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America's War on
Drugs:
Searching for Solutions
With
Catherine Crier
Aired Thursday, April 6, 1995 by ABC News (#ABC-59)
ANNOUNCER:
Illegal drugs,
marijuana, cocaine, heroin- they're a plague across America, a disease
spreading crime and violence into every corner of our society.
WILLIAM BENNETT,
former Director, National Drug Control Policy:
This is a deadly
and poisonous activity. People should be imprisoned for long periods
of time for doing it.
ANNOUNCER:
Each year America
spends billions of our tax dollars trying to win the war on drugs,
policing our borders, arresting the pushers, imprisoning the users.
Judge JAMES GRAY,
Orange County, California, Superior Court:
The war on drugs
has turned into a war on our people. We almost can't do it worse than
we are today. There's got to be a better way.
ANNOUNCER:
In Europe they
think they've found a better way. In Holland you can buy marijuana
as easily as a cup of coffee and junkies can buy heroin from pushers
right on the streets. And in Great Britain doctors prescribe heroin
to addicts who just can't quit. They believe it cuts crime and reduces
the harm drugs cause to society. Could it work here?
WILLIAM BENNETT:
You will never
persuade the citizens of this country - never - that they should legalize
drugs.
ANNOUNCER:
But some Americans
say that we're losing the war, that we must search for new answers.
Is it time for a change?
ETHAN NADELMANN,
Director, Lindesmith Institute:
If that means
providing him with heroin or morphine or injectable methadone, then
we should do that.
ANNOUNCER:
"America's
War on Drugs: Searching for Solutions" with Catherine Crier.
CATHERINE CRIER,
ABC News:
Good evening.
Tonight we'll take a very different look at the war on drugs. There's
not much disagreement that we're losing it. What is just as striking
as our lack of success is the lack of any widespread public debate
about alternatives to our current policies.
Our
purpose tonight is not to advocate any specific policy change. Rather
it is to open up the discussion, to look at some very different -
you might even say radical - approaches to fighting drugs, approaches
which are based on experiments currently under way in other countries.
[voice-over]
Approaches which might help America wage its fight against drugs more
successfully.
1st
POLICE OFFICER:
2nd POLICE OFFICER:
Search warrant!
Police officer!
1st POLICE OFFICER:
2nd POLICE OFFICER:
CATHERINE CRIER:
[voice-over]
It is the longest-running
war in U.S. history-
3rd POLICE OFFICER:
CATHERINE
CRIER: [voice-over]
-a front line
moving through the front yards of America.
3rd POLICE OFFICER:
CATHERINE
CRIER: [voice-over]
Searched
and seized and sent to jail, nothing has stopped Americans from using
illegal drugs, a problem targeted by presidents for more than a generation.
-total
war against public enemy number 1 in the United States, the problem
of dangerous drugs.
I
believe they are a devastating affliction on our society and ought
to be eliminated, as much as we can.
CATHERINE
CRIER: [voice-over]
And
until America deals with its drug problem, it cannot deal with its
crime problem.
CATHERINE
CRIER: [voice-over]
On
the street, the business of black market drug dealing brings in tens
of billions of dollars each year. It has also brought alarming increases
in crime and violence, AIDS and addicts, drug-addicted babies, prison
overcrowdingand more. And you are paying. The total estimated cost
to society for illegal drug use each year: almost $67 billion.
Today
there are as many illegal drugs on the streets as ever and more Americans
behind bars for drug violations than ever before, over 300,000. Some
are dangerous drug dealers, but many are non-violent drug users, like
Oklahoma auto mechanic Jim Montgomery, a 41-year-old paraplegic with
no prior criminal record.
My
worst violation, I think, is a speeding ticket. That's about as out
of hand as I get.
CATHERINE
CRIER: [voice-over]
Montgomery
smokes marijuana, he says, to relieve the pain of his broken back.
But Oklahoma police seized his drugs from a couch behind his wheelchair
and a jury gave him a life sentence for possession with intent to
distribute two ounces of marijuana, an amount equal to the tobacco
in two packs of cigarettes.
They
attacked with a vigilance, accused me of just about being Manuel Noriega's
right-hand man. "Here's his pot. Here's his pipes. He runs a
drug house. People, let's get him."
CATHERINE
CRIER: [voice-over]
Montgomery
is now in prison, with a reduced sentence of 10 years, still longer
than the average time served in the U.S. for murder.
Thirty-five
million Americans, 15 percent of the population, smoke marijuana.
CATHERINE
CRIER: [voice-over]
Rabon
Martin is Jim Montgomery's attorney. He says thousands of drug users
are serving long, unjust sentences because Americans mistakenly believe
the only place for drug users is in prisons- overcrowded prisons.
When
you shove somebody in the front door for possessing two ounces of
marijuana and you pop a rapist or a murderer, or a child molester,
out the back door- you know, they don't want to see that, though.
They- they say, "This person's a dope dealer. We want him to
go to prison and our minds are closed and we're not going to think
about anything else. We're not going to think about the cost. We're
not going to think about the consequences. We're not going to think
about who might be released.
Judge
JAMES GRAY, Orange County, California, Superior Court:
The
war on drugs, I regret to say, has turned into a war on our people.
