Drugs and Drug Policy: The Control of Consciousness Alteration

In discussing drugs, their effects, and policies regulating them, it is obviously important to review the scientific literature; this book includes extensive coverage of research published in medical, scientific, social-scientific, and other academic journals. However, unlike other authors writing on the topic of drugs, we also draw extensively from print and Internet media discussions of drugs. We adopt this strategy because we believe, based on our teaching experience and participation in public forums on these issues, that most of the general public derive their (often mis-) information about drugs, their effects, and drug policies from these sources. While a considerable proportion of the discussion of drugs in print media sources is, in fact, derived from scientific literature, reporters and journalists, either through ignorance or design, often misinterpret the scientific information in ways that serve to mislead the general public. It is thus necessary to include, and critically review, media materials on drugs.

We also draw on materials from organizations such as the National Organization for the Reform of Marijuana Laws (NORML), the Marijuana Policy Project (MPP), the Drug Policy Alliance (DPA), and Common Sense for Drug Policy (CSDP), all of which have been critical of U.S. drug policies and have called for reform. We are aware that some will see these organizations as “advocacy groups” in the drug policy context, and we would tend to agree. However, we find many of the arguments made by these organizations to be compelling; as will be demonstrated, unlike several “official government” publications and commentaries on drugs and drug policies from bureaucracies such as the Office of National Drug Control Policy (ONDCP), to support their arguments for drug law reform, these so-called advocacy groups typically refer to actual scientific studies in their publications. In contrast, much of the information on drugs published by official government organizations is blatantly misleading and, in many cases, false. It is thus also important to critically review the information disseminated by these government sources because, as will be discussed, this information has had a direct impact on policies regarding both licit and illicit drugs.

In recent years, much of the misinformation on drugs has been presented by “drug czars” appointed by U.S. presidents. For example, in criticizing the more relaxed approach to drugs taken in the Netherlands, General Barry McCaffrey (drug czar under President Clinton) commented, “The Dutch drug experience is not something we want to model. It's an unmitigated disaster” (as quoted in J. Gray, 2001). McCaffrey claimed that all youth in [Page xii]Amsterdam's Vondel Park were “stoned zombies” and stated that “the murder rate in Holland is double that of the United States … that's drugs” (as quoted in Reinarman, 2002, p. 127). In justifying this claim, the drug czar noted that there were 17.58 murders per 100,000 population in the Netherlands, compared to 8.22 per 100,000 in the United States. Interestingly, the Dutch homicide rate cited by McCaffrey combined homicides and attempted homicides in the same category; the actual Dutch homicide rate was 1.8 per 100,000, or less than one-quarter the U.S. rate (Reinarman, 2002). When an official from the Dutch embassy questioned McCaffrey's deputy drug czar about these misleading statistics, the deputy's response was “Let's say that's right. What you're left with is that they [the Dutch] are a much more violent society and more inept (at murder) and that's not much to brag about” (as quoted in Reinarman, 2002, p. 129).

In a more recent example of distortion and misinformation propagated by government officials, John Walters, drug czar under President George W. Bush, pointed to data from the Monitoring the Future Study (a study that tracks drug use among young people in the United States) and claimed that “this survey confirms that our drug prevention efforts are working” (as quoted in J. Cole, 2005). But as Cole points out, a comparison of the 1991 and 2002 Monitoring the Future data indicated that over this period, marijuana use increased 30% for 12th-grade students, 128% for 10th-grade students, and 188% for 8th-grade students. These data prompted Cole to ask, “How can John Walters say this study shows our drug prevention efforts are working? Could the drug warriors possibly be lying to us?” Throughout this book we will critically assess the contentions of government officials in their support of the United States’ continuing War on Drugs.

It is important to note that in addition to the groups mentioned above who have advocated for drug policy reform, several prominent Americans, including leading conservative thinkers, politicians, judges, and law enforcement officials, have called for drug law reform. Former CBS News anchor Walter Cronkite (2006) noted that the casualties of the War on Drugs “are the wasted lives of our own citizens” and commented that “amid the clichés of the drug war, our country has lost sight of the scientific facts. Amid the rhetoric of our leaders, we've become blind to reality. The war on drugs, as it is currently fought, is too expensive, and too inhumane.” Nobel Prize–winning economist Milton Friedman argued in a 1998 New York Times editorial,

Similarly, in the introduction to a series of articles about American drug policy published in 1996, the editors of the conservative magazine National Review commented,

