrested each year for drunk driving, although it was estimated that there were about 3 billion episodes of drunk driving in 1981. Fully 24% of the population admit to driving after drinking too much. Alcohol is implicated in approximately 1/2 of more than 40,000 traffic fatalities annually. Most alcohol-related fatalities, however, involve only one car. A drunk driver usually kills himself and/or his passengers. Alcohol-related fatalities involving persons that are not intoxicated are relatively rare.

According to Vallance (1995), 900 deaths have occurred prior to 1979 from 57 million Valium prescriptions to help people live with stress and 700 deaths connected with 9 million prescriptions for Elavil to help people feel better. In 1985, Rice et. al. (1990, p. 120) report that 6,118 deaths were connected with illegal drug use; a more recent estimate is 7600. A 1991 report of the National Commission on AIDS found that a third of AIDS cases were related to intravenous drug use. However the disease is not caused by the drugs, but by contaminated hypodermic needles. Marijuana, the illegal drug most widely in use, has yet to claim a recorded death from overdose.

2. Illicit Drug Morbidity

The medical effects of some illicit drugs have been summarized by Falco (1992, pp. 203­205). These are:

Heroin is derived from opium and reduces sensitivity to pain and induces sleep. It is a concentrated form of morphine. High doses can cause coma and death. Dependence develops quickly, and addicted individuals begin to undergo withdrawal 4­8 hours after the last dose. Symptoms include nausea, severe cramps, tremors, watery eyes, running nose, anxiety, chills, and convulsions.

Cocaine is derived from coca leaves. It is a powerful stimulant and raises blood pressure and speeds breathing and heart rate. Low doses increase alertness, talkativeness, feelings of power and energy, a decrease in appetite, and desire for sleep. Larger doses caused impaired judgment, insomnia, irritability, anxiety, psychotic episodes, and paranoia. Cocaine overdose can occur at low-dosage levels, triggering sudden heart attack, coma, and death. Withdrawal involves severe depression, strong drug ravings, stomach cramps, and exhaustion.

Marijuana comes from the hemp plant (Cannabis sativa). It raises the heart rate and lowers blood pressure. Its effects, which last 2­6 hours, include euphoria, heightened sensitivity, perceptual changes, and increased appetite. High or repeated doses can produce paranoia, panic, and reduced motivation. There is some suggestion that chronic marijuana use may irritate lung tissue, impair memory, and reduce immunity to disease. Among pregnant users, marijuana smoking is strongly correlated with higher levels of miscarriage, stillbirths, and low-weight babies, as well as with problems in nervous system development. Marijuana can cause psychological dependence and some tolerance. It is not addictive, but a withdrawal syndromeÑwhich includes irritability, depression, and insomniaÑis reported following abrupt cessation of use.

Lysergic acid diethylamide (LSD) is a synthetic drug that triggers perceptual and thought changes. Users report that colors seem brighter, shapes are distorted, and boundaries shift and dissolve. LSD increases blood pressure and body temperature, and accelerates heart and reflex rate. It can produce feelings of great insight as well as anxiety, depression, and acute panic. LSD is not addictive.

Phencyclidine (PCP) is a synthetic drug that was used as an anesthetic in veterinary medicine. It probably is the most unpredictable of the psychoactive drugs. Its effects include euphoria, numbness, reduced inhibitions, paranoia, hallucinations, and delusions. In high doses, it can cause convulsions, coma, and death. PCP's effects are intensified by alcohol and depressants, increasing the risk of overdose. Like LSD, PCP can cause "bad trips" that recur later through flashbacks.

For none of these descriptions are data provided. They are subjective reports. Thus it is hard to establish their exact meaning. They may not be inaccurate, but they may be misleading. Kaplan (1970) points out that the effects of playing tennis are a heightened pulse rate, facial flushing, sweating and marked adrenal activity. In many cases, there is a loss of breath followed by feelings of dizziness and nausea. In addition, there are reliable reports of death following the activity, especially among the middle aged who neglect exercise. Yet most physicians regard playing tennis to be a health benefit for most people.

Goldstein and Kalant (1990) have summarized the harmful medical effects of drugs (see Table 6, next 2 pages). These are: 1) Chronic toxicity from opiates includes disorders of pituitary hormone secretion and hypothalamic function, 2) Alcohol leads to liver damage, brain damage, and pancreatitis, 3) Cocaine can lead to paresthesias (strange tickling sensations of the skin), and 4) Nicotine excesses produce diseases of the circulatory system, peptic ulcers, and other problems. Amphetamines and cocaine on a regular dosage give paranoia and psychotic behavior.
 
