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Can We Win the War on Drugs?

ANNOUNCER: 'Think Tank' is made possible by Amgen, recipient of the PresidentialNational Medal of Technology. Amgen, helping cancer patients through cellularand molecular biology, improving lives today and bringing hope for tomorrow.

Additional funding is provided by the John M. Olin Foundation and the Lynde andHarry Bradley Foundation.

MR. WATTENBERG: Hello, I'm Ben Wattenberg. The battle against drug abuse hasbeen joined by both presidential candidates, but this war has been going on andoff for at least 80 years. Can it be won, and what can a president really do tofight it?

Joining us to sort through the conflict and consensus are: John Walters, formeracting drug czar in the Bush administration and president of the New CitizenshipProject; Peter Reuter, professor of public policy at the University of Marylandand author of 'Disorganized Crime: The Economics of the Visible Hand'; and AdeleHarrell, director of the program on law and behavior at the Urban Institute.

The question before the house: Can we win the war on drugs? This week on 'ThinkTank.'

America's problems with drugs did not begin recently. In fact, a century ago,there were a quarter of a million Americans addicted to various opiates,including many that are outlawed today. In response, President Woodrow Wilsonsigned the first major antidrug bill in 1915. Called the Harrison Act, itoutlawed heroin and cocaine. That combined with interdiction, treatment, publicrelations, and public education dramatically reduced drug dependence.

But 50 years later, illegal drugs were once again on the radar screen. In the1960s and the 1970s, there was an explosion in substance abuse. In the 1980s,crack cocaine brought violence to the streets. Ronald Reagan declared a war ondrugs. Nancy Reagan's campaign featured the slogan 'Just say no.'

NANCY REAGAN: (From videotape.) I'd like to see every young person in the worldjoin the 'Just say no to drugs' club.

MR. WATTENBERG: Throughout the 1980s and the early 1990s, drug use declined. But look at the data since 1990. The number of 12 to 17 year-olds using drugshas doubled. That has become a political flashpoint. Did substance abuseincrease because of a lack of government spending? Expenditures continued to goup in the last few years, but with little apparent effect.

Lady and gentlemen, thank you for joining us once again. You're all veteranshere. Let's go around the room just kind of quickly, perhaps starting with you,John Walters, and let's talk substance, not substance abuse, about this issue. What does the battleground now look like?

MR. WALTERS: Well, it's a serious and growing problem. The number of youngpeople using drugs which is the entry point; if you don't use drugs by age 20,you're unlikely to go on has increased. It's doubled, as you said, since '92.It's increased for even I mean, people think of marijuana, but it's increased it's at a record level for LSD since we've been measuring in the '70s. Cocaineand heroin, although small in that population, have increased remarkably. Emergency room mentions for people connected with drug use overall, but forheroin and cocaine, are at record levels since we've been measuring, going backto more than a decade. And the price of drugs on the street is at increasinglylow prices, and purity is increasingly high.

So almost every way in which we measure the drug problem, the trends are going inthe wrong direction, after going in the right direction.

MR. WATTENBERG: Adele Harrell of the Urban Institute, do you sign onto that?

MS. HARRELL: I think the trends are going in the wrong direction. I wanted totake issue with the analogy to war. I think it should be viewed as an epidemicwhich flares up from time to time because I see it primarily as an ongoing socialissue. We have a new group of kids coming along who haven't been exposed to someof the lessons that we learned before. And if you look at the span of history,you see, as you noted earlier, waves of drug epidemics that vary by drug. Thiswar will be very different, or this epidemic, from some that went before. Themarijuana is a different breed of marijuana than it was for the parents of thesekids, or the grandparents in some cases.

MR. WATTENBERG: Is it more addictive or more harmful?

MS. HARRELL: The addictive property of the drug is much stronger, and it is muchmore likely to have been produced in the United States, which will change all therules about interdiction.

MR. WATTENBERG: Peter Reuter, University of Maryland.