[Page xiii]Among the contributors to this edition of National Review was William F. Buckley, Jr. (founder of the magazine), who lamented the tremendous costs (both monetary and social) of the War on Drugs and recommended legalization of the sale of most currently illegal drugs, except to minors (Buckley et al., 1996). In the same edition of National Review, Kurt Schmoke, then mayor of Baltimore, Maryland, referred to the United States’ War on Drugs as a “domestic Vietnam” and called for medicalization or regulated distribution of drugs (Buckley et al., 1996). Under this system, the government would set up a scheme to place drug addicts in the public health care system, and would control the price, distribution, and purity of addictive substances. In a 1989 Wall Street Journal article, George Schultz, former Secretary of State under Ronald Reagan and George H. W. Bush, made a similar argument, noting,

An increasing number of law enforcement officials have also called for drug law reform. Former Kansas City and San Jose police chief Joseph McNamara referred to the extensive corruption in law enforcement created by the drug war, and commented,

Norm Stamper, who served as chief of the Seattle police department for six years, wrote a book (Stamper, 2005a) and an op-ed article that appeared in the Los Angeles Times and several other newspapers, in which he argued “it's time to accept drug use as a right of adult Americans, treat drug abuse as a public health problem, and end the madness of this unwinnable war” (2005b). Stamper commented, “It's not a stretch to conclude that our draconian approach to drug use is the most injurious domestic policy since slavery” and called for the legalization of all drugs (not just marijuana), including heroin, cocaine, methamphetamine, psychotropics, mushrooms, and LSD (Stamper, 2005b).

While it is certainly true that they do not represent the views of all—or even a majority of—criminal justice system officials, perhaps the most prominent example of law enforcement officials’ critique of the drug war is represented by a group known as Law Enforcement Against Prohibition (LEAP). This organization was formed in 2002 and consists of over 3,500 current and former members of law enforcement who

LEAP's mission is to reduce the harmful consequences created by the War on Drugs and to “lessen the incidence of death, disease, crime, and addiction by ultimately ending drug prohibition.” Jack Cole (2005), a member of LEAP, echoing some of the comments above, referred to the war on drugs as a “total and abject failure … a war on our people—our own [Page xiv]people—our children, our parents, ourselves” and recommended the legalization of all drugs “so we can regulate and control them and keep them out of the hands of our children.”

While we realize that many reading this book will have considerable difficulty accepting arguments in favor of the legalization of drugs, and we are not necessarily advocating outright legalization of all drugs, these arguments must be placed in the context of an evaluation of the successes and failures of current drug policies. The apparent goal of drug policy is to reduce, if not eliminate, drug abuse and the social harms associated with drug abuse. However, as the commentaries above indicate, and as will be further demonstrated in this book, not only have these goals not been realized, but current drug policy has resulted in tremendous social and economic costs and significant ancillary harms. As such, serious consideration must be given to drug policy reforms.

In Chapter 1, we address the widespread use of psychoactive drugs across time and society. The ubiquity of drug use is particularly interesting given that the use of all forms of drugs—legal and illegal—involves some level of risk. The substantial level of harm posed by the use of legal drugs contrasts with the typical view of some drugs as “good” and others as “bad.” Accordingly, this chapter demonstrates how legal and illegal drugs are similar and different and addresses the way certain drugs have been demonized in order to justify their illegal status.

A variety of strategies have been employed to emphasize the dangers of (illegal) drugs over the past century. Common tactics include claims that illegal drug use is responsible for the majority of crime that occurs in society; that illegal drugs possess unique powers that encourage otherwise normal people to engage in bizarre and often violent behavior; that minorities, immigrants, and foreign nationals are the primary users and traffickers of illegal drugs; and that illegal drugs (in contrast to legal drugs) pose a unique threat to the health of children. Finally, illegal drugs have been demonized through a misrepresentation of the scientific evidence on the effects of these drugs, particularly by government agencies.

The intent of Chapter 1 is not to ignore or minimize the substantial harm caused by the use of drugs in society, but rather to properly assess the threat posed by the use of particular drugs and to demonstrate that both legal and illegal drugs pose significant risks. Socially constructed epidemics tend to exaggerate and distort the nature and magnitude of drug problems, making appropriate prevention, treatment, and drug control responses more difficult.

