The Why Behind the Drug War

The Drug War’s Goals

A book I haven’t read, that has been on a reading list of mine for a while, is Simon Sinek’s book Start With Why. While I haven’t read the book, I am familiar with Sinek’s ideas and have listened to him in several podcasts and TED talks. At the root of the book is the idea that great leaders think deeply about the why behind their actions. They understand their motivations, understand their goals, and understand how the things they do contribute to a larger picture of the world. When we start with why, we ask ourselves about purpose, about our fit for what we do, and we consider our end goals and how we can best approach the outcomes we want.

 

The global drug war, which the United States leads and forces upon smaller countries, doesn’t really have a why at its heart. In researching his book Chasing the Scream, Johann Hari traveled across the globe to discover and write about the impacts of the drug war on the lives of drug users in the United States, communities controlled by drug cartels in Mexico, and public policy officials from Vancouver, Canada to Portugal. Everywhere he traveled he saw lives destroyed and people left with nothing, not just due to their own drug use, but also due to the policy responses and financial drives of the governments and people confronting each other in our global drug war.

 

In the face of all the violence and destruction of the drug war, Hari asks, what is the rational for the drug war? What is the why behind the global prohibition on drugs and the global persecution of drug users and suppliers? He writes, “The United Nations says the war’s rational is to build a drug free world—we can do it! U.S. government officials agree, stressing that there is no such thing as recreational drug use. So this isn’t a war to stop addiction, like that in my family, or teenage drug use. It is a war to stop drug use among all humans, everywhere. All these prohibited chemicals need to be rounded up and removed from the earth. That is what we are fighting for.”

 

I think Hari would argue that this why is under-developed, impracticable, and unreasonable. He details animals like mongoose and elephants that do intentionally use chemicals at times to alter their states of consciousness. Humans, he explains, are not alone in using drugs, and there are some common times when animals and humans will turn to drug use. The elimination of all chemicals, Hari believes, is not a real goal that we should be working toward as a global community.

 

For some reason humans have decided that all drugs besides alcohol should be strictly prohibited. We seem to accept that alcohol can be fun, stress relieving, and enjoyable, despite the fact that it can also be addictive, harmful to health, and deadly if used inappropriately. Other drugs that might be recreational, are not given the same leniency as alcohol, and our efforts to stop anyone from ever using other drugs has created a deadly war, with rival gangs competing for product and territory, and drug users pushed out of society and shunned from basic healthcare and normal functioning human connections.

 

Hari believes that we will fail in our efforts to eradicate all drugs from the planet because the why behind the goal is so weak. The rational is built on the fear and egos of those who don’t use drugs and think of themselves as being superior to those who do. The drug war doesn’t fully consider the reality of humans, society, and animal nature to respond to hardship by altering states of consciousness. The why misses the point, so the how will never be successful.
Violence and the Drug War

Violence as a Reason to End the Drug War

My last post was about violence related to drugs. When we make drugs illegal, we open the door for a black market. The best way to control a black market is through force and violence. A direct result of drug prohibition is violence related to black markets. We saw this in the United States with alcohol prohibition and in the 1970’s as the drug war in the United States escalated.

 

In Chasing the Scream Johann Hari writes, “By the mid 1980’s, the Nobel Prize-winning economist and right-wing icon Milton Friedman calculated that it [drug prohibition] caused an additional ten thousand murders a year in the United States. That’s the equivalent of more than three 9/11’s ever single year. Professor Miron [Jeffrey Miron, Harvard University] argues this is an underestimate. Take the drug trade away from criminals, he calculates, and it would reduce the homicide rate in the United States by between 25 and 75 percent.”

 

What Hari is doing in this quote is turning around the justification for a drug war and using it as a justification for ending the drug war. The typical argument that someone would make would be along the lines that drugs cause crime, so drugs should be illegal. Hari instead writes that drug prohibition causes crime, so drugs should be legalized.

 

The first option is instinctual and popular. Hari’s opinion is counter-intuitive, and would be a tough political sell. Nevertheless, I think Hari is correct.

 

I think it would be terrible to have huge numbers of people using recreational drugs during all their free time. I worry about the economic losses our country would face as people chose to do more drugs, harming their brains and bodies. These considerations make me fearful of finding legal ways to provide safe drugs to people.