 

¹Bronchitis, emphysema, precancerous changes, lung cancer, pulmonary hypertension, and cardiovascular damage by carbon monoxide are consequences of smoking tobacco or marijuana, not due to the respective psychoactive drugs. Inhalation of smoke by nonsmokers is also a significant hazard. With equivalent smoking, these chronic toxic effects occur sooner with marijuana than with tobacco.
 

All users of addictive drugs do not become addicts. For those that are addicted to cocaine and heroin, the maintenance dosage escalates with time. Moreover everyone does not show all of the symptoms. The percentage of respondents reporting problems with alcohol, marijuana, or cocaine use is given in Table 7. It can be seen from Table 7 that fewer than 10% of users report any given symptom, except for the 14.1% of cocaine users that reported nervousness and anxiety.

The number of hospital emergency department drug mentions per year are given in Figure 13. Drug mentions for all drugs went through minima in 1990 and have been rising each year since then. The number of total drug mentions rose from the minimum value in 1990 of 635,183 to 900,317 in 1994. Total drug episodes correspondingly rose from 371,208 to 518,521. For the 3 major illicit drugs, the corresponding rises of drug mentions were from 80,355 to 142,878 for cocaine, 33,884 to 64,013 for heroin/morphine, and 15,706 to 40,183 for marijuana/hashish. On a per 100,000 population basis, The number of mentions in 1994 was 62.0 for cocaine, 27.8 for heroin/morphine, and 17.5 for marijuana/hashish (Table 3.86 in Maguire and Pastore, 1996).
  Figure 13: Hospital Emergency Department Drug Mentions. Data from Table 5 of Drugs and Crime Data (1996).

 
a. Cocaine: Kleiman (1992, pp. 286­287) summarized the effects of cocaine. It is a powerful stimulant. It leads to increased productivity. However anhedonia (no pleasure at all) and anxiety can result from cocaine removal. At the end of a cocaine session, there can be depressed cognitive and sensory activity (the "crash"). Cocaine is also addictive.

A detailed discussion of the effects of cocaine was given by Grinspoon and Bakalar (1985). The most common problem for moderate users is rhinitis (Grinspoon and Bakalar, 1985, p. 134). Other problems include insomnia, irritability, anxiety, and weight loss (Grinspoon and Bakalar, 1985, p. 228)

In dogs the lethal dose was found to be (Grinspoon and Bakalar, 1985, p. 111) 20 mg per kg taken orally (about 1.4 grams for a 150-pound man) or 10­12 mg per kg given subcutaneously or intravenously (about 700­850 mg in a 150-pound man). The LD50 in mice is 31mg per kg when injected intravenously (Grinspoon and Bakalar, 1985, p. 114).

There are a number of medical uses of cocaine. These have been discussed by Grinspoon and Bakalar (1985, pp. 155­175). In particular it has often been used as an anesthetic.

b. Heroin: Grinspoon and Bakalar, 1985, p. 114) report the LD50 in mice is 57 mg per kg. Kleiman (1992, pp. 361­365) discusses what the heroin problem might be if heroin were legal. Heroin would be a cheap potent central nervous system depressant providing highly euphoric intoxication and sometimes an extremely pleasurable, though brief, onset: the "rush." The heroin users would become addicts with highly unpleasant withdrawal symptoms. Physically it is only moderately harmful. It is not life threatening. A user would have normal life expectancy, though the side effects are constipation and diminished sex drive for males. Heavy users could be unemployable because of incapacity or unwillingness to work. Many of them would be careless in their hygiene, leading to the concomitant problems of disease. The spread of AIDS and hepatitis B through sharing of needles would vanish, because there would be no need to share needles. Heroin is not criminogenic, so that crime associated with heroin use should nearly vanish.

Kleiman points out that heavy users of legal heroin would be much better off personally and much less of a problem to others than heavy users of illegal heroin, but much worse off personally and more of a problem socially than moderate users or non-users. The question is how many heavy users would there be, and how many fewer (or more) chronic users. Undoubtedly, the number of heroin addicts would increase, but the spread of disease, the cost of user crime, black-market crime, neighborhood disruption from open dealing, and the expenditure of law-enforcement resources that could be used to suppress predatory crime would decrease.