In Chapter 2, we address a variety of theoretical explanations for substance use and dependency. Theories of substance use are designed to explain why drug use and abuse occurs and why it varies across different circumstances and social conditions. We summarize nature, genetic/biological, psychological, and sociological theories of substance use and examine the scientific evidence with respect to the validity of these theories.

The nature perspective contends that people have a universal and innate drive to alter their consciousness and that substance use is simply one way in which humans express this drive. Genetic/biological explanations of substance use emphasize that inherited predispositions to substance use largely determine whether an individual will use, and especially abuse, psychoactive drugs. The disease model of addiction is often confused with the genetic model, [Page xv]but there are important differences. Like the genetic model, most versions of the disease theory assert that substance use and addiction are related to genetic predispositions; however, the disease model makes several ideological assumptions (e.g., that abstinence is the only remedy for alcoholics and that alcoholism invariably grows worse, ultimately resulting in death) that are not supported by scientific research.

Psychological perspectives on substance use include the self-derogation perspective, which contends that people use psychoactive substances as a result of a lack of self-esteem. According to this perspective, individuals engage in substance use and abuse in the pursuit of positive affirmation from others—affirmation they have not received from more conventional sources. Another predominately psychological perspective is “problem-behavior” theory, which asserts that substance use is just one type of behavior that is typical of a “problem-behavior personality.” The traits that characterize this personality (e.g., risk taking, rebellion, pleasure seeking) are not necessarily negative or pathological in and of themselves; however, they encourage behaviors that often conflict with social and legal norms.

Sociological perspectives on drug use addressed in Chapter 2 include social learning theory, social bonding theory, anomie or “strain” theories, social development theories, and conflict theories. Social learning theory emphasizes how interactions with others, especially intimate others, may contribute to substance use when people learn positive messages that encourage substance use. Social bonding theory contends that substance use results when a person is not sufficiently integrated into conventional society in terms of his or her relationships to family, spouses, children, conventional friends, employment, education, religion, school, community organizations, and other institutions in society. Anomie or strain theories of substance use emphasize the importance of economic and emotional stressors in the etiology of substance use and abuse, while developmental theories focus on changes in substance use across the lifecourse. Finally, conflict perspectives of substance use emphasize the importance of power differentials in society in influencing substance use and drug policies and pay particular attention to differential outcomes across social class and race/ethnicity in criminal justice system responses to illegal drug use and trafficking.

In Chapters 3 and 4, we discuss several categories of drugs based on their physiological, psychological, and behavioral effects. Based on these effects, psychoactive substances—which include herbal supplements, over-the-counter medications, prescription drugs, and other legal and illegal substances—are grouped into the following categories: stimulants, depressants, opiates; hallucinogens; PCP and ketamine; inhalants; marijuana; antidepressants; aphrodisiacs; and steroids and other performance-enhancing drugs.

As noted above, the illegal status of certain drugs is often based on rhetoric that illegal substances are distinct in terms of the harms they pose to society and the user. To assess the potential of a drug to cause harm to the individual and society, multiple dimensions of risk must be considered simultaneously. In addition to their psychoactive effects, drugs can be assessed in terms of their ability to generate physical dependence, psychological dependence, and both short- and long-term adverse health effects in users. When substances are evaluated across all these dimensions of harm, it is clear that there are few differences between legal and illegal drugs.

Chapters 5 and 6 examine patterns of legal and illegal drug use in society. Information on the use and abuse of legal and illegal drugs is derived primarily from several large-scale surveys and selected compilations of criminal justice and health statistics, as well as observational studies and interviews with drug users and officials in drug-related fields. These [Page xvi]data have enabled researchers to demonstrate that drug use is more common in some populations than others.

The key demographic factors that influence legal and illegal drug use are age, gender, race/ethnicity, social class, and urbanity. Drug use is more common in late adolescence and early adulthood than at any other point in the lifecourse. Gender is another important predictor of illegal drug use because males are more likely than females to use illegal drugs. Drug use also varies by race/ethnicity, but in contrast to what is commonly believed, whites are among the most likely to use both illegal and legal drugs. Where data allow, in Chapters 5 and 6 we examine the divergent patterns of drug use that exist within certain racial/ethnic subgroups (e.g., Hispanics and Asians), illustrating that drug use varies both within as well as across race/ethnicity. We also note that racial differences in drug use are linked to social class and review the data on the relationship between social class and substance use and abuse. Finally, residence characteristics, such as whether one lives in an urban area as opposed to a small town or rural area, are important for understanding drug use.