 

However, that perspective doesn’t consider the costs that are in our current status quo. The current drug prohibition creates criminals and black market drug dealers. It gives gangs a profit source, and leads to young people choosing gangs over legal ways to make money, and in the process, still destroys the lives of huge numbers of people. Perhaps a legal system would reduce our deaths, and maybe even if drug use picks up, the overall number of people dying and losing opportunity to meaningfully contribute in this world would decrease. We wouldn’t have as much gang violence, wouldn’t arrest so many young black men, wouldn’t have so many people die from using unsafe drugs. Hari argues this trade-off will pay off, and I think he might be right.
Gang Violence and Drug Prohibition

Gang Violence and Drug Prohibition

Imagine the following: A recreational drug has been in use for quite a while and has enjoyed relatively widespread use. A lot of people use the drug in social or private settings, with some people developing an addiction and some people using the drug inappropriately and causing property damage or loss of life to other people directly as a result of their drug use. Government agencies respond by making consumption, possession, and sale of the drug illegal. An underground market of suppliers, buyers, and places to enjoy the drug pop-up, along with gangs to enforce rules and norms that are hidden from formal legal structures or the police. Gangs compete for territory and distribution, and a few top gangsters make tons of money, while street level thugs are shot up.

 

That scenario played out with alcohol prohibition in the Untied States, and we could easily apply the same perspective to the widespread war on drugs which launched in full force in the 1970’s and is still with us today. Forcing alcohol underground created gangs, just as making everything from weed to crack illegal today has produced gangs. As Johann Hari wrote in his book Chasing the Scream, “Professor Jeffrey Miron of Harvard University has shown that the murder rate has dramatically increased twice in U.S. history – and both times were during periods when prohibition was dramatically stepped up. The first is from 1920 to 1933, when alcohol was criminalized. The second is from 1970 to 1990, when the prohibition of drugs was dramatically escalated.” 

 

Gang violence is related to black markets, to social structures that are disconnected from the rule of law and acceptable law enforcement. We look back at the time of prohibition and the gangs that appeared at that time in a somewhat nostalgic manner. We almost think highly of the mafia crime syndicates that were murdering people in the streets to control illegal alcohol distribution chains. But it is unlikely that their violence and viciousness was really much different than what we see in gangs today. What is likely very different, however, is the color of the skin that we associate with gangsters of the 1920’s compared to the gangsters of today.

 

Youth gang violence is a huge problem, and it is deeply connected with the war on drugs. Hari writes, “The National Youth Gang Center has discovered that youth gangs like the the Souls of Mischief are responsible for between 23 and 45 percent of all drug sales in the United States.” The violence we see is directly related to the gang’s control of illegal drug markets, markets that our policies and our war on drugs create.

 

I would agree with anyone who said they didn’t want widespread use of drugs in society and didn’t want people simply using drugs rather than contributing to society in constructive ways, but is the gang violence, our nation’s high overdose rate from unsafe drugs, and the social out-casting of anyone who makes a mistake and uses drugs really worth the prohibition we force on the country? Do we want to accept the high levels of incarceration for minority inner-city youth which creates a positive feedback loop of more violence, less opportunity, and more illegal drug activity? Perhaps giving people a safe space to use drugs sold openly and legally, in legitimate markets that take away from the black market has fewer costs to society than our prohibition efforts which create more gang violence and death. This was a trade-off our nation made with alcohol when it ended prohibition, but is it a trade-off we are willing to make with a vast suite of drugs today? For Johann Hari it is, and his book gives us plenty of reason to believe that it is a trade-off that might be beneficial for all of us.
Drug Related Violence

Drug Related Violence

In his book Chasing The Scream, Johann Hari writes about common misconceptions related to drug violence in the United States. Misconceptions influence drug policy, shape the way people think about drug crimes and drug users, and prevent us from taking real action to help reduce the conflicts and negative externalities related to the American war on drugs.

 

Hari writes, “When we hear about drug-related violence, we picture somebody getting high and killing people. We think the violence is the product of the drugs. But in fact, it turns out this is only a tiny sliver of the violence. The vast majority is … to establish, protect, and defend drug territory in an illegal market, and to build a name for being consistently terrifying so nobody tries to take your property or turf.”

 

What Hari suggests throughout the book is that many of the negative things we relate to drug use is more associated with prohibition against drugs. Making drugs illegal and trying to stamp out any drug use in an all-out war creates negative externalities that justify violence and prohibition. The war on drugs creates a positive feedback loop, making drug use and drug trafficking more dangerous, building support for harsher treatment and destruction of drug users and sellers.