In sum, the current policy of illegal heroin is to punish the ill (heroin users) and harm the innocent (the victims of heroin crime) for the benefit of reducing the number of ill. From a financial viewpoint, this would be justified if the reduction in the number of ill is sufficient to pay the costs encumbered. However from the philosophical viewpoint of a lawful society, it would seem to be an unacceptable trade.

c. Marijuana: Over the years, a number of official government reports have been issued giving the medical effects of marijuana. Apparently the first of these was the Indian Hemp Drugs Commission Report of 1894. Its findings have been summarized by Mikuriya (1968). The Commission concluded that there was no connection between hemp drugs and disease, physical or mental. It did conclude that occasional moderate use of hemp may be beneficial. The Commission further concluded that for all practical purposes, there is no connection between the use of hemp drugs and crime.

The more recent reports through 1970 have been described by Brecher et. al. (1972, pp. 451­454). These reports include The Panama Canal Military Investigations (1916­1929), The La Guardia Committee Report (1944) conducted by the New York Academy of Medicine, The Baroness Wootton Report (1968) conducted by the United Kingdom Home Office, The Interim Report of the Canadian Government's LeDain Commission (1970) conducted by the Ministry of National Health and Welfare of Canada. These reports, as well as five books published in 1970­1971 (The Marijuana Smokers by Erich Goode, Marijuana Reconsidered by Lester Grinspoon, Marijuana: The New Prohibition by John Kaplan, The Strange Case of Pot by Michael Schofield, and the New Social DrugÑCultural, Medical, and Legal Perspectives on Marijuana by David E. Smith) all came to the same conclusionÑmarijuana is a relatively harmless drug.

From 1916 to 1929 in the Panama Canal zone, the U. S. Army conducted a medical investigation of marijuana that it reported in The Military Surgeon in 1933 (Brecher et. al., 1972, p 451). The army found that it was "not possible to demonstrate any evidence of mental or physical deterioration in the users" (Grinspoon, p. 152).

In 1970, the Canadian government's Le Dain Commission published a report suggesting that marijuana is a relatively harmless drug. According to the commission, the short-term physiological effects of smoking marijuana are "slight" and have "little clinical significance."

In testimony before a Congressional Committee in 1979, Dr. William Pollin, Director of the National Institute of Drugs and Alcohol (NIDA), stated (see Vallance, 1993, p. 87):

Dr. Pollin concluded: "Any attempt to compare the health impact of marijuana with that of alcohol and tobacco at current levels of use is certain to minimize the hazards of marijuana."

The privately funded, Washington-based Drug Abuse Council, in 1980 issued a 291-page report titled "The Facts about Drug Abuse." It concluded that "marijuana use in moderate amounts over a short term poses far less of a threat to an individual's health than does indiscriminate use of alcohol and tobacco."

The above reports also have been summarized by Trebach and Zeese (1990, pp. 34­38). In addition they summarize the more recent reports of the National Commission on Marijuana and Drug Abuse (1973), the 1982 report of the National Academy of Sciences, and the 1988 and 1989 reports of the Advisory Council on the Misuse of Drugs. The findings of these later reports were consistent with the findings of the earlier reports.

The above and other evidence led the DEA's own administrative law judge Francis L. Young to conclude in 1988 that marijuana is among the safest therapeutic substances known and is less hazardous than many common foods (Randall, 1989, p. 440).

According to Duke and Gross (1993, p. 48) marijuana is non-addictive and causes no permanent psychological effects. While under the influence of marijuana, there is a reduced motivation to work or study. The same can be said for a heavy meal. After the effects of marijuana have passed (about one hour), there is no long-term effect on work or school performance.

Grinspoon and Bakalar (1993, p. 152) report that "Marijuana smoke burdens the lungs with three times more tars (insoluble particulates) and five times more carbon monoxide than tobacco smoke. The respiratory system also retains more of the tars, because marijuana smoke is inhaled more deeply and held in the lungs longer. On the other hand, even the heaviest marijuana smokers rarely use as much as an average tobacco smoker. So far not a single case of lung cancer, emphysema, or other significant pulmonary pathology attributable to cannabis use has been reported in this country."