Chapter 7 presents a critical examination of current policies dealing with illegal drugs in the United States, focusing on issues of effectiveness in achieving their stated goals, economic and social costs, and unintended consequences resulting from these policies. Several Western countries treat drug use and dependency primarily as a public health issue, but the United States has a long history of addressing drug problems through the criminal justice system. Our review of U.S. policies suggests that criminal justice responses to drug use do little or nothing to reduce drug use in the general population, while they simultaneously create a number of social and economic problems. The most problematic consequences of these policies are that they substantially increase prison populations and justice system expenditures, with a disproportionately negative impact on members of minority groups and the lower social classes.

While “wars on drugs” have been virtually continuous throughout the 20th century in the United States, the most recent “War on Drugs,” which began in the mid-1980s, has resulted in an intensification of the criminal justice system response to drug use. Annual arrests for drug use have increased substantially since the mid-1980s, average sentences for drug crimes are considerably longer, and the number of people incarcerated for drug offenses has increased exponentially. These policies have also had a disparate impact on the lower class and members of minority groups. Despite the fact that African Americans and Hispanics use illegal drugs less frequently or in approximately the same proportion as whites, the consequences of drug policies fall disproportionately on minorities in terms of arrests, prosecutions, incarcerations, and a host of additional social and monetary costs.

While the United States policies toward illegal drugs were apparently implemented with the goal of preventing and reducing drug use and drug-related harm, after more than 20 years and hundreds of billions of dollars in criminal justice system and other expenditures, it is clear that these policies have failed to achieve these goals, and they have also created substantial ancillary problems in the process.

In Chapter 8, we examine issues related to drug use prevention. Drug use prevention involves a wide variety of strategies intended to limit the use and abuse of psychoactive drugs. While research indicates that prevention efforts focused on reducing drug risk factors and enhancing drug protective factors can be effective, current prevention expenditures and efforts are primarily invested in programs that are based on narrow and misguided conceptions of the reality of drug use. Among these programs are select drug education programs [Page xvii](e.g., DARE), anti-drug advertising campaigns directed primarily at youth, zero tolerance drug policies in schools, and drug testing (as applied in schools and the workplace).

The Drug Abuse Resistance Education (DARE) program is the largest school-based drug education program in the United States. Nearly every scientific study of DARE has found the program to be ineffective at reducing drug use. This is largely because DARE (similar to many other drug prevention programs) is based on a number of problematic assumptions about drug use, including that (1) experimentation with drugs is not a common aspect of youth culture; (2) any drug use is either equivalent to, or will eventually lead to, drug abuse; (3) marijuana is the gateway to hard drugs such as heroin and cocaine; and (4) exaggerating the risks associated with drug use will deter young people from experimenting with drugs. Despite DARE's ineffectiveness, the program persists because it is popular with several law enforcement agencies, school administrators, teachers, and parents, many of whom (mistakenly) believe that the program is effective.

Anti-drug advertising campaigns are another form of drug prevention campaign that have been found to be ineffective at reducing drug use by youth. These advertising campaigns often present false and sometimes ridiculous information about illegal drug use (some may recall the “frying egg” commercial), and they typically pay little attention to the dangers of tobacco, alcohol, and prescription drug use. Like the ineffectiveness of DARE, the ineffectiveness of these campaigns is tied to how young people respond to the messages promoted. The campaigns may have a counterproductive effect on youth drug use because youth tend to reject all anti-drug messages when they identify some as being false, or because they encourage young people to desire and seek out something that is forbidden (known as “reactance”).

School-based “zero tolerance” policies typically involve the suspension or expulsion of students who are in possession of or under the influence of drugs on school property. Advocates of these policies believe that they are beneficial because they send a clear message that drug use will not be tolerated and they supposedly keep drug-using youth away from the rest of the student body. Part of this strategy involves drug testing students who want to participate in athletics or other afterschool activities. These policies have little preventative effect on drug use among students who remain in school, and they may, in fact, encourage drug use by those students who are most at risk.