 

When we make something illegal, we create a black market. On the black market, as I wrote about from Brookings Scholar John Hudak’s book Marijuana: A Short History, suppliers don’t have to meet safety and quality standards that would exist in a regulated legal market. This is where the dangers of drug use arise and where drug related violence comes into the picture. Many of the people using drugs directly are non-violent, and don’t want to cause harm to others when using drugs. They harm others when they need to obtain drugs illegally, on a costly and dangerous black market. The sellers create relationships and build territory, and use their own force to control their territory, since relying on police protection and legal backing to defend property and product is not an option in a black market.

 

I don’t know what the world would look like without a war on drugs and with a legal market for obtaining drugs. I don’t know what new externaliteis would arise and how we would face them. But I do think that Hari is correct and that we should acknowledge that much of the drug related violence and crime, and much of the safety concerns related to drug use, stem from the very prohibition and war that we approve of to stamp out drug use. The current approach seems incapable of eradicating drugs, but it does seem to spur substantial drug related violence and safety issues.
A Racist Start to the Drug War

A Racist Start to the Drug War

My last post was about Harry Anslinger’s racist views and how they influenced public policy. I wanted to focus on what we could learn from his mistakes, and how we could think about our own policy positions given the terrors we have seen in the past from biased policy positions, confirmation bias, and believing things are true simply because we want them to be true.

 

Today’s post is more specifically just an examination of race and drug policy, looking all the way back to the start of the war on drugs. During a time when protests against racial violence in policing is front and center, I think it is helpful to consider how race was specifically used in drug wars to hurt racial minorities, especially black men and women. Black lives matter, but our nation has not always believed that, and we cannot separate the disparities in racial sentencing, death rates, and wealth from the policies of our nation’s past.

 

In his book Chasing the Scream, Johan Hari writes about his shock at finding that the drug war, in its early days, was not so much about mitigating drug addiction or preventing new addiction in teenagers, as it is today, but about controlling racial minorities. He cites overtly racist headlines in newspapers and talks about Anslinger’s efforts to target minority populations, while letting white drug users off the hook and helping them find treatment to wean off drugs. A central character in the book is Billie Holiday, a black musician targeted by Anslinger for her drug use. Her story provides a window into the racialized tactics used to enforce drug laws, and create a nationwide story about the danger of black people using drugs.

 

Hari writes, “Many white Americans did not want to accept that black Americans might be rebelling because they had lives like Billie Holiday’s – locked into Pigtowns and banned from developing their talents. It was more comforting to believed that a white powder was the cause of black anger, and that getting rid of the white powder would render black Americans docile and on their knees again.”  The failure of black Americans to become successful was blamed on drugs, and ultimately on a genetic and/or cultural inferiority that justified their low social positions and justified a drug war waged against them. White American’s didn’t want to believe that they could be held responsible for the strife of African Americans, so they invented new excuses for racist policies.

 

As we look around the country today, we should keep these kinds of policies and views in mind. It was not that long ago that we were so openly racist in the development of policies that are still impacting the world today. We can no longer justify racial disparities by saying that there is some type of problem with minorities that justifies the disparities in our policies and outcomes. We need to demonstrate that black lives matter and advance policies that correct the wrongs of our past.
Racially Motivated Policy

On the Dangers of Racially Motivated Public Policy

In his book Chasing the Scream, Johann Hari writes about Harry Anslinger, the Nation’s first commissioner of the Federal Bureau of Narcotics. Anslinger was a staunch anti-drug crusader, but he also held deeply racist views which came to influence his opinions about drug use and national policy related to specific drugs. In many ways, it was Anslinger’s racist views that created a national prohibition on marijuana, and lead to years of laws prosecuting marijuana use and racially disparate arrests.

 

Early in his career, Anslinger wasn’t very interested in marijuana. He was more focused on heroin and cocaine, but Hari explains that heroin and cocaine use was not wide spread enough in the American population to justify the size of his agency. As newspapers began to report on crime related to black and brown people in the United States who had used marijuana, Anslinger seized on the opportunity to demonize the drug. Hari writes, “almost overnight, he began to argue the opposite position. Why? He believed the two most-feared groups in the United States – Mexican immigrants and African Americans – were taking the drug much more than white people.”

