Comments on The Report of the California Research Advisory Panel

See also: The Report of the Research Advisory Panel

The Drug Policy Foundation's

LEGISLATIVE FORUM ON DRUG POLICY

State Capitol, January 27, 1992

FREDERICK H. MEYERS, M.D.

Professor of Pharmacology, University of California, San Francisco, CA

Note from Cliff Schaffer: This was sent to me personally by Dr. Meyers, with a few of his own hand written notes. He was the head of the Research Advisory Panel for the State of California and states that this speech paraphrases the conclusions of the Research Advisory Panel.

The premise of this meeting--- that the legislature must at this time accept the suggestions of the nominal experts in problems of drug abuse here assembled and begin the decriminalization of drug use-- appears at first glance to be presumptuous. It is not, however, if one considers our deteriorating social and economic state and the forbidding prospect of the adjustments that must be made by the legislature at this session.

I think that no area of informed, disinterested thinking will challenge the conclusion that whatever we have attempted by legislation to regulate the use of the emotionally loaded street drugs --- that is, excluding the laudable alcohol---has been palpably damaging. The prohibition or legal approach has not been merely ineffective but that approach, rather than the effects of the drugs themselves, is responsible for the individual and societal damage that so appropriately concerns us. Heroin, indeed the non-medical use of narcotics in general, cannot be inherently too dangerous or harmful or the legislature would not have mandated the provision of methadone, a pharmacologically equivalent narcotic, to some of our heroin habituated citizens.

It is, then, the reaction of society to the use of certain drugs rather than the drug effects themselves that cause the problems and damage that concern us.

I react to these problems as I see them in individual patients and am most concerned about the damage imposed on the individual by social drug use less dangerous to society than the use of alcohol and by compulsive drug use that is not that different from cigarette smoking. The physical damage and consequent cost to society in medical care is much less with heroin, but, cigarettes being legal and relatively inexpensive, the smoker is not subject to the risk of prosecution or of being driven to criminal activity.

A California legislator in 1992 would, I should think, be more interested in the expense involved to the state and recognize an area where budgetary relief can be achieved with a social and humanitarian gain rather than the curtailment of a program of some value. The financial burden at each governmental level of enforcing laws whose violation cannot be managed by ordinary police tactics is significant. Even greater is the expense and disorganization imposed by the associated criminal activity on police, jail, court, prison, probation and parole activities.

Now in deciding whether to accept my thesis, be influenced by your own observations and common sense, which will establish the clinching argument: all of the enforcement activity of the past fifty years has been wasted in that the use of more and more varied drugs has grown progressively to its present level.

Before discussing what changes should be made and in what order, I will acknowledge and meet the fear of legislators that a show of rationality will be interpreted as being "soft on drugs". This idea will be imposed, and the conclusions presented here today will be challenged only by agents of what I call the enforcement industry. (Or at least the administrators of those agencies. I have not recently met an agent or investigator working at the street level who thinks that the war on drugs has been or can be won, and I do work with peace officers.)

Workers in the enforcement area are given to protecting a special position within police work. They are not disinterested informants just as I am not a disinterested informant in matters of pay and privilege for U.C. professors. They have great influence on those citizens who depend on the daily media, press or TV, or who confuse TV dramas with reality. The daily press is not required to be accurate or comprehensive or to provide follow-up; it is required only to report more or less accurately whatever information, misleading or otherwise, is provided by an informant who may not even be identified. Thus we have had a long series of largest ever seizures, biggest dealer ever, etc, but it is street level users who resorted to crime to "maintain" who congest our system of criminal justice, and we see no relief in the face of more and more money for enforcement.

I insist that if you examine more deliberate, quality journalism from as liberal as one dares to be today, for example, The Nation , across the spectrum to Buckley's conservative journal; if you examine the technical literature of medicine, sociology and even economics and if you note the names and positions of people supportive of organizations such as the Drug Policy Foundation, you will agree with my statement above that no area of informed, disinterested thought disagrees with the conclusions of this meeting. Their agreement is often expressed in terms of legalization of drugs, but, except for radicals like Buckley and Greenspan, decriminalization is meant.