CATHERINE
CRIER: [voice-over]
California
Superior Court Judge JAMES GRAY says America must find alternatives
to simply locking up drug users.
You
cannot get anything worthwhile by putting drug-dependent people into
prison. We don't accomplish anything beneficial and we spend enormous
amounts of money in the effort. And again, I'm convinced that if we
were to use the money for treatment instead of incarceration, we'd
have fewer people using these drugs tomorrow than are using them today.
CATHERINE
CRIER: [voice-over]
Judge
Gray is part of a growing movement talking about a radical new drug
policy for America, one that includes some form of drug legalization
and of government distribution of drugs directly to the junkies who
abuse them. If you think the judge is smoking something, think again.
CATHERINE
CRIER: [voice-over]
Well,
I personally would have a program of the regulated distribution of
heroin, cocaine and marijuana, where people, adults, could go to a
government package store and purchase these. You would also have warning
labels, similar to those of cigarettes. Inside you would have drug
information, treatment information- "Hey, are you tired of using
this garbage yet? Call 1-800-such-and-such. We have a treatment program
for you."
Nobody
advocates the use or abuse of these drugs, but we can reduce the harm
that will flow from them enormously.
Judge
Gray's idea is just one being debated as part of a controversial new
approach called "harm reduction," which combines legal and
medical strategies. The idea is this: If America cannot win the war
on drugs, it should try instead to reduce the harm associated with
drug abuse.
The
main goal is to keep addicts functioning in society. Give them treatment,
not punishment. Give them clean needles. Legalize marijuana. And even,
under supervision, give hard-core addicts their drugs.
[voice-over]
All of this, aimed
at keeping drug users away from the black market in drug dealers and,
by cutting down the profits of the drug trade, reducing the harm done
to the rest of us.
Mayor KURT SCHMOKE,
Baltimore:
The biggest problem
is that the current approach makes it very profitable to distribute
drugs at the street level.
You
got a problem, huh? Yeah. All right. They'll take care of you there.
CATHERINE
CRIER: [voice-over]
Baltimore Mayor
Kurt Schmoke supports "harm reduction." A former prosecutor,
Mayor Schmoke has studied the drug problem on the streets where, he
says, it is critical to eliminate the profits from drug dealing.
Mayor KURT SCHMOKE:
Most of the people
that are doing all these shootings out here are not folks that have
taken the drugs and then gone crazy and started shooting. It's a war
over money at the street level. And so, what I'm suggesting is that
we have an approach that takes the profit out of distributing drugs
at the street level.
CATHERINE CRIER:
[voice-over]
It is one of "harm
reduction's" boldest gambles- make the government the official
distributor of drugs so there will be no profit to make on the street.
And with no drug profits, the reasoning goes, there will be no drug
dealers.
Judge JAMES GRAY:
They would be
out of business and hooray for that. We could do that and we could
focus our attention upon drug education, which does work, and also
for drug treatment, which does work. We will be far, far ahead.
CATHERINE CRIER:
[voice-over]
But treatment,
which is critical for drug abusers, is rarely available. Only about
20 percent of America's estimated three million hard-core addicts
can get help.
NICK PASTORE, Chief
of Police, New Haven, Connecticut:
No violence. That's
the big thing. No violence. We can talk as long as we put the guns
away, you know what I mean?
CATHERINE CRIER:
[voice-over]
In New Haven,
Connecticut, a city hard hit by hard drugs, police chief Nick Pastore
preaches "harm reduction" to anyone he can.
Chief NICK PASTORE:
And my friend,
my best friend, died with the needle in his arm- heroin. You understand?
CATHERINE CRIER:
[voice-over]
Pastore believes
that by monitoring addicts with treatment and government-supplied
drugs, harm and crime will be reduced.
Chief NICK PASTORE:
The thing that
I feel good about is that that heroin addict is not preying on society,
is not killing somebody, not banging somebody on the head, not breaking
into your or my home. They're getting help.
CATHERINE CRIER:
What happens when
you have drug abusers on the street that don't want treatment and
continue to bring about violence-
Chief NICK PASTORE:
CATHERINE CRIER:
Chief NICK PASTORE:
Lock them up and
throw the keyaway.
CATHERINE CRIER:
[voice-over]
But if reformers
are to succeed in changing the war on drugs, they will first have
to fight a war of words.
Mayor KURT SCHMOKE:
If I say "I'd
like to talk to you about legalizing drugs tonight," my audience
immediately draws conclusions that people have their own sense of,
in their own mind, of what legalization means and you don't get to
the next step.
TEACHER:
What happens to
the person that ends up doing drugs?
CATHERINE CRIER:
[voice-over]
In fact, most
people believe that any form of legalization would be dangerous to
society and would dramatically increase drug use, particularly among
children.
WILLIAM BENNETT,
former Director, National Drug Control Policy:
You will never
persuade the citizens of this country - never - that they should legalize
drugs.
CATHERINE CRIER:
[voice-over]
WILLIAM
BENNETT, national drug czar during the Bush administration, is adamant
that the war on drugs is an ongoing battle and that America must never
admit defeat.