 

Despite evidence from researchers and physicians indicating that marijuana use generally did not lead to the atrocities that Anslinger began to claim, he pushed forward with harsh drug policies related to marijuana, policies that he knew would have a racially disparate impact. At a certain point, in the picture Hari presents, it appears that Ansligner began to believe what he wanted and see what he wanted in the world around him. After he proved how dangerous the mafia was in the United States, contrary to the view of many experts, he began to believe his own rhetoric about racial inferiority and marijuana dangers. Hari writes, “Anslinger began to believe all his hunches would turn out like this. He only had to defy the experts and keep using his instinct until, finally, he would be shown to be more right than anyone could have predicted.”

 

Anslinger was clearly wrong, and his stance and attitude are easy to denounce today. But what we should learn from his story is just how dangerous public policy can be when it is motivated by racist values and hatred. For many of us today, we believe our values are high minded, and we believe that the policies we favor can have no downside. Nevertheless, we can still learn from the example of Anslinger and the resulting racial problems his policies created in the Untied States.

 

We need to be honest with ourselves and those around us about the values that drive our policy decisions. We should be honest about the potential failure points of the policy we support, and we should acknowledge that there are potential negatives of what we do. This requires that we recognize the message we are trying to push, and avoid simply looking for examples in the world that confirm what we already want to believe. If our values are indeed high-minded, and if we can be open and honest about our motivations, then our policies should be supported by a larger audience. Failing to be honest and open can put us in a place where we defend bad policy, and push for policies that explicitly hurt others, without us acknowledging the downsides. It is also critical that we acknowledge the role that race plays (or has the potential to play) in the policies and attitudes we support. The same reflection and honesty regarding our policies must apply to the racial outcomes of the policies we favor, and we have to push back against policies with disparate negative outcomes for minority groups.
Harry Anslinger and the Fragility of Civilization

Harry Anslinger and the Fragility of Civilization

To open his book Chasing The Scream, author Johann Hari tells a story about Harry Anslinger and the fragility of civilization. Anslinger was the first commissioner of the Federal Bureau of Narcotics, and sparked the war on drugs in the United States. As a young child, Hari explains, Anslinger was at a farm house where he heard a woman screaming in agony as she possibly experienced drug withdrawals. The owner of the house sent him to the pharmacy to return with a package and drugs to ease the woman’s suffering, which Ansligner did, but the memory of the screams would haunt Ansligner forever, pushing him to spend his entire life fighting against any drugs that he believed were dangerous.

 

In World War I Anslinger became a diplomatic agent in Europe, and he saw the destruction of entire cities and the destruction of human life first hand. At  the end of the war, Anslinger learned another lesson that would stick with him for life. Hari writes, “What shook Harry most of all was the effect of the war not on the buildings but on the people. They seemed to have lost all sense of order.” Ansligner was concerned about riots, starving desperate people driven to chaos, and entire institutions crumbling, leading to strife among the people. Hari continues, “Civilization, he was beginning to conclude, was as fragile as the personality of that farmer’s wife back in Altoona. It could break.”

 

Chasing the Scream is a brutally honest look at drug policy and the war on drugs in the United States. Anslinger was key in kickstarting the war on drugs, but his message was carried on after he left office, and to this day after his death. Hari asks tough questions, trying to understand if there is a way to win a war on drugs and whether we should be more concerned about the consequences we have seen from battling drugs in every arena. At the end, Hari concludes that what we need to fight a war on drugs is not a war mentality, but an understanding of the importance of community, and a rebuilding of social solidarity, trust, and a new sense of our responsibility to each other. Anslinger was right, to conclude that civilization was fragile, but he was wrong is his prescribed treatment. A war to end vice only tears apart our social fabric, weakening the communities which build our civilization.

 

Hari believes that what we need are better ways to understand each other, and more supports for everyone in society. Many of the evils that we attribute to drug use, Hari argues, are in fact byproducts of the war we wage against drugs. In an effort to impose social order on people, with the rhetoric of war and a mindset steeped in racism, Ansligner helped to create a system that broke civilization for some of the most vulnerable among us, just as he always feared from the moments he heard the screams of the farmer’s wife in his childhood.