MR. REUTER: I also think the term 'war on drugs' is an unfortunate one. Thisis not a war that we've won or lost. This is a social problem that we manage,and we manage it now rather poorly.

MR. WATTENBERG: Well, didn't we, I mean by and large, win a war on drugs in theearly part of the century? I mean, that's the way it's been I didn't invent theterm. I mean, it was

MR. REUTER: No, no, no, no. The war on drugs is a very late 20th century term. It was not described that way. The Harrison Act was passed, actually, with verylittle fanfare at the time, and the drug problem, though certainly there was aproblem about opiate and cocaine abuse, was not a particularly high profileproblem. The numbers were, even when you account for the difference in the muchsmaller population, the numbers were, if you take cocaine and heroin together,opiates together, dramatically smaller than it is now. Prohibition of alcoholcaptured the attention throughout the early part of the century. The move toprohibit opiates and cocaine was really quite a small movement.

MS. HARRELL: Certainly no presidential elections previously debated it. MR.WALTERS: I think there's one other difference, though, that is important here,and that is the information we have on earlier in the century is more scattered,but it suggests that today the problem is much more focused on younger people andchildren, that these other problems were more an adultfocused problem. Andwhat's frightening about that is not only the responsibility society has tochildren, which is important enough, but also the degree to which their use tendsto move into more frequent, more heavy, more dangerous avenues and predict futureproblems.

MR. WATTENBERG: And you are saying, basically, young people are a predictorgroup because when they become adults, many of them will continue to be addicted. I mean, is that the idea as to why this is

MR. WALTERS: Well, we at least know that, as I said, people who do not try drugs and this also applies to alcohol and tobacco, by the way by age 20 are unlikelyto go on later on. I think there's a kind of conception in people's minds thatthe drug problem is about kind of, you know, young adults who are responsible forthemselves, but in fact this is a scourge that affects our children and

MR. WATTENBERG: Is it let's pick up that word for just a minute is it ascourge? I mean, when you start seeing the numbers of people I don't know, whatare we talking about, 30 million people or something that are using something orother in America? And they must be the people you're seeing walking up and downthe street all the time.

MR. REUTER: Yeah, but look, even William Bennett, sort of the leading hawk, saidin what is a wonderful essay in the first national drug control strategy in 1989,he said, look, most people just desist of their own free will and not much harmcomes to them from using drugs. See, they wanted to make this elegant argumentthat the risk of them getting into trouble was high enough that we had to takeeven that casual use seriously.

Sure, you know, there are 70 million people who have tried drugs. I think you'dsort of be hard pushed to say that 15 percent of them had incurred seriousproblems as a result of that.

MR. WALTERS: Let me just take one exception with what Peter said. There areprobably a little over

MR. WATTENBERG: You're here to take more than one exception to what Peter says.(Laughter.)

MR. WALTERS: Well, according to the best national survey that you have, andagain, the data is not perfect, but there are roughly 70 million, probably alittle over 70 million people who have ever used drugs in the United States intheir lives. According to that same survey, about 30 percent of those of thatnumber used in the last year. That's numbers from 1995.

MR. WATTENBERG: So 20 million people in the last year in America used drugs atsome point. MR. WALTERS: Yeah, right. A little over 20 million people. Andthese numbers this doesn't entirely overlap, but the last estimate in the WhiteHouse drug control strategy is that there are seven million people who have drugdependency. Now, I think that suggests a you know, 30 percent of the people whohave ever used are using in the last year, and somewhere around 25 percent ofthose people or more, or of that whole population, have a drugdependent problem,that the path here is a little more dangerous than you kind of try it and mostpeople kind of don't have a problem.

MR. WATTENBERG: Is there a statistical correlation between drug use and, say,violent crime?

