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[Prepared for House Select Committee on Narcotics Abuse and Control hearing, September 29, 1968)

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The suggestion that some form of Legalization of illicit drugs a seriousli
considered has become the focus of serious cetate in the last 31 months.
Despite the protestations of some prominent politicians chat debating any form
of legalization is "zany" or "insane. " a variety of perfectly sane, thoughtful
and intelligent individuals from various walks of life have emerged in support
of this position. Despite the apparent political unpalatability of
legalization today, it is neither radical nor unrealistic to suggest that
once questions about legalization scenarios are answered in a thoughtful and
sytematic way, public perceptions of this issue may shift quickly and
fundamentally.

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In order to conduct a reasoned and intelligent discussion of this issue, it is
necessary to eschew political demagoguery, and to avoid the temptation to
brand those who vary with us, whatever stance we may take, as morally obtuse
or possessed of ulterior motives.

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Support for serious consideration of legalization extends across the political
spectrum, and cannot be deemed a conservative or liberal, a democratic or
republican, position. I know from personal discussions with police officers
and highly placed prosecutors in the United States Department of Justice, that
the legalization approach also has supporters in the law enforcement
community. Like all supporters of legalization, they have questions about
implementation, and like most supporters of legal:zation, they do not embrace
an across the board, libertarian approach where all illicit drugs are placed
on a legal footing equivalent to alcohol.

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It is my opinion that at some juncture. some form of legalization will become a reality. It is my concern that if we do not carefully consider all the problems inherent in various legalization scenarios. and answer the many questions raised regarding legalization, we may create an unwieldy and incoherent system.

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At a drug policy workshop in August under the auspices of Mayor Kurt Schmoke,
ethicist Robert Royal made some points that are important when considering
approaches to reforming the narcotics laws. First, Royal observed that
individual rights are not absolute, and are invariably balanced against
perceptions of what benefits the commonweal.
Second, good ethics are practical ethics. Third, Royal observed that
the notion that mor ality cannot be
legislated is not entirely accurate, pointing to the impact of
civil rights legislation in changing public conceptions of what is right and
wrong regarding the treatment of minorities. Finally, and not
insubstantially, he noted that there is a strong and constant tension between
Americans' desire to be protected from a variety of dangers, and their respect
for what president Ronald Reaçan recently called "the right to march to a
different de limmer."

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I am neither politician nor public official, but I believe that
an unwillingness to e.amine dispassionatel, evidence bearing on the

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legalization issue is bad policy, and ultimately a disservice to the public.
In some cases, misinformation may tempor arily
deflect public attention from consideration of legali:ation as a serious polic:
option. It will not, however, make the issue go away.

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Let me briefly 044 or two examples of what appear to be at best careless, and
at worst, distorted approaches to the legalisation issue. In one instance,
prominent northern Congressman circulated a letter in which he essentially
equated the dangers of PC and marijuana. in another case, a prominent
southern congressman circulated a letter in which he asserted that 75 percent
of illicit drug users become addicts, as compared to only 10 percent of
alcohol users. I am deliberately avoiding more precise identification,
as I have no desire to become involved in what could be construetas ad
hominem attacks. Inentin these cases, however, to point out that wh:
misinformation may temporar:lv mislead the cutiis, in the long run it will
contribute to a credib:lit, çap when the sources of such misin or natico
e: pound on the 11!:::t tr. :ssue.

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Everyone with whom I have come in :a:: agrees with Feo. !farci !at
"-gr 20 long we have into the rart cause, railing to see teisane::on
between drugs and opelessness, heiclacsness and despair." Tho succes:
that individuals considering the legalizat:35 option are somehow insens:tive
to that connection, and are ready to write c! te disad.ar. aged you !
inner city is simply incorre::. orical!. -an, roer ty 1-13:.:ation,
such as Professor Ethan Nadelnarri. Oricetcr, Take a large SARL + 'ei-
case precisel. 9-ds that is the :: and distantaje? who are
sustering most crie.bul, rom ar 28:2. W

eszes a 1.orceste Slic health.

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Another point that has become muddled is the existence of two separate "drug problems."

The drug problem of the socio-economically depressed inner cities is indeed linked to hopelessness and despair. Hopelessness and despair, however, do not account for the huge numbers of affluent, middle-class citizens who occasionally use drugs such as cocaine and marijuana on a recreational basis and who otherwise are no different from their non drug using counterparts.

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At some level, individuals on both sides of the legalization debate must find
common ground with their opponents. If we recognize that we share many
goals in common, but differ greatly on how most humanely and practically to
accomplish those goals, the rhetoric and sarcasm can be replaced by an
attitude of thoughtful listening.