 

We must remember just how close our civilization can be to chaos and disorder. We need to look for leaders who can bring us together rather than leaders who seek to castigate others and toss them out. We need to think about how we build new institutions that help develop greater sense of community, and how we help those who have the least. If we fail to do so, we will increase inequality, and then blame the inequalities on those who faced the greatest adversity as a result of our inequalities. This will segregate our societies and create more chaos, making it harder for us to come together when we need to, exacerbating our drug and violence problems.
Pharmacy Benefit Managers

Pharmacy Benefit Managers – Another Shadow Healthcare Actor

Unless you are a health policy person, I’m guessing you have not heard of pharmacy benefit managers, or PBMs. The Commonwealth Fund describes a PBM as “a company that manages prescription drug benefits on behalf of health insurers, Medicare Part D, large employers and other payers … by negotiating with drug manufacturers and pharmacies to control drug spending.” I always thought that pharmacy prices were set directly by my insurance carrier, in contracts that they had worked out somewhere along the line. But it turns out it is more complicated than that, and if you are like me, you will probably understand that PBMs provide some value, but also feel as though they are another actor doing little but driving the cost of healthcare up. For me, it is probably a bit unreasonable, but I hate PBMs.

 

In his book The Opioid Crisis Wake-Up Call, Dave Chase explains how pharmacy benefit managers negotiate rebates with drug companies and insurance carriers for specific drugs. However, the rebates don’t actually get back to the patients. Usually the insurance carrier and PBM are the ones who benefit from the rebate, and specific medications are pushed toward patients so the PBM and insurer can get the rebate. PBMs operate way in the back, and don’t get the same scrutiny as health insurance companies. They are hidden and shielded from risk, which means they have little incentive to put patients first.

 

“PBMs are typically paid by the transaction or employee; it’s not their money, so its not their risk,” writes Chase. “They may strive to handle claims quickly and efficiently, but their defenses against fraud and abuse of prescription drugs are antiquated. The shared responsibilities of the employer or government agency and the PBM create situations in which neither can see the whole picture. Criminals exploit this weakness, leading to a flood of prescription opioids on the street. The American insurance system has allowed this distribution explosion to occur, doing little to nothing to halt its growth.

 

The quote above highlights the misaligned incentives with PBMs, insurers, and governments or employers. PBMs that hide data, favor medications for unclear reasons, and don’t face a lot of direct risk have created lots of problems for the American healthcare system. I opened with a discussion of pricing problems brought on by PBMs, and Chase’s quote shows how they have also contributed to the abuse of prescription opioids. Chase’s book, with examples like the ones laid out in this post, paints a worrying picture of pharmacy benefit managers in the United States. It is partly the complexity they add in the system, and partly the shady behind the scenes deals they are a part of that make me dislike them so much. This type of confusing and apparently unethical role for PBMs is also part of the reason that a lot of people want a universal healthcare system that is able to negotiate drug prices and set specific limits on some costs. It might not save everyone a ton of money in the long run, but it might be more ethical and clarify some of the most confusing parts of the system.
Drug Policy as Electoral Strategy

Drug Policy as an Electoral Strategy

One of my big takeaways as a public policy student at the University of Nevada was that public policy is not detached from our values. We like to think that elected officials and public administration officials are able to look at the world rationally and make judgments based purely on empirical facts, but this is not the case. Our values seep into all of our judgments and influence what we find as good or bad evidence. A good example of this at the federal level is Richard Nixon’s drug policy.

 

Drug policy seems like an area where empiricism and facts would rule. It feels like an area where we could identify the harms of drug use, estimate the social costs of drugs, and set policy accordingly, but American history shows that is not the case. John Hudak examines this history in his book Marijuana: A Short History, and shows how Richard Nixon used propaganda related to drug use to fuel his electoral campaign.

 

Hudak writes, “In fact, crafting public opinion on drug use and crime was central to Richard Nixon’s electoral strategy: he recognized that if he could stoke fears among the public about the drug problem and then position himself as the individual most capable of fighting the war against drugs, he would benefit electorally. In many ways he was right.”

 

Even though we can track drug related crimes, we can record drug overdose deaths, and we can estimate the social cost of drug use, our policies are driven more by fear and the desire to others into villains than by facts. Richard Nixon was clearly a master of understanding and manipulating public opinion, and used this reality to his advantage. Rather than encouraging public opinion to reflect the realities of drug uses, Nixon tied drug use with racial anxiety and resentment in a way that helped his own electoral fortunes. Public policy, Nixon demonstrated, was not swayed primarily by facts and logic, but by fear and irrationality.

 

For those of us who care about an issue and want to see responsible policy regarding the issues we care about, we must understand that empiricism and facts is not the only thing behind public policy. Public policy reflects emotion, power, and influence, and is subject to framing by people whose motives are not always pure. Advocating and supporting good public policy requires that we get beyond facts and figures, and understand the frames being applied to the policy in question.