WILLIAM
BENNETT:
This is a deadly
and poisonous activity. It should be against the law. People should
be imprisoned for long periods of time for doing it. It's- it's a
matter of right and wrong.
Judge JAMES GRAY:
Just because we
discuss our options does not mean we condone drug abuse. We can deal
with this very significant problem with these very dangerous drugs
much more promisingly through the medical system and through our social
system. We almost can't do it worse than we are today. There's got
to be a better way.
CATHERINE CRIER:
Reformers like
Judge Gray are looking to Europe, where some countries have already
adopted a radically different approach to the war on drugs.
[voice-over]
And when we come
back, we'll take you to a Dutch coffee shop and show you how the legalization
of the use of marijuana has become the cornerstone of their approach
to fighting the war on drugs.
[Commercial break]
CATHERINE
CRIER:
Today the drug
crisis is exploding all over the world and some European countries,
including Italy, Spain, Germany and France, are searching for new
solutions. But nowhere in Europe is this movement for change further
along than in Holland, where a policy of punishment has been replaced
by a policy of tolerance.
[voice-over]
This is a coffee
shop in the city of Amsterdam and this is a scene that today could
never take place anywhere in the United States: young people smoking
marijuana openly and in public. For almost 20 years, the sale and
possession of small quantities of soft drugs - marijuana and hashish
- has not been a crime in the Netherlands. Anybody over the age of
16 can buy up to 30 grams, about 15 marijuana cigarettes, without
having to worry about being arrested and going to prison.
Rob Hessing is chief
of police in Rotterdam and a critic of the tough law -and-order approach
used in America.
ROB
HESSING, Chief of Police, Rotterdam:
If one should
have the idea that the police or the authorities should solve this
problem by law, then they make a big mistake.
CATHERINE CRIER:
[voice-over]
The Dutch have
long believed that society cannot stop, but can only control the illegal
use of drugs. They believe there has always been and always will be
a problem with addiction and have rejected America's war on drugs
in favor of a broad harm reduction strategy based on tolerance, a
strategy that looks at the drug crisis as a health problem and not
a criminal problem. And the key to their approach is that policy that
legalizes the use of marijuana.
Bob Keizer is head
of addiction at the Ministry of Health.
BOB
KEIZER, Ministry of Health:
We believe that
if young people are interested in taking drugs, with this system they
can just buy it in a more or less open atmosphere. There's no secrecy
so they are not forced to get into contact with all the criminal figures
who are more interested in offering hard drugs to them.
CATHERINE CRIER:
[voice-over]
By legalizing
the use of marijuana, the Dutch say, they have successfully prevented
kids from experimenting with hard drugs. And while some studies in
America do show that smoking marijuana may lead to the use of other
drugs, the Dutch do not believe that marijuana is a gateway, a stepping
stone to heroin, cocaine or amphetamines.
BOB KEIZER:
And statistics
show that this policy works because the number of hard drug users
has stabilized for more than 10 years in the Netherlands.
CATHERINE CRIER:
So that's telling
you that young people are not moving into that.
BOB KEIZER:
Exactly. The stepping
stone theory doesn't work.
CATHERINE CRIER:
[voice-over]
The Dutch also
spend very little money policing the coffee shop scene because, they
say, there's virtually no crime associated with the use of marijuana.
But
there are problems, especially in border towns where foreign tourists
come to buy soft drugs that are illegal in their countries. The Dutch
spend most of their law enforcement budget trying to control the crime
and violence associated with their hard core drug problem. They've even
adopted a harm reduction strategy when it comes to their heroin addicts.
Chief
ROB HESSING:
A lot of users
are not criminals. They are working, have a job, are not unemployed.
What we fight is against the dealers, the traffickers, the organized
crime, and very hard. We don't hunt the users.
CATHERINE CRIER:
[voice-over]
Unlike the United
States, in Holland the war on drugs is waged almost entirely against
the big drug dealers. Addicts can buy and sell up to a half gram of
heroin, cocaine or amphetamines and the police will look the other
way.
[interviewing]
If I'm a hard drug addict and I am not stealing to support my habit-
I've got a job, I-
BOB
KEIZER:
CATHERINE CRIER:
Is anybody going
to arrest me?
BOB KEIZER:
CATHERINE CRIER:
BOB KEIZER:
Usage is not prohibited
by law. Drug usage is not illegal in the Netherlands.
CATHERINE CRIER:
You've still got
addicts on the street-
Chief ROB HESSING:
CATHERINE CRIER:
-needing drugs
from the black market.
Chief ROB HESSING:
CATHERINE CRIER:
How have your
policy changes lowered the crime rate?
Chief ROB HESSING:
Because we know
the market. We know the people. And we are not only repressive, as
a police organization, but try to help the drug addicts to fight their
problems, to look for solutions and to try to get any results.
CATHERINE CRIER:
[voice-over]
The police say
that by knowing the market and the people, they can keep addicts out
of trouble and reduce crime. They believe that you cannot force hard
core junkies to stop taking drugs until they want to. The police have
worked with Dutch policy makers to develop what's probably the most
important part of their harm reduction strategy, a comprehensive drug
treatment program that focuses on the addict and public health.
Ton
Quadt is the coordinator of all drug treatment programs in Rotterdam.