The time for academic discussion has passed. Now it is time to think tactically, no longer asking if the drug laws should be changed to achieve decriminalization but looking at what changes should be made and in what order.

My discussion from here on, that is, the changes and tactics suggested to the legislature, is almost entirely quotes or paraphrases from a report to the legislature by the Research Advisory Panel. I do not appear as a representative of that group, but I see no reason why I should not exploit the competence and effort reflected in the report.

The panel first established three prior cautions or bases for deriving the changes:

1. Differentiate different drugs and different routes of administration. Do not discuss the drug problem.

2. Separate drug effects from associated criminal activity.

3. Consider the risk/benefit ratio for any change. The goal is to reduce the damage

done by a drug without significant increase in its use. No unregulated (legalized) drug nor any industry comparable to cigarette or alcohol industry proselytizing for drug use.

The panel then suggests a stepwise approach by the legislature. The three changes suggested for the first year would demonstrate that change could be safely accomplished and prepare the public for more comprehensive revisions.

The suggested legislative changes are:

Allow Cultivation of Marihuana for Personal Use

Insofar as damage to the individual and society is concerned, the quantitatively most important drugs are alcohol and nicotine in the form of cigarettes. There remains, then, as the other quantitatively important drug, marijuana, which has become, for a large fraction of the population, a social drug comparable to alcohol in pattern of use and approaching alcohol in extent of usage.

Marijuana is a disinhibiting drug used socially to relieve anxiety and as such has many liabilities in common with alcohol. I acknowledge that marijuana is not without its effect on the individual user and would not suggest any change that carried the risk of a great increase in the use of marijuana. I resist the use of the word "legalization" in relation to any drug, including marijuana. On the other hand, an objective consideration of marijuana shows that it is responsible for far less damage to the individual and to society than are alcohol and cigarettes. A further consideration in forming a reaction to the wide use of marijuana is that is a source of conflict between generations and of disrespect for the law. The huge cost of attempting to enforce these disrespected laws and to punish their infraction by people who do not feel guilty is, in my opinion, entirely wasteful and damaging and the monies should be applied in areas of greater need.

Also important is the economic and, to some extent, criminal activity associated with the marketplace of marijuana. At the moment, we are adding millions to our trade deficit, off of the books to be sure, by our purchases of marijuana in Colombia, Mexico, Thailand, and elsewhere. Yet, thanks to a previous action of the California Legislature, the product of this illegal activity may be possessed and used by the citizen with the possibility of only minor sanctions. This change has not lead to any disastrous consequences. On the contrary, it has reduced the tension between generations and decriminalized to some extent the generally sanctioned use of this new social drug by large numbers of people.

This new situation, for which we applaud the Legislature, is however, not stable, in the sense that the failure to act in relation to the supply of the drug leaves unmet the question of the still illegal market and the economic problem that that entails. If this disparity could be resolved there would be economic gain and a great simplification of law enforcement which now devotes a considerable effort to seizing a small fraction of the illegal importations or cultivations.

I therefore suggest that the law be changed to permit cultivation for personal use. Such cultivation would be permitted only on property serving as the residence for the individual, this is, it would not authorize the cultivation of fifty plants on a National forest and it would not permit the possession outside of the home of more than the present one ounce, nor would it sanction the provision to others in or out of the residence whether by sale or in the form "parties".

Any change regulating the provision of this drug must be made in such a way that we do not see the development of another industry comparable to the alcohol or cigarette industry. Permitting the restricted cultivation would avoid that evil but achieve an of the gains promised above.

There are people, including I am sure some legislators, who, out of genuine concern rather than mere timidity, will wonder whether such a change, however, warranted by social and economic gains, would not also result in increased use. I do not dismiss this justifiable concern out of hand. the Panel insisted, and I agree, that no attitude of approval of marijuana, or alcohol, or tobacco be projected. I would be a prohibitionist if prohibition would work. To the extent that prohibition creates a marketplace or social conflict, we suggest more flexible, practical, and humane policies. It does ,however, appear that the supply and experience with marihuana is such that a

plateau has been reached and that usage over foreseeable circumstances will remain about at its present level, as is the case with alcohol.

