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Since its role in bringing an end to the Haight-Ashbury "summer of love" in 1967, methamphetamine's nasty reputation for bringing out especially undesirable behavior traits in its frequent users has tended to confine its use to a few areas of the far Southwest and to the "biker" fringe of the white working class. That appears to be changing, and once again stories of bizarre behavior are following the path of the drug. In the opinion of those who know both drugs, methamphetamine has a worse set of behavioral and physiological sequelae than cocaine, even cocaine consumed in the form of freebase or crack.
While most users report liking methamphetamine less than cocaine, it is enormously more cost-effective, partly because the effective dose is smaller, partly because methamphetamine is much longer-acting. Roughly speaking, a gram of meth costs about the same as a gram of cocaine but will keep its user high for ten times as long.
For Mexico to make real progress against its other drug- trafficking problems -- cocaine transshipment, poppy and marijuana growing, heroin processing -- would require tackling the serious endemic corruption problems in Mexican law enforcement, which in turn would require major changes in, e.g., the ludicrously low pay of Mexican police and soldiers. Especially in light of the peso crisis, this is impossible in the short run and unlikely even in the next several years.
Precursor controls, by contrast, involve regulating the behavior of a limited number of chemical companies in order to make it harder for drug producers to get the necessary supplies of a relatively short list of chemicals. Regulatory corruption is always a possibility, but policing the regulators is easier than policing the police.
Less is to be hoped for from interdiction and domestic law enforcement. While there seems to be good justification for boosting the share of enforcement resources devoted to meth, it presents a relatively hard enforcement target. It's more compact than cocaine, complicating anti-smuggling efforts. Its synthesis, given the availability of ephedrine as a precursor, demands relatively little skill or capital; thus breaking up clandestine laboratories and arresting the chemists will do little if anything to shrink the supply. There may be a role for street- level enforcement in keeping retail availability limited, but the methamphetamine market is, to a large extent, already the sort of discreet, indoor market that successful street-level enforcement generates.
Prevention, and especially the distribution of appropriate messages to potential new users, increases in importance at the beginning stages of any drug epidemic, especially when the drug in question has spread so quickly as to outrun its bad reputation. While the use of scare tactics on the "Reefer Madness" model tends to reduce the credibility of some prevention efforts, in the case of methamphetamine the sober truth is quite scary enough. The challenge is to develop, test, and implement an anti-meth campaign before the problem spreads much further. That will require some basic "market research" on who the new users are and what they believe.
The current concern about the upsurge in adolescent marijuana use may create resistance to devoting significant resources to prevention messages aimed specifically at methamphetamine. The politics of drug prevention is dominated by the parents' anti-drug groups, whose concern tends to focus on marijuana, the illicit drug most widely used by minors. Not only would a renewed "Speed Kills" campaign compete for resources with anti-marijuana messages, but an accurate description of the horrors of methamphetamine would tend to make marijuana look relatively unthreatening. Emphasizing that some illicit drugs are much more dangerous than others is logically consistent with a message that all drug use is to be avoided, but it is psychologically inconsistent. Simply adding meth to the list of no-no's in a generic campaign against "drugs" would likely attract little opposition, but it would also likely do little good.
While treatment demand tends to lag behind new drug epidemics, in the case of methamphetamine the average time from first regular use to presentation for treatment will tend to be shorter than for most other drugs: much shorter, for example, than for heroin. (This may have the optimistic implication that the epidemic will tend to be short-lived.) As in the case of cocaine, the absence of any proven pharmacotherapy, either substitute or blocker, limits treatment effectiveness.
Like heroin, methamphetamine can be snorted, smoked, or injected. There is an urgent need to learn more about the transition from snorting or smoking to injection, and how to prevent it, if that is possible. (It may be the case that the irritating effects of methamphetamine powder on the nasal mucosa, and of methamphetamine vapor on the throat and lungs, make injection nearly inevitable for chronic high-dose meth users.) The methamphetamine problem may further complicate the issue of policy toward the supply of injection equipment for illicit drug use. It certainly widens the target population for warnings about the dangers of injection.
Heavy methamphetamine users will present themselves in three different guises: as substance abusers in need of treatment, as psychiatric emergency-room cases with stimulant-generated psychoses, and as criminal defendants in cases of one or another degree of assault. The natural tendency will be to handle each case as it presents: treating the substance abuse without dealing with the psychosis or the risk of criminal behavior, treating the psychosis without dealing with, or perhaps even noticing, the underlying substance abuse, and processing the criminal case without appropriate attention to the high risk that continued use of meth will lead to continued, and increasingly serious, incidents of violence.
The need for coordinated action between substance abuse treatment and mental health providers, and between each of them and criminal justice agencies, is a familiar story; equally familiar is the list of reasons why it doesn't happen. The need is especially great in the case of methamphetamine; the current threat ought to be the occasion for a concerted effort to overcome the barriers to cooperation. This would seem to be a major early test of the skills and powers of the rejuvenated Office of National Drug Control Policy.