TON
QUADT, Drug Rehabilitation Coordinator:
It's not one miracle
policy. You have to take a lot of small steps to find different solutions
for different kinds of people- small steps, custom-made solutions
for people who can relate to that solution.
CATHERINE CRIER:
[voice-over]
The Dutch begin
by trying to help even the most desperate junkies. There are almost
25,000 users here and even though it's hard to draw comparisons between
the number of heroin addicts in Holland and the United States, it
is clear the Dutch spend a higher percentage of their $100 million
drug budget trying to prevent addicts from harming themselves as well
as others. One of the programs they've launched is free needle exchange
to stop the spread of AIDS. HIV infection is the biggest health problem
in the heroin community and one of the main reasons, the Dutch say,
they expanded their harm reduction strategy.
TON QUADT:
So if you put
in enough clean syringes and needles, people don't have to use dirty
needles, so the risk of getting HIV is lessened. And I think the Dutch
number will prove it.
CATHERINE CRIER:
[voice-over]
Since the needle
exchange program was first introduced almost 10 years ago, the HIV
infection rate among injecting drug users in cities like Amsterdam
has dropped from 11 percent to 4 percent and is now one of the lowest
in the world. But Holland's harm reduction strategy doesn't only focus
on keeping its junkies healthy. There are many drug treatment programs
all over the country to help addicts kick their habits.
BOB KEIZER:
We have a system
of free methadone. Everybody who wants can get free methadone. The
effect is that people are seen very regularly by the health care system.
TON QUADT:
By seeing them
nearly every day, we can watch over them- how are they doing? Whenever
somebody, anybody, is giving the sign of "I want to stop using
drugs," we are there. So we can pick them out of our maintenance
programs and we can put them in a rehabilitation program.
CATHERINE CRIER:
[voice-over]
This, too, seems
to be working. A recent study in Amsterdam shows that many junkies
are now in rehabilitation, learning a trade, and that over 75 percent
of the city's heroin addicts are on methadone maintenance, living
relatively normal, crime-free lives. But despite these successes,
Holland's black market in hard drugs continues to thrive. Cocaine
and now crack are causing more violence and some critics say they
don't want to see junkies who openly shoot heroin on the streets.
[interviewing]
There is certainly the view that Dutch society's very permissive, that
it's crumbling, from a moral point of view. Is that a fair perspective?
BOB
KEIZER:
CATHERINE CRIER:
BOB KEIZER:
Because it works,
our system, compared to other systems. Of course we have problems,
but I don't believe drug policy will ever be a success story. It's
just a matter of keeping the problem within certain limits.
CATHERINE CRIER:
[voice-over]
Today some Dutch
policy makers believe their harm reduction strategy doesn't go far
enough, that until the laws are changed and all drugs are legalized,
the black market trade in drugs, with all its crime and violence,
will never go away.
Chief ROB HESSING:
In the end, we
had to legalize because more police, more courts, more prisons- they
don't solve the problem. They didn't and they will not.
CATHERINE CRIER:
[voice-over]
So the Dutch continue
to debate the future of their drug policy and continue to question
America's tough law-and-order approach.
BOB KEIZER:
The United States
has still this strong belief in the war on drugs and, of course, the
United States is a very big and very powerful country and the Netherlands
is a very small country. So we don't have the illusion to change your
policy, but maybe you have the illusion to change our policy.
CATHERINE CRIER:
The Dutch feel
pressured to adopt a tougher law-and-order approach at every international
meeting on the drug crisis. So do the British, whose harm reduction
strategy even allows doctors to prescribe drugs to addicts.
[voice-over]
It's called "heroin maintenance." In the United States, doctors
could go to jail for doing it. In Britain, doctors say, it's a weapon
critical to winning the war on drugs. How does it work? We'll show you
when we come back.
[Commercial
break]
ANNOUNCER:
"America's
War on Drugs: Searching for Solutions" continues, with Catherine
Crier.
CATHERINE CRIER:
The British, like
the Dutch, are also looking at harm reduction as an alternative to
America's war on drugs. They too have a system of free methadone and
an extensive needle exchange program. But the British, unlike the
Dutch, are also experimenting with a radical approach to treatment
called "heroin maintenance." It's not for all addicts, but
targets a small group of long-term junkies who have repeatedly tried
but just can't stop taking drugs.
TIM:
I romanticized
junkies, I suppose- you know, pop stars like Richards and Lennon.
But no, at no point did I think, "God, in 10 years time, I'm
going to be a junkie."
CATHERINE CRIER:
[voice-over]
Tim is a hard
core heroin addict. He's 29 years old and has been shooting heroin
for over a decade.
TIM:
You know, on a
hit, I'm steady as anything, I'm clear as a bell.
CATHERINE CRIER:
TIM:
Without it, I
just turkey, just withdrawal, don't want to know, don't want to talk,
just want to lay on a bed, no energy.
CATHERINE CRIER:
[voice-over]
Although he's
always worked as a building surveyor, he has spent every penny shooting
heroin up his arm. He's tried quitting dozens of times, but has always
failed.
[interviewing]
Did you ever try methadone?
TIM: Yeah, I was
doing methadone for quite a few months.