Remove Penalties for Possession of Needles and Syringes

The statement that heroin is inherently not a dangerous drug has been weakened by the appearance in the community of the AIDS virus. This virus is transmitted, among other ways, by the use by one persons of paraphernalia for injection contaminated with the blood of an infected person. The AIDS virus has already spread through the, drug-using community to an extent that varies with the sanitary practices of the local population. The prevalence of infection is much higher, for example, in New York City than in San Francisco and lower throughout the balance of California than in San Francisco. There is thus some urgency and advantage in instituting control methods.

There are two suggested methods of controlling the spread of this relatively new virus. The first, demonstrably ineffective, is to adopt a moralizing attitude, continue our current practices and simple add the individual tragedy and economic burden to the community of more AIDS patients. Such an attitude is consistent with the feeling that heroin users (and gays and psychotics) are better dead and is genocidal.

The other method of controlling the spread of the AIDS virus would be to encourage sanitary practices at the time of injection by making it possible for each heroin user to use his own "outfit", that is, syringe and needle, rather than accept the risk of using one contaminated with another addict's blood. This would become permissible as well as possible if the intravenous (IV) drug user were permitted to legally possess his own syringe and needle.

Heroin users understandably try to avoid carrying supplies of their drug and their injecting paraphernalia any more than is absolutely necessary since the mere possession of the substance and the equipment is a punishable crime. The possession of paraphernalia is defined as a misdemeanor. The availability of the charge becomes a convenient mean of harassing the addict and of subjecting him, in effect, to a three-day jail sentence without trial. A person with a prior drug related conviction must be especially careful since, in such a situation, even the possession of an ordinary spoon can be construed, according to the statute, as possession of paraphernalia. As a result, users are reluctant to carry their own outfits and, their compulsion being upon them, are quite likely to use whatever equipment is available at the site of drug purchase. People driven by the compulsion that the heroin user feels, and given their choice between using someone else's outfit and being without their drug will use the possibly contaminated equipment. Laudable as the "needle" exchange programs are and admirable as I find their practitioners, they (and the impending legislative respond) are inadequate. The situation is too urgent for an "experimental" program in one city and statutory change is the definitive change needed to permit education in

proper practices by the junkie.

Prohibit (legal or illegal) Drug Use in Special State Establishments

At the same time that we carry out what will be seen as a liberalization of some drug regulations we should demonstrate that our ultimate goal is the reduction of all drug use. The effectiveness of education in reducing drug abuse is obviously disappointing. Not even the success in controlling cigarette smoking extends to the youthful population. However, it is from the successful imposition and acceptance of restrictions on smoking by the adult population that we must learn. Drug education efforts have focused largely on the populations that we consider to be deviant and at risk, that is, young people and minority groups. Our efforts to limit the use of quantitatively important drugs should act to influence the entire population so that an unambiguous attitude of disapproval is projected.

The amazing progress in dissuading people from the use of tobacco, suggests additional action in relation to alcohol, already a regulated drug. That prohibition is not feasible has certainly been adequately demonstrated, but restricted use of alcohol in inappropriate places is justifiable and would be an essential step in projecting the attitudinal change desired.

The Panel applauds the establishment of tobacco free areas in State institutions. As a condition of their funding the Legislature should now insist that certain agencies within the State system not sell or provide alcoholic beverages within the confines of their campus or building. This should be immediately applied to any medical center campus or hospital. Doctors and other care-givers have a generally favored status and acquire with that a special responsibility to project an attitude of disapproval about the use of any disabling drug while they are accepting responsibility for a dependent patient. Certainly the State acquires a liability in providing alcohol to individuals who are then going to drive or see patients. More importantly, such use then projects an attitude totally at odds with that which we claim throughout our discussions as desirable.

Similarly, it is impossible to rationalize the use of a depressant drug, clearly shown to impair performance after small doses, on a University or State University campus dedicated to intellectual activity.

Conclusion

These changes are minor indeed. However, they would achieve some real progress and, equally important, would demonstrate to the alarmed citizenry that constructive change is possible and permit a freer discussion next year. I hope that the Legislature senses the urgency in the situation in our state. I close by threatening you with the aphorism of Francis Bacon of 400 hundred years ago, "He that will not apply new remedies must accept new evils; for time is the great innovator."