Grinspoon and Bakalar (1993, pp. 146­151) summarized the long-term effects of marijuana for people that had smoked up to 10 marijuana cigarettes per day for long periods (such as glaucoma patients). They concluded that:

1. There is no evidence that marijuana is more likely than alcohol or nicotine to lead to use of narcotics.

2. Marijuana smoke does not stimulate sexual desire or sexual power.

3. Several studies support the conclusion that marijuana will not by itself lead to any disease or mental or moral damage.

4. Usually there are no withdrawal symptoms from discontinuing the use of marijuana.
 

Nevertheless, Marshall (1988, pp. 62­63) has pointed out that marijuana has a half-life of 50 hours in the body. (By contrast, cocaine has a half-life of slightly more than 1 hour.) Thus regular users of marijuana may be continuously exposed to delta­9­tetrahydrocannabinol (THC). Intoxication with marijuana blunts reflexes and makes the user clumsy. Impact on performance can last 8 hours.

Not only is marijuana not harmful, it has some beneficial effects. Goode (1984, PP. 99­100) interviewed 200 marijuana smokers and asked them to describe the effects of marijuana. The most common response (46%) was that marijuana made them more relaxed, peaceful, calmer. The next most common response (36%) was that it made them more sensitive or perceptive. Other effects mentioned by more than 20% of respondents was thinking deeper and more profoundly, a sense of merriment or easy amusement, slowing down or stretching out of time, introversion, feeling happy or pleasant, mind wandering or free association. According to Brecher et. al., (1972, p. 457), the Le Jain Commission notes that the positive reasons given for marijuana use include that it is a relaxant, it is disinhibiting, it increases self-confidence and the feeling of creativity, it increases sensual awareness and appreciation, it facilitates concentration and gives one a greater sense of control over time, it facilitates self-acceptance and in this way makes it easier to accept others.

According to Duke and Gross (1993), the marijuana experience is almost uniformly described as being pleasant and relaxing. Marijuana as a trigger to violence seems never to have been reported by any user or researcher. The relationship is in the other direction. Marijuana is anti-criminogenic.

It should be pointed out that the majority of those that have tried marijuana find the experience unpleasant and discontinue its use (Duke and Gross, 1993). In some it induces paranoia and/or hallucinations. These people discontinue use.

Grinspoon and Bakalar (1993) have pointed out the important medical uses of marijuana. Thus it is a useful medicine. It relieves nausea induced by AIDS and chemotherapy. It relieves the pressure causing glaucoma, and can reverse the effects of that disease. Taken with other drugs, 2­5 joints per day of marijuana can prevent epileptic seizures. Multiple sclerosis can be reversed by 4­6 joints per day of marijuana. It can control muscle spasms and pain and return sexual potency to paraplegics and quadriplegics. Five to ten milligrams of THC can reduce chronic pain where other pain killers fail. It also prevents migraine headaches and can cure atopic neurodermatitis.

Some states have passed laws permitting the medical use of marijuana if prescribed by a medical doctor. However U. S. federal law takes supremacy, and the medically prescribed use of marijuana still is criminal, even in those states that permit its use (Duke and Gross, 1993, pp. 182­183). On September 6, 1988, Francis L. Young, Chief Administrative Law Judge of the Drug Enforcement Administration, wrote (Randall, 1989, p.445): "The evidence in this record clearly shows that marijuana has been accepted as being capable of relieving the distress of great numbers of very ill people, and doing so with safety under medical supervision. It would be unreasoning, arbitrary, and capricious for the DEA to continue to stand between those sufferers and the benefits of this substance in light of the evidence." Nevertheless, Young's recommendations were rejected by John Lawn, the Administrator of the Drug Enforcement Agency, on the grounds that there have been no extensive large-scale controlled studies to demonstrate the effectiveness of marijuana (Trebach and Zeese, 1990, pp. 97­103). Of course, it is criminal to conduct such investigations.
 

3. Alcohol Morbidity

Nadelmann (1989) has pointed out that alcohol is consumed by 140 million Americans and tobacco by 50 million. In 1986 alcohol was identified as a contributing factor in 10% of work-related injuries, 40% of suicide attempts, and about 40% of the approximately 46,000 annual traffic deaths in 1983. An estimated 18 million Americans are reported to be either alcoholics or alcohol abusers. Estimates of the number of deaths linked directly and indirectly to alcohol use vary from 50,000 to 200,000 per year. In the U. S. an estimated 320,000 people die each year as a result of tobacco use. In comparison the National Council on Alcoholism reported that 3,562 people were known to have died in 1985 from the use of all illegal drugs combined.