CATHERINE CRIER:
TIM:
It never took
the place of heroin.
CATHERINE CRIER:
TIM:
It just hasn't-
it's not the same thing. It's like really feeling like a big feed
and somebody giving you half a sandwich. You know, it's food and it
goes into your stomach, but it hasn't done the trick.
CATHERINE CRIER:
[voice-over]
Tim is now one
of about 400 heroin addicts in Great Britain who are part of a small,
experimental treatment program that most of us in America cannot even
imagine. It's called "heroin maintenance" and it's part
of Britain's harm reduction approach to fighting the war on drugs.
Dr.
Jeffrey Marks is the chief psychiatrist at the Cheltenham Drug Service
and one of dozens of doctors who practice heroin maintenance.
[interviewing]
Tell me how the program works.
Dr.
JEFFREY MARKS, Chief Psychiatrist, Cheltenham Drug Service:
If we have a patient
presenting to our clinic who is injecting heroin and who makes it
clear that he's not yet ready to stop taking opiate drugs, we are
willing to provide for those people controlled amounts of pharmaceutical
heroin.
CATHERINE CRIER:
[voice-over]
It's called diamorphine
[sp?] and it comes in several forms. Tablets, liquid, powder or smokable
heroin is given to long-term junkies with the goal of trying to stabilize
their addiction.
Jeremy
Clitherow is the former head of the National Pharmaceutical Association
and one of Britain's leading experts on heroin maintenance. He says
there are dozens of studies that show it's the other substances, from
brick dust to plaster, used to dilute illegal heroin that destroy the
physical health of the addict.
JEREMY
CLITHEROW, former Chairman, National Pharmaceutical Association:
In small doses
and in pure composition, heroin is, according to textbook, a remarkably
safe drug.
Dr. JEFFREY MARKS:
Yes, they are
addicted to it and have to have it to feel normal, but you can give
somebody heroin for the rest of their lives and it will do them no
harm at all. It has no long-term, serious side effects at all.
CATHERINE CRIER:
[voice-over]
Pharmaceutical
heroin has always been legal in Great Britain. It was routinely prescribed
to control addiction until the mid-1960s when the government decided
to strictly regulate the practice after doctors were convicted of
illegally selling the drug on the black market. The prescribing of
pharmaceutical heroin almost ended during this period and it was not
until 1988 and the AIDS epidemic that doctors once again began experimenting
with heroin maintenance to help control adictts.
[interviewing]
When someone comes in to you and says, "I am an injectable heroin
user," what's to say this isn't someone who simply would like a
free ride? Or does it even matter?
Dr.
JEFFREY MARKS:
It does matter.
I think it would be very wrong to give someone like that heroin, in
which case, we wouldn't give it to them. It has to be someone who
can use the program constructively.
Right.
Now we need to review Tim on the ward.
CLINIC
STAFFER:
Dr. JEFFREY MARKS:
CLINIC STAFFER:
He is withdrawing,
quite visibly.
Dr. JEFFREY MARKS:
CLINIC STAFFER:
I mean, he's suffering,
really.
CATHERINE CRIER:
[voice-over]
Tim was carefully
selected by Dr. Marks as a candidate for heroin maintenance. He was
closely monitored by a team of experts as they tried to transition
him from street heroin to pharmaceutical heroin.
Dr. JEFFREY MARKS:
The dose of heroin
that we give isn't a dose that will make them high. We're not giving
them a free high. We are giving them just enough heroin to keep the
withdrawal symptoms at bay, but to keep them at a state where they're
not intoxicated.
TIM:
I expected it
to be a bit of an easier time than the last week's been. The last
week's been tough because, obviously, there's got to be a certain
amount of me withdrawing and them seeing to what extent I'm withdrawing
and- and giving me enough heroin to stop me withdrawing, which is
what they've done. But it's a pretty painful process.
CATHERINE CRIER:
[voice-over]
All addicts who
enter the heroin maintenance program at the Cheltenham Drug Service
go through this same process of evaluation. It would take Dr. Marks
two weeks to find the right dose of heroin to stabilize Tim. Today
he's out of the clinic and picking up his prescription each morning
at a pharmacy. He's attending weekly therapy sessions and trying to
rebuild his life.
[interviewing]
Do you sort of see a life cycle of addiction in people?
JEREMY
CLITHEROW:
Oh, there is,
without a doubt. People mature out of addiction.
Dr. JEFFREY MARKS:
That's part of
the thinking behind our program. We are willing to prescribe heroin
to buy time, to get them out of criminal behavior, to get them to
be functioning in society so that when they do come through that cycle,
they have a normal life to latch onto.
CATHERINE CRIER:
But what about-
what about on the days when you're really having trouble? [voice-over]
David is another of those addicts, like Tim, who's trying to come
through that cycle of addiction and build a productive life. David
has been part of Britain's heroin maintenance experiment for over
two years. He's committed no crimes, bought no heroin on the black
market and is now working part-time in an insurance office. He's prescribed
heroin-laced cigarettes called "reefers" and smokes five
of them each day.
DAVID:
I wake up in the
morning and I'll smoke a reefer before I go to work. And I'll get
dressed for work, have a shave, get ready, and then I'll smoke another
one on me way to work. While I'm at work, it's not too bad because
I've got work to do and- and I know that when I come home at night,
it's going to be there.
