TWENTIETH ANNUAL REPORT OF THE RESEARCH ADVISORY PANEL 1989 [part 2]

There are people who will express concern about whether such a change, however warranted by social and economic gains, would not also result in increased use. These justifiable concerns must not be dismissed out of hand. The Panel insists that no attitude of approval of marijuana, or alcohol, or tobacco be projected. In fact, as we have said above, we all remain prohibitionists to the extent that prohibition will work. To the extent that prohibition creates a marketplace or social conflict, we suggest more flexible, practical, and humane policies. It appears that the use of marijuana has reached a plateau at this time, and that usage over foreseeable circumstances will remain about at its present level, as is the case with alcohol.

From the point of view of the younger members of the population, the problem becomes-a matter of consistency which we should answer by saying marijuana is "just as bad as alcohol", rather than as the defenders of marijuana would probably say, "it's no worse than alcohol".

The resulting conflict between the proposed change in California Law and existing Federal law is apparent, but the liberalization of State regulations would result in decreased enforcement activity at the State level, and Federal enforcement activity is directed primarily at a level above the activity we are presently discussing. The success of a trial of this sort would provide leadership to other states and nationally. It would have no immediate effect on problems related to other more emotionally-laden drugs, except as it demonstrates the need to consider these problems separately and one-by-one with an awareness of risk/benefit ratios.

REDUCING THE USE OF DRUGS

The present status or effectiveness of education aiming at drug abuse prevention is obviously disappointing. The amount and variety of drugs with which younger people are experimenting and subsequently using have increased to its present level during the very period when this State had a required kindergarten through 12th-grade anti-drug use curriculum in place. National efforts, in or out of the formal school situation, have been equally 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 important lessons about which target population to focus on and about which arguments work and which do not. The successful campaign against smoking did not focus entirely on the user but engaged most of the population in making an aesthetic and personal responsibility issue out of smoking.

The abstract advertisements about cancer and other deadly issues were ineffective compared to the demonstration provided by intelligent community leaders and, laudably, doctors who publicly gave up tobacco and made an issue of passive smoking. In drug education we have focused on physical damage, which is not important to a young risk-taker. And we have focused on the population that we consider to be at-risk, that is, young people and some minority groups. The target population should be the total population and should examine the use of all drugs, including or even especially, the nominally legal alcohol, tobacco and prescription drugs.

In efforts to limit the use of quantitatively important drugs, we should act to influence the entire population so that an unambiguous attitude of disapproval is projected. Even those of us who continue to drink or smoke should be willing to do so without claiming that our practices are anything but bad. For a parent to decide that his children will never see him drink and that he will not keep alcohol in the home, even though he may drink socially elsewhere, is not hypocritical, but exemplary.

A major effort in changing the attitudinal climate will eventually have an effect on potential new users or judging from the experience with cigarettes, shorten the duration of their habit.

However, efforts at drug abuse prevention or limitation must be multiple in that populations exposed to hard drugs present separate problems. Certain populations, notably those in urban ghettos, have greater contact with smoked cocaine and injected heroin, drugs which by those routes of administration are highly addictive, that is, highly likely to be used compulsively. About these "hard drugs", there are two preliminary points:

1) Drug education among these high-risk populations proceeds at the level of individual experience and independently of our efforts. The loss of control in using certain drugs becomes recognized, and most people in these populations then resist their use. That is, some drugs do get a bad name. As a result, epidemics of such use are self-limiting to some extent, and, after these epidemics (of which we have now seen four: two heroin, one high-dose IV-speed and one smoked-cocaine as crack), we see a residual number of users who have not matured out of their habit.

2) The spread of the habit from these established users to now recruits can be best understood by the infectious disease model mentioned above, and accounts for the relatively small number of new users after the initial period of high use. The number of people involved with these "hard" drugs is small compared to the numbers using the social drugs discussed above, and the problems, however destructive and however exaggerated in extent, are geographically limited and are typically associated with non-pharmacologic problems.

For the general public, effective drug education would consist of neutralizing advertisements (however disguised) that glamourize and proselytize for drug use. Instead, an aura of general disapproval of all drugs, including the common socially used drugs should be established.