MR. REUTER: It depends on the drug. If you talk about

MR. WATTENBERG: Because then it would affect us all; you can't say, well, it'sjust seven percent, because if these addicts then commit crimes

MR. REUTER: Yeah, the difference between dependence on illicit drugs anddependence on alcohol is basically the harm that illicit drugs causes to the restof the community. Most of the harms from alcohol are borne by the alcoholic andher family. But with illicit drugs, I mean there's no question that the crimethat that generates and some of the health problems, particularly relating toAIDS, are borne mostly by others.

MS. HARRELL: I think the public thinks that the effects of drugs arepharmacological, that is, that they inspire people to go out and commit violentcrime. There is a connection with violent crime, but it is really through thedrug markets primarily, and that is that the violence occurs around drugtransactions, between buyers and sellers, among dealers. ppSMR. WATTENBERG: Butif a person is addicted to crack and needs money to support his habit and it's asubstantial amount of money, isn't he likely to commit crime to get the money tosupport his I mean, that's what

MS. HARRELL: Yes, but many of those crimes are shoplifting, prostitution. Whenyou say violent crime, I just think we should be clear about this. I think itdoes not really spawn huge numbers of armed robberies.

MR. WALTERS: I guess I would take issue with that, too, and I would include,with drugs, alcohol here, that they are a catalyst pharmacologically to makepeople more violent, less inhibited. It does vary by substance, that is true,but you know, look, in most jurisdictions today where we have data, a majority ofthe people arrested for crimes, including violent crimes, test positive fordrugs, and a majority would test positive probably if you had more reliablepredictors over time for alcohol.

It's not just that because the market's illegal and there's violence, that's theviolence. The single biggest source, I believe from what I've read on ourcomprehensive national numbers about the levels of child abuse and familyviolence and the severity of child abuse and family violence that's been morewidely visible in the last few years, is clearly connected to crack. MR. REUTER: But now we're talking about much smaller numbers than the 20 million or even 7million we were talking about before.

MR. WALTERS: That's true.

MS. HARRELL: And I think it's really important to distinguish between the drugsand between classes of drug problems in this country. We look at the numbers ofthe youth using marijuana and it's a big leap from that to what we need to doabout that to what we need to do about the aging pool of crack and heroin addictsthat we have in this country.

MR. WATTENBERG: What do you mean when you say an aging pool?

MS. HARRELL: Well, what we have seen in the charts is a desistence in casualuse, but a persistence in the heavy chronic users of cocaine and heroin. Andthat's the certain small portion of those who initiate drug use who really staywith it over time, and they've become the public health problem. They've become alot of what we see coming through the criminal justice system, appearing in thedawn emergency room counts. These are the chronic users. They are now in theirthirties, many of them.

MR. REUTER: Well, I mean thirties I mean, for crack it's thirties. For the

MS. HARRELL: For heroin it's over.

MR. REUTER: For heroin we're talking about forties. I mean, we're getting closeto geriatric wards for heroin addicts now. So the good news is that heroindoesn't kill you. The bad news is you keep on using. I mean, we had a heroinepidemic 20, almost 25 years ago, really, between '67 and '73. Not much not manynew heroin addicts have arrived. In the mid-1990s, it's mostly those people whoare still our heroin addicts, and they're getting old.

MR. WATTENBERG: So you're all kind of agreed that it is a disaster. Maybe youhave different emphases. You say it's a huge disaster and you say it's amoderate disaster, but nobody's saying don't worry about it. Is that right?

MR. REUTER: Right.

MR. WATTENBERG: That's correct. All right, let me just go through a couple ofthings just quickly to kind of lay the base here. Does drug treatment work?

MR. WALTERS: Sure it does. I mean, look, if any of us had a problem or a familymember with a problem, we'd send them into drug treatment. The problem is, and Ithink the way the debate is not focused is the a large part of the publiclyfunded treatment system is not working well for a variety of reasons: that youhave longterm hardcore addicts that need residential treatment, a lot offollowup; the system is by the federal government is blockgranted, it's notvery focused, it's not well managed; a growing portion of the slots being createdare outpatient slots, which aren't going to help; you have older addicts thathave been cycling through treatments.