CATHERINE CRIER:
[voice-over]
No longer on the
streets looking for his next fix, David says he's planning for the
future, attending college, working toward a degree in nursing.
DAVID:
Because I've had
this prescription, I've been able to get me life back in order, so
that prescription has given me a second chance and so that's- that's
why I think it's important that the heroin prescription should be
there.
CATHERINE CRIER:
[voice-over]
Many doctors and
law makers in Great Britain say that heroin maintenance is an important
part of their harm reduction strategy. And while there have been no
major studies, small, anecdotal studies like this one show a 15-fold
reduction in criminal convictions amongst the addicts on maintenance
and that the heroin dealer has slowly but surely abandoned the streets.
[interviewing]
Doctor, do you consider the program a success?
Dr.
JEFFREY MARKS:
I do. I have no
doubt that it is successful. We have plenty of people who previously
we would have called hopeless cases who would never stop taking drugs,
who would never stop committing crimes, and who would probably kill
themselves, who have now come off and are leading drug-free lives
and who are happy.
CATHERINE CRIER:
[voice-over]
But there are
critics in Great Britain, critics who say there's no real proof that
heroin maintenance works, that some addicts who've been stabilized
still buy heroin on the black market and that others, just like those
doctors in the 1960s, routinely sell their prescriptions to make a
profit.
[interviewing] Are
you worried, though, about the mixed message that, "Don't ever
start, but if you do, we, in fact, will maintain you with your problem"?
JEREMY
CLITHEROW:
These are different
messages to different parts of the environment and different parts
of the community.
CATHERINE CRIER:
But kids are hearing
that.
JEREMY CLITHEROW:
CATHERINE CRIER:
JEREMY CLITHEROW:
They are. We must
get the message across to them. The down side of using the drugs is
far worse than the short-term pleasurable up side.
CATHERINE CRIER:
[voice-over] Today
other countries are beginning to look at Britain's heroin maintenance
strategy. The Swiss are in the middle of a three-year scientific study
involving 700 addicts and the Dutch, who have already legalized the
use of marijuana and hashish, are reviewing plans to launch an experiment
of their own.
The
British, too, are debating the future of heroin maintenance. And even
though some government policy makers would like to see tougher anti-drug
laws, many of the police on the streets wouldrather see heroin maintenance
greatly expanded.
Phil
Williams, head of the drug squad in Cheshire County:
PHIL
WILLIAMS, Cheshire County Drug Squad:
We've got a drug
problem in the country, as it is in the rest of the world. Somebody
has to do something about it and this is one method that we've found
that is working.
CATHERINE CRIER:
[voice-over]
JEREMY CLITHEROW:
We are now just
tapping the reservoir of users. There must be so many more people
though who could be helped. My personal view is it's an investment
we must make.
CATHERINE CRIER:
A drug treatment
center in London is now in the process of setting up its own scientific
study on heroin maintenance. The study involves about 125 hard-core
addicts and should be completed in about a year.
[voice-over]
So the question now is, should America be experimenting with heroin
maintenance and some of the other harm reduction strategies we've shown
you? We'll talk about that when we come back.
[Commercial
break]
CATHERINE
CRIER:
For decades there's
been a broad American consensus against changing the tough law-and-order
approach to our drug crisis. In part, that's because American policy
makers don't believe that harm reduction or heroin maintenance really
work, that these policies only encourage addicts to keep on using
drugs. Moreover, they believe that America already has the answer
on how to cure addiction, through our own brand of treatment.
[voice-over]
This is a group therapy session at Phoenix House, one of the most well-known
drug treatment centers in this country. And this is the key to America's
drug treatment strategy: getting addicts to stop taking drugs.
1st
GROUP MEMBER:
You know, you're
stuffing a lot of feelings. You need to use your groups and you need
to confront those feelings that you're stuffing!
CATHERINE CRIER:
[voice-over]
Here drug addiction
is considered to be symptomatic of other problems, so addicts - heroin,
cocaine, amphetamine addicts - are all forced to come to grips with
themselves in sessions that are often confrontational.
2nd GROUP MEMBER:
I suggest you
use this game and talk about it. Let it out. Let us know what's going
on or let me know what's going on.
CATHERINE CRIER:
[voice-over]
Many do not come
by choice. Some have been forced here by parents, others by friends,
but most by the criminal justice system. Dr. Mitchell Rosenthal heads
Phoenix House. If there is one problem that upsets him almost as much
as addiction, it's America's lack of commitment to treatment.
MITCHELL ROSENTHAL,
Director, Phoenix House Foundation:
This country should
be embarrassed about the fact that it has so little in the way of
treatment resources.
CATHERINE CRIER:
What do you say
to those people who respond, "This is not my life. I don't take
drugs. These people are committing crimes, endangering me. Lock them
up, get them off the street, and I don't want to hear any more about
them"?
MITCHELL ROSENTHAL:
I think those
people are right. They should be stopped by locking them up. But what
we ought to do is see that prison is the first part of a treatment
plan.
