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DRUG-RELATED CONSEQUENCES AS CANCER, HEART DISEASE, PNEUMONIA, AND

MENINGITIS.

A SIGNIFICANTLY LARGE NUMBER OF THE PATIENTS WITH KIDNEY

FAILURE NEEDING DIALYSIS A HARLEM HOSPITAL HAVE AN UNDERLYING DIAGNOSIS OF
DRUG ABUSE AS THE CAUSE OF THEIR KIDNEY DISEASE. IF THESE EXAMPLES OF
DISEASE AND ILLNESS WERE NOT ENOUGH, THE LATE SEVENTIES HAS USHERED IN
WHAT IS PRESENTLY ONE OF THIS NATION'S MOST PRESSING PUBLIC HEALTH
PROBLEM, THE ACQUIRED IMMUNODEFICIENCY SYNDROME AND OTHER MANIFESTATIONS

OF INFECTION WITH THE HUMAN IMMUNODEFICIENCY VIRUS (HIV). MANY OF THESE

MEDICAL COMPLICATIONS OF DRUG ABUSE HAVE SERIOUS MEDICAL IMPLICATIONS EVEN

FOR THOSE OF US WHO DO NOT USE THESE PSYCHOTROPHIC SUBSTANCES.

FOR

EXAMPLE, THE SCIENTIFIC LITERATURE ADEQUATELY DOCUMENTS A GREATER RISK OF

TUBERCULOSIS AMONG THE DRUG ADDICTED THAN AMONG THE GENERAL POPULATION FOR

A NUMBER OF REASONS.

BECAUSE TUBERCULOSIS INFECTION DOES NOT REQUIRE

INTIMATE CONTACT, IT IS NOT SURPRISING TO FIND THAT MANY COMMUNITIES WITH

A HIGH PREVALENCE OF TUBERCULOSIS ALSO HAVE A CONSIDERABLE PREVALENCE OF

DRUG ABUSE.

AIDS REPRESENTS ANOTHER EXAMPLE OF HOW DRUG ABUSE HAS AN IMPACT BEYOND

THE PERSON USING THE ILLICIT SUBSTANCES.

WHILE INTRAVENOUS (IV) DRUG USE

REPRESENTS ONLY THE SECOND MOST FREQUENT BEHAVIOR ASSOCIATED AIDS CASES

REPORTED TO THE CENTERS FOR DISEASE CONTROL, IV DRUG USE IS THE MOST

CRITICAL FACTOR RESPONSIBLE FOR THE PREVALENCE OF AIDS AND HIV DISEASE

AMONG ETHNIC/RACIAL MINORITIES, WOMEN, AND CHILDREN.

EVEN MORE

POIGNANTLY, OF THE PERSONS WITH AIDS ACQUIRED BY HETEROSEXUAL

TRANSMISSION, FULLY SEVENTY PERCENT ADMIT THAT THEIR SEX PARTNER USED IV

DRUGS.

WHILE MY TESTIMONY THUS FAR SUPPORTS FULLY THE PREMISE THAT FEDERAL DRUG POLICY IS INADEQUATELY RESPONSIVE, I AM NOT PREPARED TO SUPPORT LEGALIZATION AS A MORE EFFECTIVE OPTION. TO THE CONTRARY, LEGALIZATION, IN MY OPINION, DOES NOT CONFRONT THE REASONS WHY THE UNITED STATES IS

UNSUCCESSFUL IN RESPONDING TO DRUG ABUSE.

PLEASE ALLOW ME TO ENUMERATE

SOME OF THESE REASONS. AS AN HEALTH CARE PROVIDER, I AM APPALLED AT HOW WE AS A NATION CAN RECONCILE THE INDIRECT SUBSIDY OF TOBACCO, THE LEADING CAUSE OF DRUG-RELATED MORBIDITY AND MORTALITY, AND YET EXPECT OUR YOUTH TO

BE RESPONSIVE TO OUR "SAY NO" CAMPAIGNS.

THE STIGMA ATTACHED TO DRUG ABUSE OR TO THOSE WHO USE DRUGS HAMPERS

OUR UNDERSTANDING OF THIS MEDICAL DISORDER AND OUR RESPONSE.

