These are but a few examples of what should and can be done. We have not yet begun to tap into our vast resources to solve this national problem of addiction.

Finally my strong opposition to legalization stems from the realization that by legalizing illicit drugs we accept the inevitability that use will increase. In my opinion this approach cannot be reconciled with ethical principles because it would be implemented with recognition of the increased personal and social destruction connected with drug abuse that would result. We, as a civilized society, are responsible for preventing disease and destruction not spreading them.

1 Masi, D., Drug Free Workplace: A Guide for Supervisors, Buraff Publications, Inc., Washington, D.C., 1987.

2 Cook, R. and Harrell, A., "Drug Abuse Among Working Adults: Prevalence Rates and Recommended Strategies," Health Education Research: Theory and Practice, Vol.2, No.4, 1987, pp. 353-59.

TESTIMONY ON THE LEGALIZATION OF DRUGS

SELECT COMMITTEE ON NARCOTICS

SEPTEMBER 30, 1988

LAWRENCE S. BROWN, JR. MD, MPH

DEPARTMENT OF MEDICINE, HARLEM HOSPITAL CENTER AND THE
COLLEGE OF PHYSICIANS AND SURGEONS, COLUMBIA UNIVERSITY

MR. CHAIRMAN:

PLEASE LET ME OFFER MY MOST SINCERE GRATITUDE FOR THE OPPORTUNITY TO ADDRESS THIS ISSUE FROM THE VANTAGE POINT OF A PRIMARY HEALTH CARE PROVIDER. FEW HOSPITALS CAN PROFESS A GREATER EXPERIENCE THAN HARLEM HOSPITAL WITH MEETING THE CHALLENGES OF ILLICIT OR LICIT PSYCHOTROPHIC DRUG USE. BECAUSE OF HARLEM HOSPITAL'S LONG LEGACY OF COMMUNITY SERVICE TO ITS LARGELY ECONOMICALLY DISENFRANCHISED COMMUNITY, IT IS ESPECIALLY IMPORTANT THAT WE SHARE WITH YOU, AND THE OTHER MEMBERS OF THE SELECT COMMITTEE, OUR PARTICULAR EXPERIENCES. WHILE DRUG ABUSE KNOWS NO COLOR, RACIAL, SEXUAL, OR ECONOMIC BARRIERS, ITS PREVALENCE IN THE HARLEM COMMUNITY IS GREAT AND THE IMPACT OF DRUG ABUSE UPON THE CITIZENS OF HARLEM REPRESENTS, WITHOUT QUESTION, A MAJOR PUBLIC HEALTH PROBLEM.

DISCUSSIONS OF THE LEGALIZATION OF ONE OR MORE OF THE PRESENTLY

ILLICIT DRUGS ARE STIMULATED, AT LEAST IN PART, BY TWO RELATED FACTS. ONE
IS THE MOUNTING EVIDENCE THAT THE CURRENT RESPONSE OF THE AMERICAN SOCIETY
TO DRUG ABUSE HAS BEEN SHAMEFULLY INADEQUATE. THE SECOND, IS THE
HYPOTHESIS THAT LEGALIZATION REPRESENTS A REASONABLE ALTERNATIVE TO THE
CURRENT AMERICAN RESPONSE TO DRUG ADDICTION. I WOULD LIKE TO ADDRESS
THESE FACTS SEPARATELY.

I AM GOING TO LIMIT MY REMARKS TO PUBLIC HEALTH OR MEDICAL CARE ISSUES,
NOT BECAUSE THEY ARE NECESSARILY THE MOST CRITICAL AREAS FOR CONSIDERATION
BY THIS HEARING PROCESS, BUT RATHER BECAUSE THERE ARE MANY OTHER
INDIVIDUALS AND PERSONS OF VARIOUS LEVELS OF EXPERTISE WHO ARE ARGUABLY
MORE VERSED IN THE SOCIAL, ECONOMIC, AND CRIMINAL IMPLICATIONS OF DRUG
ABUSE. FROM THE PUBLIC HEALTH PERSPECTIVE, ONE CAN MEASURE THE
EFFECTIVENESS OF THE AMERICAN POLICIES DIRECTED AT DRUG ABUSE BASED UPON
THE PREVALENCE OF CONSUMPTION OF THESE PSYCHOTROPHIC SUBSTANCES AND/OR THE
PREVALENCE OF DISEASE AND DEATH DUE TO THE USE OF THESE AGENTS. I CONTEND
THAT WE DO NOT TRULY KNOW THE EXTENT OF USE OF THESE SUBSTANCES. CURRENT
DATABASES TO ASCERTAIN THE PREVALENCE OF DRUG ABUSE ARE EITHER BIASED BY
VIRTUE OF THEIR SELECTION METHODOLOGY OR SO ATROPHIED DUE TO INADEQUATE
MAINTENANCE SO AS TO COMPROMISE THE RESULTS THAT MAY BE DERIVED FROM THEM.
FOR EXAMPLE, ANNOUNCEMENTS ABOUT THE PREVALENCE OF DRUG ABUSE BASED UPON
SURVEYS CONDUCTED AMONG HIGH SCHOOL STUDENTS CAN NOT BE TRULY
REPRESENTATIVE AS TO WHAT IS OCCURRING AMONG ADOLESCENTS WHEN IN SOME
URBAN CENTERS HIGH SCHOOL DROPOUTS (WHO ARE NOT SURVEYED) MAY BE THE MOST
PRONED TO USE ILLEGAL OR LEGAL DRUGS. EVEN SO, IT CAN HARDLY BE SAID THAT
THE UNITED STATES IS MAKING MAJOR GAINS IN RESPONSE TO DRUG ABUSE WHEN ONE
PSYCHOTROPHIC IS BEING MERELY REPLACED BY ANOTHER.

IF ONE WERE ON THE OTHER HAND TO LOOK AT THE PREVALENCE OF SCIENTIFICALLY DOCUMENTED MEDICAL CONSEQUENCES OF DRUG ADDICTION AS A GAGE OF THIS SOCIETY'S RESPONSE, THE UNEQUIVOCAL CONCLUSION WOULD REMAIN THAT AMERICAN POLICY TO ADDRESS DRUG ABUSE IS A FAILED POLICY. AS MEDICAL PROVIDERS AT HARLEM HOSPITAL WE SEE A CONTINUOUS PARADE OF PATIENTS ADMITTED FOR SUCH

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.

IN NEW YORK

THE STIGMA ATTACHED TO DRUG ABUSE OR TO THOSE WHO USE DRUGS HAMPERS OUR UNDERSTANDING OF THIS MEDICAL DISORDER AND OUR RESPONSE. 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