CATHERINE CRIER:
[voice-over]
But today few
prisoners get treatment, nor do most addicts on the street, because
most of the drug budget is spent on our tough law-and-order approach.
And there are other problems. Treatment doesn't always work. Addicts
who've gone through it frequently relapse. The success rate at even
some of the best treatment facilities is only 25 percent.
Once
again, former drug czar WILLIAM BENNETT.
WILLIAM
BENNETT:
I'm all for effective
drug treatment, but one thing I learned for sure from drug treatment
is it's best not to get in this, in the first place. It's best not
to get involved in drugs, in the first place. And the way that works,
I think, is through prevention efforts and law enforcement is a very
effective kind of prevention effort for most people.
CATHERINE CRIER:
[voice-over]
But as we have
seen, that tough law enforcement and minimal treatment approach is
not working. So some cities are beginning to adopt some of the European
experiments in harm reduction. In Baltimore, as in Holland, they use
methadone maintenance and mobile vans to help addicts stabilize their
lives. And in a few cities, like San Francisco, there is free needle
exchange so that addicts won't transmit AIDS. All attempts to control
the harm addicts cause to themselves and others
But
these programs are rare. Ethan Nadelmann heads the Lindesmith Institute,
founded to study alternative solutions to America's drug policy. He
is passionate about the need for more tolerance to addicts.
ETHAN
NADELMANN, Director, Lindesmith Institute:
Somehow, our war
on drugs says that it's immoral to give junkies clean needles, as
if the more moral message is to let them get AIDS and die and, before
they die, to bring down their children and their lovers and their
friends with them, and meanwhile, costing everybody who doesn't use
drugs billions of dollars in hospital costs and emergency room costs
and what have you.
MITCHELL ROSENTHAL:
I don't think
we have any data yet that is compelling that needle exchange is making
a difference.
CATHERINE CRIER:
[voice-over]
But Nadelmann
says the proof is there. In Holland, as we've already shown you, needle
exchange is effective. And a recent study of addicts in New York confirmed
it yet again. The HIV infection rate dropped from 6 percent to 2 percent
for those getting clean needles.
[interviewing]
If it is so clearly the right thing to do for all of these reasons,
why the objections in this country?
ETHAN
NADELMANN:
Why? Because people
focus on the first message: "You're giving a junkie a needle
to take drugs with." That's a bad thing, therefore we shouldn't
do it.
CATHERINE CRIER:
[voice-over]
Harm reduction
experts argue tens of thousands of junkies and former addicts with
AIDS, and others who have been unknowingly infected by them, could
have been saved by needle exchange. But as we said, American policy
makers don't believe in it, nor do they believe in this, Great Britain's
experimental heroin maintenance program, where addicts like Tim and
David are given prescriptions of heroin.
MITCHELL ROSENTHAL:
Heroin maintenance
is a bust and any treatment that is looking at fixing a complicated
human problem from a pure pharmacologic and drug method, that they're
going to fix this mess by adding a drug, is doomed to failure.
CATHERINE CRIER:
[voice-over]
And other policy
makers believe maintenance could never work here because of America's
much larger heroin problem. But Ethan Nadelmann is not as negative
and feels we, too, should be experimenting with heroin maintenance.
ETHAN NADELMANN:
What we're saying
is, "Show me a junkie who can't quit and who's at risk of AIDS
and who's committing crimes- let's reduce that crime. Let's reduce
that AIDS. Let's reduce the vulnerability to disease. Let's try to
help him get his life together. If that means providing him with heroin
or morphine or injectable methadone, then we should do that."
CATHERINE CRIER:
[voice-over]
And like heroin
maintenance, this, too, is hard for Americans to accept. It is the
Netherlands' liberal approach to marijuana. American policy makers
worry when they see sights like this. After all, if we allow the legalization
of small quantities of marijuana, could we be encouraging a future
generation of marijuana smokers?
WILLIAM BENNETT:
You know, we don't
need a drug that makes kids stupider. We don't need this more widely
used. This is not our problem is that our kids are overly smart and
we need to destroy their memory.
Dr. LESTER GRINSPOON,
Harvard Medical School:
CATHERINE CRIER:
[voice-over]
Dr. Lester Grinspoon
is professor of psychiatry at Harvard Medical School. He, too, used
to worry about the dangers of marijuana, but 20 years of research
has changed his mind.
Dr. LESTER GRINSPOON:
But if we accept
the fact that people are always going to use something, I would far
rather people used marijuana than any of the other drugs.
CATHERINE CRIER:
And yet this country
has prohibited marijuana and one of the main reasons is it's a "gateway"
drug. It's going to lead people to harder drugs.
Dr. LESTER GRINSPOON:
There is no evidence
for that whatsoever. That is another myth about cannabis. It has nothing
to do with any inherent property of the drug, that one will go on
to use another drug.
CATHERINE CRIER:
[voice-over]
Remember, though,
there are some studies that suggest marijuana may lead to the use
of hard drugs. But other reports, U.S. government reports, have repeatedly
come to the opposite conclusion about not only the gateway theory,
but marijuana itself.
COMMISSION OFFICIAL:
We also firmly
believe that criminalizing the vast majority of users is unjustified
and unwarranted.