The benefits and harm caused by alcohol have been summarized by Kleiman (1992, pp. 206­207). It produces a sense of relaxation and well being that helps social intercourse. A drink a day reduces the likelihood of a heart attack. On the negative side, it is a carcinogen, or at least a co-carcinogen at the doses used by many imbibers. It causes cirrhosis of the liver, leading to many deaths each year. It is criminogenic in that its relaxant effect induces irresponsibility and violence such as drunk driving, domestic violence, child abuse, and suicide. Accidents are caused by the use of alcohol before or during work and by the use of alcohol with other drugs. Alcohol also plays a role in teenage sexual activity and unwanted pregnancies. It has an adverse effect on fetal development.

Meier (1994, PP. 196­198) analyzed the data and concluded that there was a strong correlation between alcohol consumption and cirrhosis of the liver, traffic fatalities, and suicide. Alcohol consumption is correlated with all violent crime, with robbery, and with burglary, but Meier found no correlation with assault. This does not mean that a person under the influence of alcohol is not more likely to commit assault, only that gross per capita consumption is not related to assault. Presumably some people drink rather than committing assault.

Meier (1994, p. 209­210) also reports that estimates for the number of Americans with drinking problems range from 5.75 million to 18 million. More than 1.4 million per year are treated for alcohol abuse and dependence. In a 1988 report, the National Highway Traffic Safety Administration concluded that 52% of traffic fatalities in 1986 involved alcohol. Alcohol is also implicated in 50% of accidental deaths from falls, approximately 50% of fire deaths, and 38% of drownings. Owing to accidents and greater health risks, the mortality rate for persons with alcohol problems is 2­6 times higher than the average for all persons. In addition alcohol is responsible for lost productivity from excessive absenteeism and accidents, increased health care expenditures (1.1 million hospital admissions per year), and increased burdens on the criminal justice system. The National Council on Alcoholism estimates that the alcohol problems cost American society about 3.87% of the gross national product.

Health After 50 (1997) reports that up to 2 drinks per day for men increases life expectancy by reducing heart attacks and strokes caused by arterial blockage. For men over 65 and for all women, less than 1 drink per day is recommended. A drink is defined as 12 ounces of beer, 4 ounces of wine, or 1.5 ounces of 80-proof distilled spirits.
 

4. Tobacco Morbidity

Since the Surgeon General's report (Terry, 1964) that first documented the adverse medical effects of nicotine, there have been numerous studies that show the harmful effects of tobacco, both to the user and those exposed to tobacco smoke. It is not necessary to summarize all of those studies here. Our main concern will be with the effect of tobacco on non-users exposed to secondary tobacco smoke. Results from a few of the most recent studies are given below.

Law and Hackshaw (1996) report that for a non-smoker living with a smoker, the exposure to environmental tobacco smoke (ETS) is equivalent to about 1% of that from actively smoking 20 cigarettes/day based on plasma cotinine. It is estimated that there is an increase in lung cancer risk of 24% compared to unexposed non-smokers. Several hundred lung cancer deaths/year in Britain are attributable to ETS exposure. Passive smoking is associated with an increase in risk of chronic respiratory disease in adults of 25% and increases the risk of acute respiratory disease in children by 50­100%.

Mannino et. al. (1996) report the results of the 1991 National Health Interview Survey. People exposed to ETS in the home both daily and less than daily were more likely to have had ?1 day of restricted activity, bed confinement, and work absence in the 2 weeks prior to the survey than people without reported ETS exposure, after adjusting for confounders.

Steenland et. al. (1996) report that after correcting for many cardiovascular risk factors, there was 22% higher coronary heart disease (CHD) mortality among never-smoking married men married to currently smoking wives compared to those married to wives that had never smoked. The corresponding increase for women was 10%. Those that never had smoked living with former smokers showed no increased risk.

According to Kleiman (1992, p. 317), nicotine is not an intoxicant, a behavioral risk, or criminogenic. However it is addictive and toxic, affecting the heart and lung. In addition tobacco smoke is a health hazard to second parties. Tobacco smoke also has an unpleasant odor to many bystanders. Finally smoking causes fires.
 