MR. WATTENBERG: What percentage of people who go in for drug treatment arecured?

MR. REUTER: Fifteen percent would be a slightly high figure. Now, the triggeris all in the term 'cured.' That's not what we expect of alcohol treatment now. What you expect is that people will drink less, be abstinent longer. But youknow, this is a chronic, lifetime, relapsing problem.

MS. HARRELL: People typically go through treatment more than one time, so andtreatment success probabilities increase with the number of times they go throughtreatment.

MR. REUTER: But even at the end, you've still got a very large share. I thinkhalf is not too much.

MR. WALTERS: I think that's an important point here to make for young people. Ithink there's also a perception that you can kind of experiment and if you do getin trouble, we have treatment that will save you. The younger you start, themore disruptive it is to your life, the more you start in the most disadvantagedof circumstances, the less hand holds there are to help treatment get you back tothe mainstream of society. So what the boom in teenage drug use today is maybemost a point of concern for is we're creating the next bulge of addicts todaythat's going to happen in the beginning of the next century.

MS. HARRELL: The risk really has to be thought about in terms of the socialmeaning of marijuana use to young people today. And I found one trendparticularly disturbing, and you see it in movies and in fashion advertisingtoday, which is it's fashionable to look wasted. There's more and moreprojection of a drugged lifestyle as somehow faded glamour. And I think if ittakes on that meaning, then you will generalize from marijuana on to other drugsand on to a lifestyle about the way you use, what it means to use, that isdangerous to young people's lives.

MR. WATTENBERG: All right. That's tough stuff. Let's again, just a couple ofquick answers. Does interdiction of drug supply, does that work?

MR. REUTER: It has a modest impact on the price of drugs in this country.

MR. WATTENBERG: Raising them? The more you interdict

MR. REUTER: It raises the price. You can send a kilo of cocaine from Bogota toMiami by Federal Express for less than a hundred dollars. Smugglers have tospend $15,000 to get here. That sounds like a lot, except that that kilo ofcocaine when it's on the street will sell for $120,000. So it's a contributionto keeping making drugs expensive, but it's probably hard to make it a lot moreexpensive that way. MS. HARRELL: And there's very little evidence that itaffects user decisions.

MR. WATTENBERG: That it is priceelastic, as we say.

MS. HARRELL: Yes.

MR. WATTENBERG: I'm so proud of myself for using that word.

MR. WALTERS: Okay, here's my second point of disagreement. I actually thinkthat interdiction is an important part of affecting consumption, particularlyheavy users. And there was a period of we have had trouble sustaining this, butthis is a problem that if we put energy on it and I don't think we're puttingserious energy on it at the present time, if we drive up the price, especiallyfor heavy users, essentially their demand heavy users, hardcore addicts arespending all their disposable income on drugs. If you drive up the pricesignificantly, they use less, they get sicker less, they're likely to go intotreatment more, it makes treatment more effective.

We can do something here, and I think the way to think about this in part on myside is the way we think about countering terrorism, which is a realneedleinthehaystack problem, a small number of people, a small amount ofsubstance, with drugs, where you've got hundreds of metric tons of differentdrugs having to pass our borders, have to be retailed, have to involve movementsof vast sums of money, vast amounts of people and a great deal of communication,all of which is vulnerable.

And that's why I think one of the keys to this is I think the federal governmentand the citizenry to back that up have to say we want policies and programs thatare going to make a difference here.

MR. WATTENBERG: That leads to the last question before we get to politics, whichI want to get to because I think it's important. Is the ultimate remedy on thesupply side or the demand side? I mean, that's where you come down to in thisargument frequently, is that correct?

MS. HARRELL: It's the wrong argument.

MR. REUTER: Except it poses the wrong tension, I think we'd all agree, aboutthat. It's clear you need to have, you know, reasonably stringent enforcementand you need treatment and prevention programs. What's the right balance amongstthose? There we get into an argument, but no one's going to say it's a supplyside or it's a demand side.

