Prescription drug abuse and broader drug policy

Yes, prescription drug abuse is now a big problem. And cocaine/meth/heroin are a big problem. And alcohol is the biggest problem of all. Those statements are all consistent; the idea that we should stop paying attention to cocaine because kids are abusing Vicodin doesn’t logically parse.

Damien Cave reports that the upsurge in diverted pharmaceutical use is causing a re-thinking of drug policy generally. I’m all for a re-thinking, and especially for a new policy not based on the fantasy that drug law enforcement can substantially reduce international drug flows if we just keep doing it, or do more of it, or do it in some more clever way.

But it’s not as if the upsurge in abuse of oxycodone and hydrocodone has displaced the abuse of other drugs: indeed, there’s good evidence of a stepping-stone effect from the prescription opioids to heroin, which is much cheaper on a dose-equivalent basis. The volume of cocaine has been shrinking as the cocaine-using population ages, but cocaine (along with meth) remains a major problem, especially among people arrested for non-drug crimes. So the notion that the prescription-drug problem makes the problem of strictly illicit drugs irrelevant doesn’t seem to make much sense.

If the argument is that strictly illicit drugs represent a small fraction of the total drug abuse problem, that’s true, but it’s true primarily because alcohol dwarfs everything else.

So, yes, we need a prescription-drug-abuse policy, with the usual triad of enforcement-prevention-and-treatment looking even less promising than usual; if we’re looking for a treatment for hydrocodone dependence, methadone seems like an odd fit. And we need a better approach to the strictly illicit drugs. And we need to pay some serious attention to alcohol. Those are “ands,” not “buts.” Drug policy should be able to walk and chew gum* at once. Right now, it can barely do either one.

* (No, Lyndon Johnson did not say “walk.” But the newspapers weren’t willing to print what he actually said.)




Author: Mark Kleiman

Professor of Public Policy at the NYU Marron Institute for Urban Management and editor of the Journal of Drug Policy Analysis. Teaches about the methods of policy analysis about drug abuse control and crime control policy, working out the implications of two principles: that swift and certain sanctions don't have to be severe to be effective, and that well-designed threats usually don't have to be carried out. Books: Drugs and Drug Policy: What Everyone Needs to Know (with Jonathan Caulkins and Angela Hawken) When Brute Force Fails: How to Have Less Crime and Less Punishment (Princeton, 2009; named one of the "books of the year" by The Economist Against Excess: Drug Policy for Results (Basic, 1993) Marijuana: Costs of Abuse, Costs of Control (Greenwood, 1989) UCLA Homepage Curriculum Vitae Contact:

5 thoughts on “Prescription drug abuse and broader drug policy”

  1. Just wondering what you mean by cocaine “remains a major problem, especially among people arrested for non-drug crimes.” Specifically what do you mean by ‘problem’? (Not being sarcastic, I really do wonder what you mean)

    1. About a quarter of people arrested for non-drug felonies test positive for cocaine (use within the previous 72 hours).

  2. This is one of the great mysteries of the field. We have tended to assume that legal markets invariably displace/shrink illegal markets, but maybe this is wrong, or at least wrong some of the time. Gambling data are poor, but there are some indications that the explosion of legal gambling has increased rather than decreased black market gambling. If the legal markets grows by a factor of five, that increases the pool of people who become interested in the illegal market (e.g., people who burn out their credit and want to start taking money for gambling from loan sharks). The same phenomenon may be happening with licit opiates.

  3. Followed your link to see what LBJ really said about Jerry Ford. Immediately after that sentence, I found these:

    Ford’s role shifted under President Nixon to being an advocate for the White House agenda. Congress passed several of Nixon’s proposals, including the National Environmental Policy Act and the Tax Reform Act of 1969. Another high-profile victory for the Republican minority was the State and Local Fiscal Assistance act. Passed in 1972, the act established a Revenue Sharing program for state and local governments.[50] Ford’s leadership was instrumental in shepherding revenue sharing through Congress, and resulted in a bipartisan coalition that supported the bill with 223 votes in favor (compared with 185 against).[44][51]

    During the eight years (1965–1973) he served as Minority Leader, Ford won many friends in the House because of his fair leadership and inoffensive personality.[44] An office building in the U.S. Capitol Complex, House Annex 2, was renamed for Gerald Ford as the Ford House Office Building.

    Goodness … what ever happened to that Republican Party, and who are these imposters now?

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