Morristown, NJ

Contents

Introduction: Say Whatever You Want Aout Drugs As Long As It's Negative

Drug Policy and Models of Drug Abuse and Addiction

• The Disease and Law Enforcement Models of Addiction
• The Modern Drug Policy Synthesis and Its Problems
  • An Example of the Pervasiveness of the Modern Drug Policy Synthesis: The ABA Report
• Alternative Views: The Libertarian and Social Welfare Models
  • Issues Limiting the Potential of Alternative Models.
• An Innovative Synthesis of Drug Models and Its Implications for Drug Policy
  

Harm Reduction, Drug Legalization, and Models of Addiction

Marketing Alternative Drug Policies

References

Introduction: Say Whatever You Want Aout Drugs As Long As It's Negative

In 1972, Edward Brecher -- under the aegis of Consumer Reports -- published a remarkably forward-looking book entitled Licit & Illicit Drugs. Among the many myths of addiction he punctured was that of heroin overdose. To accomplish this, Brecher reviewed evidence that (1) deaths labelled heroin overdose "cannot be due to overdose; (2) there has never been any evidence that they are due to overdose; (3) there has long been a plethora of evidence demonstrating that they are not due to overdose" (p. 102).

In category (1) are historical and pharmacological data. In New York City prior to 1943, very few deaths of heroin addicts had been attributed to heroin overdose; in 1969-1970, 800 overdose deaths were recorded in New York. But over this time span, heroin purity declined steadily. In research conducted at Jefferson Medical Center in Philadelphia in the 1920s, addicts reported daily doses 40 times as concentrated as the usual New York City daily dose in the 1970s (Light & Torrance, 1929). Addicts in this research were injected with 1800 mg in a 2 1/2-hour period. Some subjects received up to 10 times their ordinary daily dosage and showed insignificant physiological changes.

In category (2) are the standard regimens of big-city coroners of simply recording as overdose deaths cases in which an addict died and had no other obvious cause of death. According to Brecher (1972),

A conscientious search of the United States medical literature throughout recent decades has failed to turn up a single scientific paper reporting that heroin overdose, as established by...any...reasonable methods of determining overdose, is in fact the cause of death among American heroin addicts (p. 105).

In category (3) are results of research conducted by two prominent New York City Medical Examiners, Drs. Milton Helpern and Michael Baden, based on the examination of New York City addict deaths, which found that (1) heroin found near dead addicts is not unusually pure; (b) the body tissue of the addicts shows no undue concentration of heroin; (c) although the addicts usually shoot up in groups, only one addict at a time dies; and (4) dead addicts are experienced--rather than novice--users who have built up tolerance to potentially large doses of heroin.

Yet, when we move from the 1920s and 1970s to the 1990s, we find in the New York Times on August 31, 1994, a front-page headline about the deaths of 13 New York City heroin users, part of which read: "They call it China Cat, an exotic name for a blend of heroin so pure it promised a perfect high, but instead killed 13 people in five days" (Holloway, 1994, p. 1). Brecher (1972) would seem to have laid to rest claims about epidemics of "multiple overdoses" of heroin like this one reported in the New York Times. Not surprisingly, two days later, the New York Times announced: "Officials Lower Number of Deaths Related to Concentrated Heroin" (Treaster, 1994, p. B3).

By this time, published reports had attributed 14 deaths to China Cat. The second New York Times article stated, "authorities yesterday lowered from 14 to 8 the number of deaths in the last week that the police believe are related to highly concentrated heroin" (Treaster, 1994, p. B3). The Medical Examiner discovered that

two of the 14 men originally suspected of having died from taking the powerful heroin had actually died of natural causes. Four others died of overdoses of cocaine.... Of the eight whose deaths apparently did involve heroin, seven also had traces of cocaine in their system" (Treaster, 1994, p. B3, emphasis added).