Drug testing in the workplace is another widely implemented prevention strategy. We do not dispute that there are occupations for which drug testing is appropriate in the interest of public safety, but workplace drug testing outside such contexts is increasingly widespread and is typically justified as being an effective deterrent to drug use that will increase worker productivity and company profits. However, scientific research does not identify a preventive effect of drug testing for employee drug use, and there is little evidence to suggest that these programs increase worker productivity. In part, this is because the drug that is most likely to be identified in drug tests (by far) is marijuana, due to the fact that it remains detectable in the urine for weeks after use. Marijuana is far less likely to limit productivity than is alcohol (which is rarely, if ever, tested for). Illegal drugs that would be more likely to negatively influence worker productivity (e.g., heroin, cocaine, amphetamines) become undetectable in the urine within days and are thus rarely identified by drug tests. Drug testing may also limit productivity because it creates a negative work environment that alienates workers from their employer.

Chapter 9 provides an overview of the five broad categories of drug treatment currently available and reviews the evidence on their effectiveness. Pharmacological drug treatment [Page xviii]involves the use of drugs or medications to treat substance abuse. This form of treatment can be temporary, long term, or permanent in nature. Temporary forms of pharmacological treatment involve using one drug to relieve withdrawal symptoms or otherwise facilitate the goal of abstinence or reduced use of another drug. Long-term or permanent pharmacological treatment involves use of a drug in the belief that the new drug will reduce or eliminate the use of a more problematic drug (e.g., methadone maintenance for heroin addicts).

Long-term residential drug treatment programs, the most notable being therapeutic communities, involve treatment provided to patients who live in a treatment facility for periods of up to two years. The therapeutic community model typically views drug abuse as only one symptom of a broader problem that afflicts the individual. Because of this, the re-socialization of the individual is thought to be necessary to achieve positive post-treatment outcomes.

Compulsory drug treatment involves treatment that is mandated in some way by the criminal justice system. While the specific strategies are diverse, this can involve treatment in prison or in the broader community. Among the most popular forms of compulsory treatment are drug courts, which allow individuals to participate in drug treatment in lieu of prison, with the understanding that sanctions (including the possibility of incarceration) may result if the individual does not comply with the requirements of the treatment program as agreed upon in court.

Alcoholics Anonymous, 12-step, and related “peer support” programs involve treatment in which individuals identified as alcoholics or addicts attend meetings in their community with other individuals identified as alcoholics or addicts, enabling them to draw on each other for support and understanding in their struggle with addiction. Alcoholics Anonymous (A.A.) represents by far the largest drug treatment “program” in the world. While the central tenets of the A.A. model—including that alcoholics are afflicted with an incurable disease characterized by a loss of control over alcohol and that total abstinence is the only effective means of treatment—are not supported by scientific research, these groups have helped many individuals with their problem drinking, largely because of the peer-support network and structure provided by the program.

The need for drug treatment from both a humanitarian and economic standpoint is clear. Studies of treatment efficacy find that many programs are useful in terms of reducing drug use, reducing criminal activity, and increasing levels of employment. As such, treatment is far more cost effective and humanitarian than dealing with drug problems exclusively through the criminal justice system.

Chapters 10 and 11 address the regulation of legal drugs. Chapter 10 focuses on the regulation of tobacco and alcohol while Chapter 11 examines policies regulating prescription drugs, performance-enhancing substances, and herbal supplements. Many of the legal substances whose regulation we cover in these chapters are, in fact, far more harmful, both in terms of their effects on individual users and on the larger society, than drugs that are currently categorized as illegal in the United States.

The apparent goals of policies designed to regulate legal and illegal drugs are the same: to prevent drug misuse and abuse and minimize the harm to society. However, the nature of regulation for legal and illegal drugs is fundamentally different. The regulation of illegal drugs relies heavily on punitive criminal justice system responses, while the regulation of legal drugs involves controlling access to them, taxing them, and, in some cases, dealing with the harmful consequences associated with the use of these drugs.

Another fundamental difference between policies regulating illegal and legal drugs is that the companies who produce legal drugs have an advantage in marketing and selling their [Page xix]respective products that is not enjoyed by those who sell illegal products. The profits associated with the sale of legal drugs, including tobacco, alcohol, and prescription drugs, are tremendous, and the companies manufacturing these products have substantial political and economic power, which they use to influence legislators who create policies to regulate these substances. While current laws allow companies to sell their legal drug products, it is also important to consider how they are dealt with by government authorities when they are found to be in violation of the (already comparatively weak) laws designed to regulate them.