CATHERINE CRIER:
[voice-over]
In 1972, the Schaefer
[sp?] Commission, a blue-ribbon panel of experts appointed by President
Richard Nixon, recommended that possession and sale of small amounts
of marijuana should no longer be an offense. California adopted that
strategy and, according to this study, saved well over a billion dollars
in law enforcement costs from 1976 to 1986 and close to another billion
dollars since then. But even considering those savings, some believe
the Schaefer Commission's recommendations have been purposely ingorned
by our nations leaders.
[interviewing]
Why is this happening? What's the rationale?
Dr.
LESTER GRINSPOON:
It's- it's a fear
of- of having to admit, "Well, maybe we were wrong about this,"
because once marijuana is legalized, they will look back and they
will say, "What in the world? Why did we spend so much energy
in the 20th century arresting people for marijuana, putting them in
jail, and so forth?" There- this is less of a problem than alcohol
or tobacco by orders of magnitude.
CATHERINE CRIER:
[voice-over]
But of course,
if there's opposition to legalizing marijuana, can you imagine the
reaction to our government distributing hard drugs, that package store
plan we told you about earlier?
WILLIAM BENNETT:
Supposing government
subsidizes drugs so that people can get it cheap. You will then have,
I would estimate, 40 to 50 million heavy users of drugs in the United
States. That is- that's not a scenario the American people are interested
in.
Judge JAMES GRAY:
That is real fear
mongering. There is absolutely no information anywhere that says that
if we were to make these drugs available under a different system
that everybody would go out and use these drugs. I wouldn't use these
drugs. I'm sure you wouldn't, either. And if I were going to, I'm
sure I'd be using them already.
CATHERINE CRIER:
If drugs were
legal, would you run out and begin taking drugs?
WILLIAM BENNETT:
CATHERINE CRIER:
Why do we think
that the world is different?
WILLIAM BENNETT:
There are lots
of people in America who live on the margin. There are lots of people
in America who live on the margin who would try things, were it- were-
were they not fearful that they might get in trouble with the law
or their job or something. And the temptation to use drugs like this
is- is rather- rather strong in such circumstances.
CATHERINE CRIER:
[voice-over]
But the real fear
is for America's children. Remember those public service announcements?
TELEVISION COMMERCIAL:
You better know
what you're jumping into.
CATHERINE CRIER:
[voice-over]
For a while, these
warnings prepared by the Partnership for a Drug-Free America had great
impact and the number of kids trying all kinds of drugs declined during
the 1980s. But today, with not enough money to teach kids about the
dangers of drugs, recent figures suggest that drug use among young
kids is up dramatically. So what would happen if drugs were even more
available, as Judge Gray has suggested? Wouldn't it lead to more kids
experimenting with drugs and make a bad situation that much worse.
Judge JAMES GRAY:
Today we have
people that are out there on our high school and junior high school
campuses pushing this garbage. The kids know where the drugs are.
They're choosing, a lot of them, not to use them. They would continue
to choose not to use them under my system. Would some get through?
Sure. But we're just trying to reduce this harm. We're certainly never
going to get rid of it.
CATHERINE CRIER:
[voice-over]
It is that fact
- we'll never completely get rid of drugs- and the crime, the destruction
of human lives, the disease- that has inspired many to look for new
solutions. While supporters of harm reduction do acknowledge there
will be an increase in drug use, they still believe we must look at
those experiments in Holland and Great Britain.
Mayor KURT SCHMOKE:
I believe that
we'll end up with safer cities-
CATHERINE CRIER:
[voice-over]
And at the very
least, reformers like Baltimore Mayor Kurt Schmoke say, we must not
repeat the errors of our past.
Mayor KURT SCHMOKE:
I think that the
war on drugs is domestic Vietnam. And didn't we learn from Vietnam
that, at a certain point in the war, we should stop and rethink our
strategy, ask "Why are we here, what are we doing, what's succeeded,
what's failed?" And we ought to do that with the domestic Vietnam,
which is the war on drugs.
CATHERINE CRIER:
At the moment,
America shows few signs of rethinking its drug strategy. The government
continues to spend more money on law enforcement,more money on building
new prisons, more money on fighting the war on drugs. When we come
back, some final thoughts.
[Commercial
break]
CATHERINE
CRIER:
Tonight we've
examined a very different and controversial approach to America's
drug problem called "harm reduction." Could it work here?
The answer is unclear.
[voice-over]
The European experiments we've shown you are small in number. The cultures
are very different from ours. The ultimate benefits of the experiments
have not been conclusively evaluated. Yet, as we've seen in each of
the countries we visited, law enforcement and medical officials seem
convinced that these experiments are working.
[on camera] Again,
our purpose tonight is not to advocate any specific policy, but rather
to suggest that as we search for solutions, we need to consider all
of the alternatives. To simply eliminate some approaches because they
may seem at first glance too radical or too different from policies
we have followed for decades cannot be in our best interest. Whether
the alternative strategies will ultimately work for America is an
open question, but it's a question which deserves a fair, spirited
and serious debate.
To
continue that very discussion, please join us for a special edition
of Nightline following your local news. For all of us at ABC News,
I'm Catherine Crier. Thank you for joining us and good night.
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