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increasing tremendously; i.e. absenteeism, excessive sick leave, accidents, rising health claims and increased workers compensation claims. Work
stress which is often associated with drug addiction is now payable under worker's compensation. Legalization will not stop these costs to industry, it will increase them.
The work place is being forced to address the issue head on. They can't wait. Companies are investing in EAPs, drug testing, and whatever else our experts recommend. The following cases typically represent employees with addiction problems in the American workplace throughout each of the States in our country. They are real, life examples taken from my consulting work. I have many of such cases. Legalization will cause more of the same, resulting in an impossible situation for American business.
First, a subway maintenance worker, self-referred and seeking help for alcohol and cocaine problems which culminated in the breakup of his 15-year marriage. This person called an EAP counselor after he had started drinking-he stated that he did not want to live and wanted to kill his supervisor.
Second, an air traffic controller, self-referred because he had been arrested for a felony and public intoxication charge. There had been continuous problems with the law and personal finances. The employee's roommate was a cocaine user which resulted in violent arguments. He was planning to move out.
Third, a data processor who was referred by her supervisor for poor job performance revealed during counseling she had to care for her grandchildren because her daughter has become a cocaine addict. The daughter goes on "rampages” threatening to kill her and the children. It has become impossible for her to work.
Solution: To achieve a drug-free work place, I am advocating a program integration model for the work place. Human resources is the center and driving force in coordinating the drug policy, EAP, drug testing, security, legal, medical and unions toward the common goal. Companies must educate people to the danger of drugs, as we have done with tobacco.
Recent studies by Cook and Harrell reveal few companies even with health promotion programs stress drug education. The IBM Corporation stands as an outstanding example with a drug and alcohol education program offered to all employees and family members throughout the country. Substantive training programs for mental health professionals who have these programs are needed immediately.
I think this information is going to surprise the committee. It seems unbelievable schools of medicine, social work and psychology rarely today require a course in alcohol or
drug addiction. Today there are fewer schools of psychology that require a course in drug addiction than they in 1950. Even the Council on Social Work Education, the accrediting board for schools of social work, does not today require a single course in addiction for the master's and social work candidates.
All managers and supervisors need training in alcohol and drug abuse. We need EAPs that concentrate on reaching drug and alcohol abusing employees early. There must be new funds for meaningful treatment, especially for outpatient programs. At Health and Human Services we funded with Blue Cross the outpatient model for treating drug addiction at the work site for Federal employees, this was right down the street at 200 Independence Avenue. In the evening, we had treatment programs in operation using EAP offices and conference rooms that were outerwise empty.
Mr. RANGEL. Professor, I hate to interrupt, but in order to make certain that we can hear the entire panel, I am going to ask you to end your testimony here. You will be given ample opportunity to finish the thoughts that you have during questioning.
Dr. MASI. I would sum up to say the work place carries a large part of the burden of drug abuse, and we don't want to see it increased.
Mr. RANGEL. Thank you for your understanding of our problem. [The prepared statement of Dr. Masi appears on p. 130.]
Mr. RANGEL. On the other side we have Dr. Lawrence Brown, a clinical instructor, Department of Medicine, Harlem Hospital, and also associated with the College of Physicians and Surgeons of Columbia University. We welcome your testimony. TESTIMONY OF LAWRENCE BROWN, M.D., CLINICAL INSTRUC
TOR, DEPARTMENT OF MEDICINE, HARLEM HOSPITAL, SUR-
Let me offer my sincerest gratitude for the opportunity to be able to talk to you about an issue that you do doubt know affects a large portion of health care providers in the Harlem community.
When I consider discussions of legalization, it seems to me that these are stimulated by two different areas; one, the mounting evidence that the current response of the American society to drug abuse is schamefully inadequate; and the second is a hypothesis that legalization represents a reasonable alternative to the current American response to drug addiction.
Addressing these facts separately, I am going to limit my responses actually to the medical issues, not because of the fact that they are necessarily the most critical issues, although it would be rare to hear a physician say health care is not one of the highest priorities in this country's considerations, but rather because there are probably going to be other individuals addressing non-medical areas more capably than I can.