The budget issue has been a major, if not the dominant, theme of the Congressional drug policy debate over the past decade or so. But there is reason to doubt that this fight over the shape of the federal drug would serve any useful purpose, even if the underlying figures were more precise and meaningful than is actually the case. [See Patrick Murphy, Keeping Score: The Frailties of the Federal Drug Budget, RAND, 1994.]
Thus a decision to move funds from interdiction to treatment would have to involve moving money from, say, the Treasury Department (parent of the Customs Service) to the Department of Health and Human Services (which includes the Center for Substance Abuse Treatment). But the Treasury spends money on many things, some of which enjoy less popular, political, and bureaucratic support than interdiction; similarly, HHS funds a wide range of programs, some of them with more support than providing better services for drug addicts. Once the OMB PADs, the Appropriations Subcommittees, and the agency budget shops are finished, neither the cut nor the addition may fall where it was intended to fall.
Increasing treatment availability is a good idea (see below). So is shortening some of the unduly long sentences for drug dealers and eliminating some non-cost-effective interdiction efforts. But neither change is necessary to making the other. Linking them politically probably reduces the feasibility of doing either one.
Given the very high crime rates characteristic of drug- involved offenders who remain heavily drug-involved, the substantial cost of imprisonment might not be too high a price to pay to avoid the crimes they commit while free (even putting aside the crimes committed by the drug traffickers they support) if there were no other way of doing so. From a crime-control perspective, this would certainly be a better use of the cells than long sentences for minor drug dealers certain to be replaced within the illicit labor market. But in fact it should not be necessary to imprison most offenders in order to reduce their drug consumption. The threat of incarceration for continued drug use might be adequate to deter them.
The current drug-testing practices of probation and parole departments combine infrequent testing and even more infrequent sanctioning for missed or "dirty" tests, with occasional punishments of great severity. But both crime and drug abuse attract the reckless and impulsive, whose behavior is not easily changed by low-probability threats.
The testing technology itself is easy to operate, and the tests are quite inexpensive on a mass-production basis. To succeed, such a program requires adequate confinement capacity (not necessarily in a jail, since persons confined for only a few days pose less escape risk, and require fewer services, than typical jail inmates) so that the threat of sanctions never fails; either dedicated judicial capacity or legal authority for administrative sanctioning, in order to avoid gridlocking the courts; and someone to go out and arrest those who refuse to come in for testing or sanctions. In addition to the testing costs, the major expense of such a program would be the time of probation, parole, and other staff required to administer it. Total costs have been estimated at less than $2000 per participant per year, more than twice the cost of ordinary probation but less than one-tenth the cost of prison, and likely to be substantially offset by reduced prison occupancy both by users and by the dealers they support.
Even without an explicit treatment component, testing and sanctions for drug-involved offenders on probation or parole could have substantial therapeutic benefit. Facing constant pressure to abstain, those drug-involved offenders who cannot stop without professional treatment will be strongly motivated both to seek out treatment and to stick with it. Others, once confronted with the fact that their preferred lifestyle of drug use and crime is no longer available, will find that they can quit on their own or with the help of one of the Twelve-Step programs. Nevertheless, failure rates among offenders subject to testing and sanctions would probably be much lower if formal treatment were available for those who wanted it.
Not only is a slot in a coerced-abstinence program much cheaper than a prison cell or a half-way house bed, it does not hit the same capacity limitation. For those offenders able and willing to comply, it offers much better life prospects, since experience of remaining drug-abstinent outside confinement is much more valuable than the same experience while confined.
Thus creating such a policy would still be a good idea even if its actual administration fell short of the ideal. A fairly significant cheating problem, for example, would reduce the efficacy of the program without eliminating its benefits or greatly increasing its costs. The program would still have value with respect to those who did not cheat. If a significant number of offenders proves unable or unwilling to comply with such a program, that would boost its costs substantially, but identifying such persistent offenders and incapacitating them by incarceration is itself a task well worth doing, if deterrence fails.
Reduced demand means less revenue for drug dealers, which in turn means fewer guns, fewer shootings, less disruption of neighborhood life, and fewer kids lured out of school or licit work into the flashy, but eventually disastrous, life of retail drug selling.
Since we literally know the names of the people who contribute most of the money that supports heroin and cocaine dealing in the United States, it is almost inconceivable that we should continue current policies, which in effect allow them to maintain their habits in between spells of incarceration.
A well-designed program of coerced abstinence would cost about $4 billion per year-- assuming that about two-thirds of the heavy heroin and cocaine users would be covered at any one time-- less any savings from reduced prison use. Measured against the social costs of drug dealing and drug abuse, or even against the roughly $35 billion national drug abuse control budget, this is a rather modest cost. The real question is not whether to try coerced abstinence, but how to make it work. Legislation passed at the end of the last Congress will require each state to mount a testing and sanctions program. Now the struggle turns to the details.
Drug Policy Analysis Bulletin is edited by Mark A. R. Kleiman of the School of Public Policy and Social Research at UCLA. For specific comments on the contents of this newsletter, or if you would like to join in the work of the FAS Drug Policy Committee, contact Dr. Kleiman at (310)206-3234 or at kleiman@ucla.edu. Members of the Editorial Board include (affiliations for identification only):