MR. WATTENBERG: Well, I wasn't looking for an absolute answer, but what do youfocus on?

MR. REUTER: I would say that we are much weaker on the demand side than we areon the supply side, and that's where at the margin we should be putting ourefforts now, to get into a

MR. WATTENBERG: And the demand side, in theory, kid by kid, you can be a hundredpercent successful. If the kid doesn't use drugs, he doesn't use drugs, whereason the supply side, you can cut 1 out of 10 shipments or 9 out of 10 shipments,but there are still I mean, so the safest thing for our viewers is to make damnsure your kids don't use drugs.

MS. HARRELL: We should be doing both.

MR. WALTERS: Well, I don't think I would phrase it in terms of one policy isgoing to be a hundred percent effective and one isn't. There's a matter ofimprovement here, but look, it's like controlling a bridge. You have to controlboth ends. And if you tell kids don't use drugs but you allow, you know, cheap,discount, widely available drugs on the street, that reality, they understandthat what you say you're not serious about. If we don't do what adults can do tohelp reduce the supply, we undermine treatment, we undermine prevention.

On the other hand, if we encourage kids to think it's, you know, fashionable touse drugs, we're going to increase the supply. And I would just say in terms ofshifting production from one to another, the money making that can be done hereis already there. It's not a matter of interdiction is going to create a lot ofdomestic markets that are greater than the current markets. I don't think that'sthe problem. The problem is we're not doing a very good job on the supply sideor the demand side today.

MR. WATTENBERG: Okay. We are at the point where we want to confront the big'P', politics. Let's begin by taking a quick look at some of the recentpresidential campaign ads on the issue of drugs.

VOICEOVER FROM POLITICAL CAMPAIGN AD: (From videotape.) And Bill Clinton? Hecut the White House Drug Office 83 percent. His own surgeon general evenconsidered legalizing drugs. And in front of our children on MTV, the presidenthimself:

MTV INTERVIEWER: (From videotape.) If you had it to do over again, would youinhale?

PRESIDENT CLINTON: (From videotape.) Sure, if I could. I tried before. (Laughter.)

VOICEOVER FROM POLITICAL CAMPAIGN AD: (From videotape.) Bill Clinton, he justdoesn't get it. But we do.

MR. WATTENBERG: Senator Dole is making the case that drug use among young peoplehas gone up, doubled, on Clinton's watch. Now, presidential candidates andpresidents, in my judgment, make a lot of statements claiming credit for they'relike the rooster that claims credit for the sun going up. They say, 'Oh, theeconomy improved and I created 20 million jobs. Aren't I wonderful?' I don'tthink they created any jobs.

Now, is it fair to say that under this president's watch, drug use went up andthere is some causality there, there is a cause and effect? MR. REUTER: I thinkthe president as the moral leader of this country, when you're talking aboutteenagers, is just utterly implausible. I mean, the president talks aboutcigarettes aggressively, repeatedly, with great credibility, and nothing hashappened to initiation into cigarette use amongst adolescents in his time. Ifanything, it's gone up slightly. I don't think you can fault him on his effortsthere.

You know, on teenage on pregnancy amongst teenagers, same thing. The governmentand the president and the president's wife all talk about this the right way,send the right moral messages. I mean, nothing to show for it.

Why on illegal drugs he should have the singular capacity to alter teenagebehavior in this country absolutely beats me.

MR. WALTERS: Well, I think there's an issue

MR. WATTENBERG: I know you don't agree with that.

MR. WALTERS: Look, it's not that the president's responsibility trumps allindividual users' responsibility or children's responsibility to avoid drugs. But there is a kind of tone set here. There's, one, how big a priority is this? This has not been a priority of the administration. And I would say Senator Doledeserves credit in the last several weeks of making this issue a national issue. And I think whoever gets elected president, they will do a more aggressive job ondrugs at the federal level than they would have if Senator Dole didn't raisethis. This is why I think politics hasn't sullied this issue. It has in factbeen a good thing for the country.