From the public health perspective, one can either address our policies on drug addiction from the standpoint of a number of people who consume drugs or the consequences that we see as a result of those who use them. Using the first one, I think even though-our colleagues at the National Institute on Drug Abuse are still themselves somewhat stymied by an ability to predict how many people are actually using illicit drugs. In part, this is because data bases are atrophied by the fact they have been underutilized for a number of years.
The other issue, from the standpoint of what we see at Harlem hospital, is a continuing parade of patients who are admitted into our hospitals for cancer, heart disease, meningitis, and kidney failure in association with drug abuse. When we look at the persons admitted for kidney failure, necessitating dialysis, one of the most common diagnoses is a history of drug abuse. A response directed at legalization does not really address these medical problems that we have in this country.
In fact, epidemiological evidence demonstrates that when a psy. chotrophic agent is legalized, the incidence and prevalence of medical sequelae (resulting from the use of these agents) increases. This was the case subsequent to the repeal of prohibition regarding alco hol and
during the period in which heroin was made legally available in England.
In this country, the current view and approach to drug addiction still seems to be as a stigma rather than the public health problem it truly is. This is evidenced by the structure of our response where drug abuse authorities are outside the framework of public health authorities in New York State and many other States across this country.
Now, if drug abuse is nothing else, it is a clear public health problem that needs to be addressed at least in that framework.
I also would like to, in fact, echo the words of Dr. Masi. I find it ridiculous in this day and age to find that we still have a paucity of formal as well as post-graduate training that involves drug abuse. It should be the role of this country to try and encourage our pro fessional schools, our health professional schools, to include this area in the curriculum and in post graduate training programs.
The other areas that deal with the response to drug abuse is the fact that when we look at treatment facilities, they still continue to be second-class facilities. How can we truly expect to have a reasonable response to drug abuse if what we do is allocate the least attractive facilities for outpatients addicted to these drugs of abuse.
It seems that while there are a number of people talking about the expansion of treatment, I just want to emphasize to the committee from the standpoint of this physician that expansion cannot be just in quantity but has to be also in quality. We have to be able to deliver a full range of services, including primary health care services. It seems to me while we have access to this patient population, we can do a lot more in providing preventive care that has benefits far beyond the drug abuser himself/herself.
One particular example of this is tuberculosis. We have recognized over the last decade that the previously falling trend in the number of cases of TB has reversed. That reversal has occurred concurrently with increase in HIV infection. The same persons likely to have HIV infection are also likely to become afflicted with tuberculosis-persons addicted to illicit drugs.
It seems if we are going to do anything, even in the best interests of persons who do not use drugs, it is important that we make an effective response to deal with all the ramifications of drug abuse. It is particularly important that this country must develop a policy that considers drug abuse in the same vein as it considers other major health problems, such as diabetes, heart disease and hypertension, for truly drug abuse is probably going to be chronic in the lives of these patients addicted.
This means encouragement of health professional schools to add drug addiction to their curriculum and to include public drug abuse authorities within the structure of their public health authorities.
It seems ridiculous that in New York State that we are in that in New York City, and particularly in Harlem, the number of sites for National Health Service Corporations has actually decreased. How are we expected to be able to respond to this growing dilemma? In fact, in Harlem, this has been an issue for a long time.
In closing, these discussions on legalization of drugs provides this country with an excellent opportunity to evaluate the effectiveness of the Federal drug policy. It is my considered opinion these discussions will far exceed their potential if we also use them as the opportunity to reassess Federal drug abuse policies and make bold steps to chart a course that will truly target those factors that promulgate the spread of drug abuse and enhance the ability of health care providers to provide the medical care to persons suffering from the disease of addiction and drug-related complications.
Thank you. Mr. RANGEL. Thank you. [The prepared statement of Dr. Lawrence Brown appears on
Mr. RANGEL. David Boaz, CATO Institute.