5. Summary

Tobacco is a major cause of coronary artery disease, peripheral vascular disease, cerebrovascular disease, lung, laryngeal, oral, esophageal, bladder, pancreatic, and kidney cancers, and of chronic obstructive pulmonary disease (Husak, 1992, p. 97). Husak goes on to report that alcohol has been linked to about 75 different human diseases and conditions. However there is no present evidence that cocaine use is a risk factor in any major physical diseases. Heroin causes relatively little physical harm to the human body. Finally there is little evidence that the occasional smoking of marijuana inflicts much harm on the consumer. One study (Shedlar and Block, 1990) concluded that humans that used moderate quantities of recreational drugs as adolescents are better adjusted than either abstainers or frequent users. However it should not be concluded that drug use was responsible for them being better adjusted.

D. Criminogenic Effects

There is a popular perception that drug use leads to a life of crime. Actually the reverse is true. For criminal addicts, almost always, their criminal careers preceded their use of drugs (Inciardi et. al., 1996, p. 9). However drugs do prolong a criminal career (Inciardi et, al., 1996, p. 39).

Harrison and Gfroerer (1992) report that there is no research indicating that cannabis or alcohol use lead to crime for economic gain. There is some evidence that opiate, and perhaps cocaine, use does lead to crime for economic gain. Narcotic addicts greatly increase their level of criminal offending during periods of elevated narcotic use. Income from property crime escalates with increasing narcotic use. Non-property crime does not covary with levels of narcotic use, suggesting that the relationship between narcotic use and crime is attributable to economic motivations.

According to Duke and Gross (1993, p. 108) heroin disinclines the user to engage in violence. Heroin addicts rarely commit murder, and, apart from prostitution, virtually never commit sex crimes. However they do engage in the theft of money and property as a way of life. The average heroin addict uses more than $10,000 worth of heroin per year (Kleiman, 1992, p. 370).

Nurco et. al. (1991, p. 223) report that on average a heroin abuser commits between 300 and 400 crimes per year. Drug sales and distribution comprised 65% of all the crimes reported. In one study in Miami, it was found that the crimes committed by heroin abusers were: shoplifting, 11.6%; other larceny and fraud, 20.9%; robberies and assaults, 2.8%; and burglaries, 3.1%. Presumably the other 61.6% of crimes were related to drug sales and distribution. There were 64,013 emergency hospital mentions for heroin/morphine in 1994 (Drugs and Crime Data, 1996). It is likely that almost all of these were heroin/morphine abusers. If so, they accounted for about 22.2 million crimes in 1994, of which about 7.8 million were property crimes and 627 thousand were violent crimes (robberies and assaults). Presumably, if heroin/morphine had been available legally to these abusers, most of these crimes would have not been committed. The property crime rate alone would have been reduced by up to 64%, since the number of property crimes was about 12.2 million in the United States in 1994 (Maguire and Pastore, 1996, p.324). Likewise, the violent crime rate would have been reduced by up to 33%, since the number of violent crimes was about 1.88 million in the United States in 1994 (Maguire and Pastore, 1996, p.324).

Falco (1992, p. 4) states that "unlike heroin or marijuana, crack makes users aggressive, violent, and paranoid." Nurco et. al. (1991, p 227) report that in one study of approximately 1500 adolescents, the subjects reporting cocaine use, who represented only 1.3% of the sample, accounted for 40% of all serious crimes committed.

However alcohol users, especially when alcohol use is coupled with drug use, are more likely to commit crimes. Harrison and Gfroerer's (1992) summary of the provisional data for 1991 is shown in Table 8.

Clearly those that abstain from alcohol use commit the lowest percentage of crimes. Alcohol use increases the likelihood of criminal activity. Alcohol coupled with either cannabis or cocaine increases the likelihood even further, with cocaine being more criminogenic than cannabis. Unfortunately the data do not contain statistics for those that use drugs, but not alcohol.

It is often stated that drug use leads to criminal activity. However the data do not corroborate this belief. Usually criminal activity precedes illegal drug use for criminals. The data have been collected by Inciardi (Trebach and Inciardi, 1993, p. 186) and are given in Table 9. Alcohol use usually does precede criminal activity, but illegal drug use comes afterward. While drug use follows criminality, once it starts, criminal activity increases in both frequency and seriousness, because the criminal drug user has to feed his habit.
 