MR. WATTENBERG: Can a president make any difference in this whole situation? Imean, as we've pointed out, it's a very broad, antique sort of problem,manyfaceted. Suppose you had a president, he says, 'This is terrible, it's mynumber one priority, we're really going to go do it.' What would he do, and isit going to work?

MR. REUTER: I think he could speak more frequently and aggressively about this,and it will make a small difference. Nobody, I think, claims that they havesomething that for another billion dollars, a mere billion, would make a bigdifference here. I would say

MR. WATTENBERG: John, you're looking skeptical.

MR. WALTERS: Well, look, all I would say is

MR. WATTENBERG: We spend now about 12 billion (dollars) a year on every

MR. WALTERS: Well, in current dollars, it's about 15 billion (dollars). Butlook, we have a history here. Now, it's not complete, it's not perfect andpredictive, but it's not just speculation here. If you help to catalyze acultural hostility to drug use, if you help to catalyze a cultural willingness touse the resources to promote, you know, getting addicts into treatment andkeeping kids away from drugs, if the federal government makes this a foreignpolicy priority Peter and I differ about this, I know from past discussions andhold sanctions as well as carrots for countries that cooperate or don't cooperatewith us on this issue, if you use a modicum of our resources for nationalsecurity against this problem, which we're using such a small part, it's almost Ithink embarrassing, and if you start making accountability in federal lawenforcement measured against making a difference, treatment programs and fundingagainst making a difference, and if we use the effectiveness of, you know,education programs here, if we support that, this is a problem we can drive down.

It doesn't have to be this way. It's not just the president, but you've got realfederal programs that only the federal government can do in the international andin federal law enforcement, and you've got a catalyst for state and local action.

MR. WATTENBERG: Okay. We're running out of time. I want to give Adele one shotat that. I am going to appoint you president. You just got elected. January 20,1997. I'm going to give you two terms. I'm going to give you a Congress of yourchoice and great influence in the Supreme Court and with the governors. What doyou do about this?

MS. HARRELL: I would build a national domestic capacity to fight the drugproblem, and I would do it in the following ways. I would direct monies Congresscan do this at the current time to build an infrastructure that will support, forexample, effective drug court programs. They have to have, just as an example,to get addicts into treatment and keep them under control, a technology base, acomputer that knows what the daily drug test is and whether or not that personwas in drug treatment that day.

You can support that kind of I think the HIDTA initiatives, which are the

MR. WATTENBERG: The what initiatives?

MS. HARRELL: Highintensity drug traffic area grants that coordinate bothtreatment and enforcement in areas where it's a problem are very intensive. Ithink that you would go forward with that kind of thing. I think you'd goforward with building local capacity to do ongoing diagnosis and early responseto a program. One thing we have learned is that the drug problem is veryvariable across areas of the United States.

MR. WATTENBERG: Would you continue high levels of incarceration?

MS. HARRELL: I think that I would use the criminal justice system to do a lotmore coerced treatment. When it fails, yes, you have to incarcerate because youhave to have teeth behind your threat. But I'm not sure that we have the range ofintermediate sanctions. We don't have the right mix right now, I think, ofincarceration versus other justice policies. MR. WATTENBERG: Madame President, Ithank you. Thank you, John Walters, Peter Reuter and Adele Harrell. For 'ThinkTank,' I'm Ben Wattenberg.

ANNOUNCER: This has been a production of BJW, Incorporated, in association withNew River Media, which are solely responsible for its content.

'Think Tank' is made possible by Amgen, recipient of the Presidential NationalMedal of Technology. Amgen, helping cancer patients through cellular andmolecular biology, improving lives today and bringing hope for tomorrow.

Additional funding is provided by the John M. Olin Foundation and the Lynde andHarry Bradley Foundation.

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