TESTIMONY OF DAVID BOAZ, CATO INSTITUTE Mr. Boaz. Thank you. I would like to thank you and the Select Committee for holding these hearings. It is high time we had a full national debate on the failure of our current drug policy and possible alternatives.
My argument today is very simple. Alcohol didn't cause the high crime rates of the 1920s, Prohibition did. And drugs don't cause today's urban crime rate, drug prohibition does.
What are the effects of prohibition, specifically drug prohibition? The first one is crime. Drug laws drive up the price of drugs and force users to commit crimes to pay for a habit that would be easily affordable if it was legal. Some drug prices might be 100 times higher because of prohibition. Some experts estimate at least half the violent crime in major cities is the result of drug prohibition, and policemen would tell you the same thing if they were free to speak out.
The most dramatic drug-related crimes in our cities, of course, are the bloody shootouts between dealers. These are also a result of the drug laws. We don't see shootouts between rival liquor dealers, but drug dealers have no other way to settle their differences; they have no recourse but violence because they can't go to the courts.
The second effect of prohibition is corruption. Prohibition raises prices, which leads to extraordinary profits, which are an irresistible temptation to policemen, Customs officers and so on. When briefcases full of cash are casually offered to policemen making $35,000 a year, we should be shocked not that there are some Miami policemen on the take, but that there are some Miami policemen not on the take.
The third effect of prohibition, and one that is widely overlooked, is bringing buyers into contact with criminals. If you buy alcohol, because it is legal, you don't have to deal with criminals; but when you buy drugs, you are often dealing with real criminals. One of the strongest arguments for legalization is to divorce the process of using drugs, especially among young people, from the process of getting involved in this criminal culture.
A fourth effect of prohibition is the creation of stronger drugs. Richard Cowan has identified what he identifies the iron law of prohibition: the more intense the law enforcement, the more potent the drugs will become. Crack, for instance, is almost entirely a product of prohibition. It probably would not exist if drugs had been legal for the last 20 years. Crack is a result of prohibition, not an example of what legalization could mean.
A fifth effect of prohibition is civil liberties abuses. When you try to stop people from voluntarily engaging in a peaceful activity, you are almost certain to run into civil liberties problems in trying to enforce that law.
The sixth effect- I won't say the final effect-of prohibition is futility. The drug war simply isn't working. Some say that much of today's support for legalization is merely a sign of frustration. Well, frustration is a rational response to futility. If a government is involved in a war and it isn't winning, it has two basic choices: One is to escalate, and we have heard proposals to get the military involved, to make massive arrests of users, to strip search tourists returning to the United States, to seize cars and boats on the mere allegation of drug possession.
I think the more sensible response is to decriminalize, to de-escalate, to realize that trying to wage war not on chemical substances but on 23 million Americans is not going to be any more successful than Prohibition was in the 1920s. It is counterproductive. To decriminalize is not to endorse drug use, not to recommend drugs. It is merely to recognize that the cost of this war-billions of taxpayer dollars, runaway crime rates, the creation of criminal institutions, and civil liberties abuses—is too high.
Thank you, Mr. Chairman.
Mr. SCHEUER. I would make a unanimous consent request that all members of the committee be-and this is the same unanimous consent request I made yesterday—be enabled to direct further questions at the various witnesses in writing and that the record be held open for perhaps two weeks to enable the witnesses to submit answers. We have an enormous number of highly talented witnesses, and with five minutes per member to address 10 witnesses, it is really impossible to do. I think this hearing has been a marvelous contribution to the discourse, and it would help if we could address individual questions to individual members.
Mr. RANGEL. No objection. I hope the gentleman might consider staying for just five more minutes as we listen to two addicts, or former addicts, rather, Ray and Gloria Whitfield, who have suffered the pains of being addicted to drugs and of having their family affected by it. Not only were they able to find recovery but they have dedicated their lives to helping other people.
So to the Whitfields, you more than any of the witnesses we have had in two days, the basic question is not only for you and your