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No one has all the answers, but Rep. Rangel, Chairman of the Select Committee on Narcotics Abuse and Control, has done a superb job of posing a host of important questions.

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while in the process of preparation of this manuscript, I was warned by a
variety of astute individuals that the proposals
would be deliberately distorted by Rep. Rangel and others. I was warned that
by taking Rep. Rangel's list of questions at face value, and presenting a
coherent vision of how legalization might work, I was "falling into his trap."
Let me note that I hold Charlie Rangel in the highest regard. He has been a
tireless fighter for the rights of the underclass, and a tough but
compassionate legislator. It would be most unfortunate for all parties if
anything other than a sober and dispassionate consideration of the evidence
should occur.

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While this manuscript has been adapted with a specific focus towards the
September 29 hearings, I have not fundmentally altered any of my

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recommendations from those made to Mayor Schmoke's August 4 workshop.

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As a mears of focusing on the very pivotal concerns raised by the prospect of legalization, I begin with a brief restatement of the questions framed by Rep. Rangel.

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REP. RANGEL'S QUESTIONS

On what

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2. Should narcotic and psychotropic drugs be made available to anyone who wishes to try them or just to people already dependent upon them?

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Would an unlimited supply be made available to habitual users or addicts? Or would they have to pay the market price, even for drugs where an increasing tolerance would require the purchase of ever larger quantities? Could those heavily dependent or addicted work or even hold a job? Or would they resort. to crime to support their legal habit and to provide livelihood for themselves and their dependents?

5. Who would provide drugs? Private companies? The government? Would they be provided at cost, for a profit, or be subject to a tax? If taxed, what would be a fair rate?

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7. would drug use by employees in certain occupations be proscribed? Since
marijuana can remain in the body for weeks after use, would marijuana use by
employees in jobs where security and safety are at issue be forbidden even
off-duty? What about airline pilots, surgeons, police, firefighters, military
per sonnel, railroad engineers, bus drivers, cross-country truckers, nuclear
reactor operators--even Wall Street brokers and teachers?

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B. What rate of addiction and dependency would you project if drugs were legalized and thereby cheaper and more readily available? Wouldn't cheap and readily available legal drugs result in more people using more drugs? What would you project the accidental drug-related death rate to be?

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What is the opinion of medical perts as to the potential effects of legalization? Drug-treatment experts?

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10. Have you asked your personal physician whether he would recommend that you, members of your family or anyone exper i ment with drugs? Would he recommend regular recreational use?

11. Would legalization affect medical insurance rates and the overall cost of health care?

12.

Would we be soreading AIDS by having more addisis using more need: es?

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1. One of the major impediments to rational debate on drug legalization has
been what I call the "all or nothing syndrome, " i.e., the call to simply
legalize all currently illicit drugs and make them available on a basis
similar to alcohol. The primary rationales for this extreme approach are, a)
philosophical, and by economic The philosophical rationale is that an adult
should be entitled to use his or her body as he sees fit without government
intrusion. The economic rationale is twofold--first,
legalization will remove black market profitability, hence ending criminality
based on greed, and, second, through taxation, revenues can be raised and
earmarked for productive ends including drug treatment and education. I have
major problems with this extreme approach, and believe that Rep. Rangel has
framed the question properly.
Philosophically, I feel that personal freedom must always be balanced against
the broader interests of society. Although drug policy of the last 50 years
has ignored the former in favor of the latter, there are legitimate medical
and psychological criteria to distinguish inherent social risks involved in
use of different psychotropic drugs.

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Economically the reasoning appears sound, but again, the risks inherent in use
of certain psychotropic drugs may more than offset the benefits of legalizing
those drugs. These issues are raised in more detail in Rep. Rangel's other
questions and will be addressed in more detail as they are answered.
Here are my suggestions for legalization and regulation
of var i ous psychotropic drugs and the criteria i believe are certral to making
this decision. Supporting references are listed at the end of this summary.

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CRITERIA FOR RECOMMENDATIONS

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It is worthwhile, from the inception, to state briefly the broad underpinnings
for my specific recommendations. I have attempted to avoid basing any
recommendation solely upon empirical considerations, and have labeled
as opinions statements based upon observation and experience but
for which no systematic studies or surveys are available.
In briet, the primary basis for all my suggestions is that public health serve
as a primary determinant of the degree of regulatory control for a given
psychoactive substance. The rationale for regulation is not that a substance
must be absolutely "safe" to all persons under all circumstances, but rather,
that the level of risk to the individual and society is manageable within my
proposed regulatory structure. Hence, while heavy smoking of marijuana,
defined by some researchers as approximately two marijuana cigarettes daily,
is hazardous to respiratory health and poses a danger to the fetus in
pregnant women, this consumption pattern applies to a small percentage of
total users, probably between five and 10 percent. Based on the statistical
data, which will be discussed later, there is little reason to believe that
this pattern would change significantly after legalization, In particular,
the group where most concern is focused--adolescents 18 and under--already
have ready access to the drug and appear to be little influenced by its legal
status.