IN NEW YORK

STATE AND MANY OTHER STATES IN THIS NATION, THE STATE DRUG ABUSE AUTHORITY

RESIDES OUTSIDE THE STATE PUBLIC HEALTH AUTHORITY.

IF DRUG ABUSE IS

NOTHING ELSE, IT IS A MAJOR PUBLIC HEALTH PROBLEM THAT SHOULD BE

APPROPRIATELY CONSIDERED IN THE DEVELOPING PUBLIC HEALTH INITIATIVES AND

IN DETERMINING HEALTH STATUS AND NEEDS.

EVEN AT THE FEDERAL LEVEL,

FRAGMENTATION IN EFFORT ALSO HINDERS THE INCLUSION OF DRUG ABUSE IN THE DETERMINATION OF HEALTH STATUS INDICATORS OR IN DETERMINING HEALTH

MANPOWER NEEDS.

THE PAUCITY OF NATIONAL HEALTH SERVICE CORPS ASSIGNMENTS

FOR PHYSICIANS IN NEW YORK CITY IS REPRESENTATIVE OF THE LACK OF INSIGHT

AS TO THE CONTINUING AND INCREASING IMPACT OF DRUG ABUSE IN THIS GEOGRAPHIC LOCATION. MANPOWER CONSIDERATIONS ARE UNFORTUNATELY NOT THE ONLY AREA OF HEALTH THAT CRIES FOR A MORE APPROPRIATE FEDERAL RESPONSE.

AS A PHYSICIAN PERFORMING HOSPITAL WARD ATTENDING FUNCTIONS DURING THIS

MONTH, IT IS MOST DISTURBING TO NOT BE ABLE TO PROVIDE INTENSIVE CARE

SERVICES TO PATIENTS IN NEED, SORELY BASED ON THE FACT THAT THE NUMBER OF

HOSPITAL BEDS AVAILABLE ARE A LIMITED FEW.

I CAN NOT COMPREHEND HOW ANY

PUBLIC HEALTH AUTHORITY, IF IT TRULY CONSIDERED THE PREVALENCE AND

MORBIDITY ASSOCIATED WITH DRUG ABUSE, CAN ALLOW SUCH A STATE OF AFFAIRS TO

CONTINUE TO EXIST.

IT IS ALSO UNCLEAR AS TO WHY THERE IS NOT GREATER

EMPHASIS ON PRIMARY MEDICAL CARE FOR THE ADDICTED ON-SITE AT DRUG

TREATMENT CLINICS.

THIS WOULD BE A PERFECT OPPORTUNITY TO PROVIDE

PREVENTATIVE SERVICES TO A POPULATION THAT IS NOT TRADITIONALLY PROVIDED

THESE SERVICES IN THE TYPICAL MEDICAL SETTINGS FOR A NUMBER OF REASONS.

LEGALIZATION IS NOT GOING TO ERASE THE FOREGOING PROBLEMS.

IN FACT IF

WE LEARN ANYTHING FROM THE PROHIBITION ERA AND THE ENGLISH HEROIN

EXPERIENCE, EPIDEMIOLOGIC EVIDENCE POINTS-OUT THAT MEDICAL CONSEQUENCES

SECONDARY TO ALCOHOLISM (SUCH AS CIRRHOSIS) ACTUALLY DECREASED AND THE

MEDICAL CONSEQUENCES OF DRUG ADDICTION INCREASED IN ENGLAND DURING THE

YEARS WHEN HEROIN WAS LEGALLY AVAILABLE.

GIVEN THE HARLEM HOSPITAL

EXPERIENCE, WHERE THE MEDICAL CONSEQUENCES OF THE USE OF THESE SUBSTANCES

OCCURS AT A DISPROPORTIONATELY GREATER RATE, MY RESPONSE TO DRUG

LEGALIZATION WOULD NECESSITATE AN EMPHATIC NO.

WHAT I DO SAY YES TO IS A RECIPE FOR THIS COUNTRY THAT INCLUDES THE

FOLLOWING:

1.