The pronounced lack of regulation for alcohol and tobacco is particularly notable when placed in the context of the levels of harm associated with the use of these substances. As one indication of their level of harm, in the United States, the annual number of deaths attributable to the use of tobacco and alcohol is roughly 30 times the annual number of deaths attributable to the use of all illicit drugs combined. While modern alcohol and tobacco policies have been enacted with the laudable goal of reducing alcohol- and tobacco-related harm, in practice, some of these policies are relatively effective, but some are totally ineffective and serve to exacerbate problems.

Chapter 10 thus examines attempts to regulate the consumption of tobacco through bans on public smoking, restrictions on the advertising and marketing of tobacco products, and taxes on the sale of tobacco products. The chapter also addresses age limits for the purchase and consumption of alcohol, alcohol interventions targeted at college populations, and policies designed to reduce drunk driving.

The regulation of prescription drugs is addressed in Chapter 11. We recognize that millions of people benefit from the products manufactured by pharmaceutical companies, but note that the motivation of these companies to increase their profits often takes precedence over more general public health concerns. Several unsafe products have been aggressively marketed by these companies and used by consumers, resulting in significant numbers of injuries and deaths. Perhaps more disturbingly, pharmaceutical companies have used their considerable political and monetary power to influence the Food and Drug Administration and to shape legislation regulating their products.

Chapter 11 also examines the regulation of performance-enhancing drugs and herbal supplements. In our discussion of performance-enhancing drugs, we discuss the rationale for the regulation of drugs in sport and note that until fairly recently, federal and state governments allowed various sports organizations to create their own policies to regulate these drugs. We also examine the regulation of these drugs across a variety of sports, noting the considerable variation that exists in terms of the stringency of the policies. Our discussion of the regulation of dietary/herbal supplements points out that these substances are associated with tens of thousands of adverse health outcomes in users in any given year. Despite this considerable level of harm, the regulation of dietary/herbal supplements is even more lax than the regulation of pharmaceutical products.

In Chapter 12, we compare and contrast the drug policies of a sample of countries with those of the United States, and also critically examine the U.S. government's efforts to influence drug policies in some of these countries, particularly in Canada and Latin America. We consider countries that have adopted very severe penalties for the use, sale, and production of drugs (e.g., China and Indonesia) as well as countries that have shifted to strategies that place more emphasis on the principles of harm minimization or harm reduction (e.g., Canada, Australia, and most Western European countries).

For many countries, the shift to drug policies based on harm reduction transpired in recognition of the substantial challenges and costs, both human and financial, that accompany [Page xx]drug criminalization and the rigorous enforcement of drug laws. Drug laws that are disproportionately based on criminalization and enforcement tend to do little or nothing to reduce the level of drug use in the general population, while at the same time creating a vast array of additional problems. In large part, this is because these policies do nothing to reduce the demand for psychoactive substances. Such policies are least defensible when they target “soft” drugs such as marijuana because they tend to cost society a great deal and result in considerable harm to users in their attempt to prevent the use of a drug that, in many cases, is no worse than available legal drugs.

Advocates of harm-reduction policies in many countries have emphasized that the damage done by the response to drug use must be weighed against the harms posed by drug use itself. Harm-reduction efforts aimed at “hard” drug use are more controversial than those aimed at marijuana. Some have nothing to do with the legal status of a drug (e.g., needle exchange programs) and simply attempt to minimize the negative consequences associated with heroin and other intravenous drug use. Other harm reduction approaches, such as heroin maintenance programs, are much more controversial because they provide users with illegal drugs. Advocates of these programs remind us that these approaches in no way “approve” of heroin use, but consistent with the harm reduction approach, they attempt to minimize severe drug problems (e.g., high rates of overdose and HIV infection) that have not been effectively managed under existing drug policies.

Several countries—in particular the United States—have attempted to prevent domestic drug use by eliminating the production of drugs in other countries. These “supply side” efforts to reduce drug use (e.g., crop eradication) face many challenges. Such policies do nothing to reduce the substantial demand for drugs in Western countries. In addition, the generally impoverished residents of underdeveloped countries have a strong incentive to produce illegal drugs, so eliminating one source of drugs does not reduce supply to Western markets; it simply relocates drug growth and production to some other area.

Future drug policies should consider the empirical evidence on the harms posed by particular drugs and enact laws that do more good than harm. The shift of most developed countries to approaches that are based on harm minimization, and the lack of substantial increases in drug use following these policy changes, suggests that the United States needs to reconsider its strict criminal justice system approach to regulating currently illegal drugs.