In the United States we often fail to think about alcohol use when we think about drug use. Our country is comfortable with the idea of recreational drinking to take the edge off a tough day, to enjoy a party or social gathering, and to celebrate a holiday. Alcohol has a lot of downsides, especially when people drink in excess. Whether people have an addiction or just drink too much one night, consequences can include drunk driving car crashes, liver and stomach problems, and general poor decision-making. Alcohol is dangerous for the user and for other people within society. Nevertheless, we understand that it can be used responsibly, and unless you have a history of alcohol abuse, it is strange to not drink.
Other drugs don’t enjoy the same acceptance in society. Marijuana is becoming more accepted, but other drugs remain strictly prohibited and shrouded in fear and secrecy. When states consider increasing access to medical marijuana or marijuana legalization, legislatures and the public will debate for hours on end all the potential consequences of legalizing marijuana and the dangers which could stem from more marijuana use. But rarely will we have the same discussions of alcohol, and rarely will we consider the consequences of people shifting their drug use as policy changes.
However, research suggests that we should strongly consider shifting drug use when we think about drug policy. When I was completing an MPA at the University of Nevada, I looked at research on people switching from opioids to marijuana within states that legalized marijuana or expanded medical marijuana programs. There is good evidence to suggest that many people will shift away from opioids, which can be dangerously addicting, to marijuana when weed is more accessible. Marijuana seems to be less dangerous than opioids, with fewer risks for overdose. There are certainly consequences for using marijuana – I know of studies that look at negative health impacts of smoking weed studies that look at potential damage to intellectual functioning. However, opioids have been ruinous for many communities in the United States, with arguably worse health consequences than marijuana. The shifting drug use might not be the best outcome we could hope for, but it might be a step in a better public health direction.
In his book Chasing the Scream, Johann Hari looks at these ideas around shifting drug use. He writes, “After California made it much easier to get marijuana from your doctor … traffic accidents fell by 8 percent.” People were not driving under the influence of alcohol as much once they began using marijuana instead. As a result, the roads became more safe. Hari gives several examples of shifting drug use that might occur if more drugs (or all drugs) were legalized. The drugs used and settings for their use would change, which would have a lot of implications for public health and safety. He shows that in many instances, shifting drug use away from alcohol would make us safer and more healthy. We don’t always recognize this, and we don’t always think about shifting drug use appropriately because we fail to think of and count alcohol use as drug use.
Hari writes, “If you don’t count alcohol as drug use, then drug use would go up. But if you do count alcohol as drug use, then there is some evidence suggesting overall drug use will not go up after legalization.” Patterns of drug use are complicated, and we don’t have a lot of evidence to help us anticipate shifting drug use in a world where access to drugs in a legal way was more available. However, if we want to express an opinion about shifting drug use, we should remember that alcohol is a drug, and we should think of it within the larger context of drug use, not as its own thing.
Ultimately, I (and I think Hari) would like to live in a world with minimal or almost non-existent drug use. However, our current approach to get there, drug prohibition, doesn’t seem to be working and seems to actually make our societies more dangerous. Shifting to a world where drugs were legalized and provided in a safe form by the state (or private entities) could lead to greater drug use, might lead to changes in what drugs people use, and would like change where, when, and how people use drugs. If we moved in this direction while simultaneously creating a strong system to help people stay healthy while using drugs and that encouraged them to find a lifestyle that didn’t include drugs, then our societies might become more healthy, and we might not actually see drug use increase in a dangerous way.
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