SUGGESTED ACTIONS

Prohibit (legal) drug use in special State establishments We have recently seen amazing progress in dissuading people from the use of tobacco. We will below suggest additional action in relation to alcohol, already a regulated drug, with at least some discipline applied. Overall, prohibition is not feasible 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. The individual instructors, that is, teachers at all levels, should probably feel an obligation to neither drink nor smoke in public, but this is not a matter for legislation.

Counter ads. In addition to the emphasis on role modeling implied by the suggestion immediately above, there is an obvious need for counter promotion to offset the various advertising techniques that subtly, or explicitly, imply sexual or other social rewards for the use of products. The experience with cigarette advertising would suggest that counter ads placed immediately after the offending ad and providing an alternate view of the problem were more effective than current isolated, however cute, anti-drug ads. To what extent this policy could be initiated intra-state is a matter beyond our competence, but it would appear more than desirable.

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Minority Report of Member M. Douglas Anglin for the 1989 Research Advisory Panel Annual Report.

While I applaud the intent of the Panel in its 1989 annual report to stimulate discussion in several major areas of policy concerning drug abuse, I am not prepared as a relatively new member of the Panel (since November 1989) to support all the recommendations contained in the Executive Summary. As is noted in the Commentary, the internal debate by Panel members on these topics was both lively and diverse. I am in agreement in philosophy, content and interpretation with much of the discussion presented in the Commentary. I particularly endorse the emphasis that policy toward illicit drugs should not disregard differences among abused drugs (and the consequences of their use), and that they should be perceived in the context of the enormity of the social problems surrounding much more frequently used substances such as cigarettes and alcohol. I further concur with the philosophy that social reaction to the use of drugs should be very carefully considered so that the inherent problems are not exacerbated by inappropriate social reaction or overreaction, particularly given the current tax burden imposed by major expenditures for criminal justice system-based efforts.

To the extent that the issues raised in the Panel's Executive Summary and Commentary can stimulate discussion in important policy areas, provide informational expertise from the Panel members' aggregated experience, and promote a thorough examination by the Legislature of alternative policy options, I am pleased to add my support. Furthermore, my lengthy experience with the AIDS epidemic among Intravenous drug users suggests that major public health benefits could be derived from more flexible policies concerning the possession of syringes and needles, as well as promotion of better disinfection techniques involving bleach.

However, I am not in full agreement with some of the Executive Summary's recommendations. In particular, allowing cultivation of marijuana use for personal consumption, a social debate of some 25 years, needs careful consideration. Certainly, the consequences of marijuana use are significantly less than use of either cigarettes or alcohol, and it is true that the majority of people do not use marijuana and, of those who do, few do so with high levels of consumption. Furthermore, public policy toward marijuana has been discredited to the extent that social overreaction has distorted evidence about medical and social consequences of its use. With all this said, however, I am hesitant, without considerable further public debate, in suggesting changes in laws, either toward further decriminalization or toward more punitive criminal penalties.

Given the current serious levels of drug use and the cost to society of prevention, treatment, and enforcement efforts, the Panel's attempt to reconsider drug abuse issues and to propose consideration of alternate social policy directions is a new emphasis that is initiated in the 1989 Annual Report. To the extent that the Panel's efforts have credence with the Legislature, the ensuing discussion may contribute to ameliorating drug abuse problems.

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Minority Report of Member Edward P. O'Brien for the 1989 Research Advisory Panel Annual Report.

The Commentary portion of the Annual Report sets forth suggested legislation to amend or repeal certain laws relating to drug enforcement and control. The Commentary states that the Panel "presumes" to recommend such changes in law because of the experience of the Panel members in activities relating to drug abuse both in their role as Panel members and their experiences outside of their Panel functions. The Commentary states that the Panel is "mandated as an advisory group to the Legislature to suggest some legislation ... to reduce the damage to society ... imposed by drugs."