Motor Vehicle Accidents: It is interesting to see what effect drugs have on driving accidents. The percent of driving accidents by high-school seniors involving drug use is shown in Figure 14. The data show that the percent of driving accidents involving alcohol for high-school seniors has decreased steadily since 1983. For marijuana/hashish, the percent decreased from 1983 to 1992 where it reached a minimum value of 1.8% before rising again in the later 1990s. Likewise for other illicit drugs a minimum of 0.6% was reached in 1990.

In order to see what effect the drug might have had on the accident rate, we need to know the frequency of use while driving. In order to obtain this quantity, we must do some calculations.

Let:               N_y = number of seniors in year y

Then:            N_y * f_dy * p_dy = C_dy = f_dy' * C_y

For the ratio of two drugs:

(f_1y * p_1y)/(f_2y * p_2y) = f_1y'/ f_2y'

p_1y/p_2y = (f_1y'/f_2y')/(f_1y/f_2y)
 

  Figure 14: Percent of Driving Accidents by High-School seniors Involving drug Use. From Table 3.57 of Maguire and Pastore (1996). Other illicit drugs include inhalants, hallucinogens, heroin, cocaine, other opiates, stimulants, sedatives, tranquilizers, steroids.

The relative liklihoods of a high-school senior drug user having an accident while using drugs are shown in Figure 15 for marijuana/hashish and other illicit drugs compared to alcohol. For marijuana/hashish the relative likelihood compared to alcohol rose from about 1.0 in 1984 to about 1.2 in the mid 1990s. For other illicit drugs compared to alcohol, the corresponding rise is from about 0.3 to about 0.5. In principal, it is expected that the ratio should remain constant with time. The fact that it does not suggests that driving under the influence of drugs is decreasing faster among alcohol users than among users of other drugs as time marches on.

The data in Figure 15 suggest that marijuana/hashish currently has about a 20% higher effect on driving accidents than does alcohol. It is not surprising that marijuana/hashish acts like alcohol, since both are depressants. On the other hand, the effect of other illicit drugs on driving accidents is considerably less than for alcohol. In fact there may be no effect at all, since even non-drug users have accidents. Again, the conclusion is not surprising, since the majority of other illicit drug use is with non-depressants.

  Figure 15: Relative Likelihood of a High-School Senior having an Accident while using Drugs. Other illicit drugs include inhalants, hallucinogens, heroin, cocaine, other opiates, stimulants, sedatives, tranquilizers, and steroids.

The above conclusion that marijuana may be implicated in automobile accidents is corroborated by the finding reported by Grinspoon and Bakalar (1993, p. 140) that marijuana leads to attention loss and forgetfulness that may temporarily impair motor skills. In one study 34% of trauma patients from all (not just auto) accidents had used alcohol and 35% had used THC.

E. Criminal Sanctions

1. Arrests

Alcohol: Figure 16 shows the arrest rate for alcohol-related offenses. The arrest rate increased through the 1970s and reached a peak of over 3.7 million per year in the 1981­1983 time period. There has been a slow decrease since then, because of increased education and the raising of the legal drinking age from 18­21 years in many states. In 1994, the arrest rate had dropped to 2.7 million per year. Those arrests that involved driving under the influence of alcohol followed a similar trend. The maximum of 1.5 million per year was reached in 1983. By 1994, it had fallen to 1.1 million per year.   Figure 16: Arrests for Alcohol Related Offenses. Data from Table 4.28 of Maguire and Pastore (1996). Alcohol-related offenses include driving under the influence (DUI), liquor law violations, drunkenness, disorderly conduct, and vagrancy.

Per capita arrest rates for alcohol-related problems are given in Figure 17. For liquor law violations, there has been a marked increase in the arrest rate from 69 to 285 per year per 100,000 persons from 1950 to 1990. This has been accompanied by a steady and dramatic drop in the arrest rate for drunkenness, disorderly conduct, and vagrancy.

  Figure 17: Arrest Rates for Alcohol Related Problems. From Meier, 1994, p. 165

Illicit Drugs: The number of arrests for drug violations reported by state and local police between 1984 and 1993 is given in Table 10 (Timrots, 1995d). In 1994, the total number of arrests was 1,351,400 (Maguire and Pastore, 1996). The arrest rate has increased steadily from 1984 to 1989 for both the sale/manufacture and possession of drugs. During 1990­1993, it remained nearly constant at about 75% of the 1989 value.