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Another significant criterion is the degree
of social disruption, above and beyond direct biological effects, associated
with use of a given drug. This second criterion is unfortunately non-
quantifiable, for it is virtually impossible to determine precisely what
part of the disruptive impact of some drugs is related to the physiological
effects of the substance, and what part is caused bv the criminal subculture

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Hence,

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and vast profits related to their illegality. An assessment must be based on
intelligent speculation, and an examination of the historical data.
an assessment must take under consideration what happens 14 a marijuana Smol er
drives while impaired, or what impact crack appears to have on the lifestyles,
as opposed to the individual health, of habitual users.

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In following a pragmatic. as opposed to an ideological approach. I have
examined the evidence in a medical, historical and social context. In
addition, hovering over all my recommendations is a belief that a revision
of the drug laws as described would have a devastating impact on profitabllity
of the current illicit drug business. The cross-cultural data on
controlling alcohol consumption without prohibition, particularly the Britis
experience, provides an optimistis referent for my belief that regulation,
rather than prohibition, can most effectively minimize the $20ial harms
associated with misuse of psychoactive agents.

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My regulatory scheme is devised with an eye to eliminating the socic-economic reasons for the existence of a criminal drug subculture. It follows logically that the elimination et most of the criminal subculture.cw associated with drugs would, ipso facto, function to shield children and adolescents from association with that subculture and exposure to individuals with a rested interest in creating addiction.

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I have taken pains to distinguish between different levels of risk
associated with different forms and modes of use of different and related
psychoactive substances. !n this area, there is significant data to support my
recommendations. A resort to empiricism is unnecessary.

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MARIJUANA

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Mar i juana (and hashish) should be legalized, taxed and treated similarly to alcohol. Cultivation for personal use should be permitted, perhaps with an annual registration fee. Revenues from taxation would be allocated towards administrative costs of drug regulation and education and treatment of drug addiction,

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Widespread assertions to the contrary, there is a significant amount of medical and psychological information on the effects of mar i juana. What is equally significant is that the last 20 years have provided us with a social laboratory in which to observe what consequences ensue from widespread use of marijuana and other drugs. The social consequences of widespread nar i juara use over the last 20 vear; appear minimal.

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While virtually every cther illicit psychoactive substance in widespread lse
in the United States has a humanly applicable minimum lethal dose, marijuana
does not. This is a remarkable fact in and of itself. Despite marijuana's
popularity, evidence of dependence is rare (1). A small percentage of people
do become dependent on marijuana, and some seek prcfessional hels in
quitting 2). Overall, however, there is a remarkatle absence of habituation
with the drug.

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Although the data on individuals seeking treatment for marijuana abuse have generally indicated that they are actually being trezte for abuse of other drugs (2a), a recent study indicated that there are some individuals dependent on marijuana alone who are seeking treatment (2b).

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A study based on 97 marijuana users established a set of criteria, based on an alcoholism model, to define marijuana abuse, as opposed to use. The results indicated that 5.5 percent of the sample displaved most of the attributes necessary to include them in the group of problem marijuana users.

It was found that up to 9.3 percent of the total sample indicated some problems related to their mar i juana use (2c). Unfortunately, the righer 19.- percent) figure has recently been cited as indicative of the percentage of marijuana users likely to develop problems with the drug (20).

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To my knowledge, a larger sampling has not been performed in order to
establish a probable rate of dependency in marijuana users. While the study
cited is worthy of consideration, caution should be exercised in drawing #ar
ranging conclusions until further survevs in this area have been completed.
The total population of current marijuana users in the United States,
(with "current" defined as use at least once a month) is somewhere between 18
and 24 million people (2e), (26), which provides additional grounds for caution
in generalizing from a sampling of 97 individuals. (The discrepancy in figures
is based on the fact that surveys do not include members of the armed forces,
peop1 living in college dormitories, grou quarters, and institutuional
populations. The inclusion of students in college dormitories would certainly
have a significant impact on current use figures).

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One area of concern regarding marijuana is its purported role as a "gateway"
drug. The "gateway" theory has replaced the "progression" theorv. The latter
was the notion that use of one drug, e.g., marijuana, led to use of another
drug. The new twist involves the statistical correlation sometimes found
between Lise of mari uana. and subsequent use of other drugs. There are
several problems with this gateway concept.