THIS COUNTRY MUST DEVELOP POLICY THAT CONSIDERS DRUG ABUSE IN THE

SAME VEIN THAT IT CONSIDERS OTHER MAJOR HEALTH PROBLEMS, SUCH AS

DIABETES, HEART DISEASE, OR HYPERTENSION.

THIS MEANS THE

ENCOURAGEMENT OF HEALTH PROFESSIONAL SCHOOLS TO INCLUDE DRUG
ADDICTION IN THEIR CURRICULA, ENCOURAGEMENT OF STATES TO INCLUDE

THEIR DRUG ABUSE AUTHORITY WITHIN THE STRUCTURE OF THEIR PUBLIC

HEALTH AUTHORITY, AND THE INCLUSION OF THE PREVALENCE OF DRUG

ABUSE AS A HEALTH STATUS INDICATOR IN THE HEALTH PLANNING

PROCESS.

2.

EVEN GREATER EMPHASIS IS NEEDED TOWARD PRIMARY AND SECONDARY

INTERVENTIONS IN CONTROLLING THE SPREAD OF DRUG ADDICTION.

PRIMARY PREVENTION EFFORTS WILL NECESSITATE TOUGH DECISIONS AS TO

HOW TO ADDRESS THE POOR SOCIOECONOMIC CONDITIONS IN MANY URBAN

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OR CLINIC OR AS PHYSICIANS IN PRIVATE PRACTICE WHERE DRUG ABUSE

IS QUITE PREVALENT.

MR. CHAIRMAN,

THESE DISCUSSIONS ON THE LEGALIZATION OF DRUGS PROVIDES THIS COUNTRY

WITH AN EXCELLENT OPPORTUNITY TO EVALUATE THE EFFECTIVENESS OF FEDERAL

DRUG POLICY.

IT MY OPINION, THAT THESE DISCUSSIONS WILL FAR EXCEED THEIR

POTENTIAL IF WE ALSO USE THEM AS AN OPPORTUNITY REASSESS FEDERAL DRUG

ABUSE POLICY AND MAKE BOLD STEPS TO CHART A COURSE THAT WILL TRULY TARGET

THE FACTORS THAT PROMULGATE THE SPREAD OF DRUG ABUSE AND THAT WILL TRULY

ENHANCE THE ABILITIES OF HEALTH CARE PROVIDERS TO PROVIDE THE MEDICAL CARE

THAT PERSONS SUFFERING WITH THE DISEASE OF ADDICTION OR DRUG ABUSE-RELATED

MEDICAL COMPLICATIONS.

AGAIN, I THANK YOU FOR THIS OPPORTUNITY.

STATEMENT OF

DAVID BOAZ
VICE PRESIDENT FOR PUBLIC POLICY AFFAIRS

CATO INSTITUTE

BEFORE THE
HOUSE SELECT COMMITTEE ON NARCOTICS

SEPTEMBER 29, 1988

I'd like to thank Chairman Rangel and the Select Committee

for holding these hearings on proposals to legalize drugs. It's time we had a vigorous national debate on whether drug

prohibition is working, and these hearings will do much to

launch that debate on a rational course.

Let me start my discussion of drug prohibition with the

following quotation:

"For thirteen years federal law enforce

ment officials fought the illegal traffic.

State and local

reinforcements were called up to help. The fight was always frustrating and too often futile. The enemy used guerrilla tactics, seldom came into the open to fight, blended easily

into the general population, and when finally subdued turned to

the United States Constitution for protection.

His numbers

were legion, his resources unlimited, his tactics imaginative. Men of high resolve and determination were summoned to Washing

ton to direct the federal forces.

The enemy was pursued

relentlessly on land and sea and in the air.

There were an

alarming number of casualties on both sides, and, as in all

wars, innocent bystanders fell in the crossfire."

That passage wasn't written recently.

It was written

about the prohibition of alcohol in the 1920s, and it il

lustrates a very simple point:

Alcohol didn't cause the high

crime rates of the 1920s, prohibition did.

Drugs don't cause

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