This claim of authority to recommend legislation on drug control and enforcement is not supported by and, indeed, is contrary to the statement in the Annual Report concerning the Panel's Legislative Mandate. This Report on page 19 states: "LEGISLATIVE MANDATE The Research Advisory Panel was created in 1969 by the California Legislature to encourage and oversee research related to controlled drugs and narcotic addiction. The Panel was given responsibility to review, approve and oversee research projects involving marijuana, hallucinogenic drugs and other controlled substances, and innovative treatment programs for narcotic addiction and abuse of controlled substances. Since 1969, such research within the State of California has operated under the aegis of the Panel. The Legislature also mandated that the Panel encourage research with marijuana and other controlled substances as well as research into the treatment of drug addiction."

Further, an examination of the statutes pertaining to the Panel reveals that the Legislature has only given the Panel authority with respect to research projects involving the use of controlled substances and research projects concerning the treatment of abuse of controlled substances. The statutes also require the Panel to report annually to the Legislature and Governor the research projects approved by the Panel including the nature and conclusion.s of the research projects. (Appendix A)

In my opinion, the Commentary's recommendations to amend or repeal the laws on drug enforcement and control are not within the legislative authority of the Panel. There is no statutory authority for the Commentary's statement that the Panel is mandated to suggest drug enforcement legislation. The Panel's "presuming' of such authority is unwarranted and ill advised. Since the Panel lacks legislative authority in the above area, it is my position that the Commentary portion of the Annual Report should be omitted.

In addition to the lack of authority for the Commentary, I would emphasize that the Commentary's legislative recommendation allowing cultivation of marijuana for personal use is particularly injudicious. The argument, that since marijuana use continues to escalate and therefore criminal sanctions should be abandoned, fails to acknowledge or discuss the extent of marijuana use if sanctions were removed. Certain premises for the recommendation, e.g., that marijuana is currently increasing in use and is comparable to alcohol in extent of usage, are not established. The recommendation is not accompanied by a strong, well-planned comprehensive program to reduce the use and abuse of marijuana. Allowing marijuana cultivation for personal use as an experimental approach is not appropriate since the research subjects would extend to all citizens of California. If the experiment were not successful, the social cost of the experiment could be significant.

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REFERENCES AND READINGS General discussions

Lapham, L.H.: A political opiate. The war on drugs is a folly and a menace. Harper's Magazine, 1989 (December): 43 [The latest in a twenty-year series of articles arguing decriminalization in this politically centrist journal.I

Gould, Stephen Jay: The war on [some] drugs. Harper's Magazine, 1990 (April): 24. [An incisive note by one of the great scientists and popularizers of our time.]

Harley, J.: Contradictions of cocaine capitalization. The Nation, 1989 (Oct. 2): 341. [important data on marijuana from the left. Below are even more permissive attitudes and equally violent criticism of current federal policy from the right.]

Friedman, Milton: An open letter to Bill Bennett. The Wall Street Journal. 1989 (Sept. 7).

Nadelman, E.A.: Drug prohibition in the United States: Costs, consequences, and alternatives. Science, 1989 (Sept. 1) 245: 939. [Among the latest of a long series of examinations by a political scientist or other social scientist of our failing system. Science is the widely distributed journal of the American Association for the Advancement of Science.]

Inciardi, J. (Editor): American Drug Policy and the Legalization Debate. American Behavioral Scientist, 1989, 32: 227-332. [An entire issue devoted to an admittedly confusing discussion of legalization, a change not advocated in this report. Noteworthy, however, as convenient source of ideas of Trebach and of Mayor Schmoke of Baltimore, practical men who advocate legalization.]

Marijuana Related Discussions

Marijuana: A signal of misunderstanding: First Report of the National Commission on Marihuana and Drug Abuse, 1972. U.S. Government Printing Office, Washington, D.C., pp. 1-184. [It has long been the consensus of medical and social scientists that in the U.S. marijuana represents a minor drug made into a major problem by societal actions. This reference is merely representative and provides little not available in 1944 in the "La Guardia Report' next listed.]

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The balance of this annual report may be obtained from:

Research Advisory Panel
455 Golden Gate Avenue, Room 6000
San Francisco, California 94102

[END OF REPORT]