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First, the statistical

association is often cited out of context to imply

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1 is a use of drug X, in this case, marijuana, leads to use of drug Y. thinly veiled effort to revive the "mariuana leads to heroin" theory of cre.

Second, longitudinal studies of cannabis users have not even been consistent
on the establishment of simple statistical correlation between use of
mar i juana and use of other drugs (29).

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Third, where a correlation has been established, the most intelligent
explanation of subsequent use of other drugs has been based on
personality attributes (zh). A highly publicized study that has since been
largely ignored concluded that people who are open to new experience are
likely to try mar i juana, and, in general, experience more than people who have
a less open life style. The architects of this study, which involved a
sampling of over 300 college students, concluded that these personality
attributes accounted for their finding that the more a person
used mar i juana, the more likely he was to try one or more other drugs (21).

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A recent study by a Texas A % M psychology professor found a gateway role for use of household inhalants, i.e., such things as spray paint, cleaning fluids, typewriter correction fluids etc., and subsequent abuse of alcohol and other drugs. Since there is no movement under way to ban typewriter correction fluid or spraypaint, it is easier to dispassionately look at the evidence and understand that while use of a substance may correlate statistically with use of other substances, this is not an argument for causality (23). Similarly, the use of the two legal drugs, alcohol and tobacco, precedes use of all illicit drugs (2k).

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Interestingly, an entirely different role for mar i juana has been postulated by
Dr. Frits Ruter, senior professor of criminal law at the University of
Amsterdam, According to Ruter, the Dutch approach is to treat mar i juana as a
"barrier" drug. This is the actual term Ruter uses to describe the system.
The logic is that by selective enforcement of the narcotics laws, emphasizing
acceptance of a small legal market in mar i juana, and continuing punishment of
sale of illicit drugs such as heroin and cocaine, the Dutch hope to establish
a barrier between marijuana and other drugs. The result.has been a mixed
success, with use of mar i Juana itself declining, use of heroin declining, and
use, but not apparent abuse, of cocaine slowly irisreasing. The Dutch, up to
now, have not experienced the crack phenomenon (2L).

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Another area of concern involves the impact of marijuana use upon adolescents
undergoing puberty. Because animal studies have shown that chronic
administration of high doses of THC may (the primary active component of
marijuana) effect endocrine functioning, the subiect deserves scrutiny.
No definite effect on adolescent development has been established. Many of
the endocrine effects caused by chronic THC administration in animals e:ther
decrease as toleranse develops or are reversible upon cessation of
administration (2m). Further research in this area is necessary, with a careful
distinction established between risks inherent in heavy ver sus moderate use at
different stages of adolescenca.

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An analysis of the data indicate the prohibition has been most
ineffective precisely in the one area where virtually everyone agrees it is
most important--keeping drugs away from children. Although patterns of use
have shifted, notably dropping in recent years, recent surveys showed that
almost 90 percent of high school seniors continue to find marijuana easily
accessible (2n). It is hard to imagine that legalization would have much
impact on mar i juana use by adolescents.

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While marijuana causes a form of intoxication, compar i son of driving impairment to that caused by alcoholic inebriation indicates that mar i juana

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causes less severe impairment (?). In fact, even a relatively high dose has
little effect on simple reaction time (4), (5). Other aspects of perception
crucial to driving skills. such as tracking abil ty, are impaired (6).
No one should drive under the influence of marijuana, although it is clearly
the lesser evil when compared to alcohol (ba).

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It is worth noting that in one of the most infamous cases in which marijuana use
was implicated in a transportation disaster--the January 1997 wreck of a
Conrail train that lilled 16 people--the engineer, Ricky Gates, admitted be:ng
intoxicated on alcohol at the time of the collision 1609. In addition, taras
had 11 traffic corictons. two license suspensions. and had been recently
arrested for drunken driving while running a red light and a stop sign (60!.
Despite these undisputed facts, the focus of the media and subsequent calls
for mandatory drug testing of railroa: emplo,ees focused on marijuana as tre
causal agent in the disaster.

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9.

Mar i juana, unlike alcohol, does not appear to cause train damage or
deterioration of the liver, stomach and other organs 7). It does appear to
cause unhealthy changes in the lungs, particularl, when smoked frecuent!
and in large amounts

This eflect on the lungs :3 compounde use with tobacco (Ba), b), Ec).

Hab:tual marijuana-only Smerers were sund to ale a signficantly lower baseline level of carbon,heroglobin compared to tobasco smoer 5. indicating that marivasa-crir 5.10 ers have less chronic cardiovascular ris un tobacco smokers 50).

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