Fine: Start telling the truth about drugs

PROVIDENCE JOURNAL
Posted Apr 7, 2016 at 2:01 AM

By Michael Fine

Drug and alcohol use represent a difficult policy challenge in a free society. We want to allow individual freedom, but we also want to protect our young people from harm and prevent the serious injury that can result from drug and alcohol overuse. We want our businesses to flourish and we want Rhode Islanders to be able to make a living, but we don’t want some people to be making a living at the expense of the public’s health.

Protecting the public’s health means the exercise of individual responsibility, the restriction of some freedoms, and being clear about conflicts of interest in our politics, so we can distinguish between those policies that serve the public’s health and those that serve only personal gain, when policies might hurt one at the expense of the other.

Too many Rhode Islanders are using drugs and alcohol. Why is that?

Simply stated, drugs and alcohol are a problem because they produce pleasure in some people, harm in more than a few, and profit for many. Most people can have a glass of wine, a single cigarette, a little marijuana, or even a hit of heroin or cocaine without ill effects. Are the 90 percent of us who can experience pleasure from a single use supposed to abandon that opportunity because 10 percent are at risk? Are the huge profits to be made by growing, producing, distributing and selling these substances to be abandoned because of the risks to a few people? These are difficult questions for a society and a state to answer.

But there are more complicated questions yet. How much should we consider the addictive potential of each substance in deciding whether or not to allow the public access to it? And how do we rate addiction? By the strength of the user's desire for the substance? Or by the intensity of any withdrawal? How about danger? Should we prohibit substances that can kill you on a single use? How about those that kill only with use over many years? Should we consider beneficial effects, which some of these substances have when they are used in small amounts and for short periods?

Adding to public policy confusion is the fact that every attempt we have ever made to ban pleasurable substances is met by the quick emergence of a black market that is often associated with violence, criminality, and varying degrees of public corruption here and around the world.

So there is no perfect calculus, telling us what to do.

At this point in our history, though, it’s time to face a difficult fact: our attempt to protect the public’s health by making some substances controlled and some illegal has failed. Illegal sources of supply appear to be able to out-run and even out-gun law enforcement. We now have an uninterrupted supply of the most dangerous substances, despite a 40-year war on drugs. Heroin is cheaper than marijuana. Marijuana is available in every high school bathroom in Rhode Island, and apparently, in many middle schools as well. Making drugs illegal has created criminals and corruption, and has led to the unjust imprisonment of two generations of African-American men.

Our current approach doesn’t appear to be saving lives. At the moment, profit and pleasure seeking appear to be stronger drivers of our social policy than our ability to protect the vulnerable among us through law enforcement, despite our best intentions and the better angels of our nature.

It’s time to start telling ourselves the truth about drugs. We can’t arrest our way, imprison our way, or legislate our way out of a basic human truth. The Old Testament struggle between easy pleasures and hard work — between self and community, a struggle older than the written word — is not being effectively addressed by our laws or our culture. Some of us like drugs and alcohol. Some of us like profit. Community takes work and work takes time to prove that it creates meaning and value.

The combination of drugs and profit is going to get and keep too many of us dependent and addicted. Given deep human vulnerabilities, unless we find new ways of preventing people from using drugs, provide better life choices than getting high for people who have been marginalized by our culture, and make sure we have immediate access to treatment for people who are using now, Rhode Islanders are going to keep using, and Rhode Islanders are going to keep dying.

Michael Fine, M.D., an occasional contributor, was director of the Rhode Island Department of Health from 2011 to 2015. He is a family physician.