The War over the War on Drugs

This chapter focuses on the war over the war on drugs, which is a secondary, derivative, and ideological war that is used as a framing device for understanding the question of drugs in the United States over the past two decades. It addresses whether the fight against drugs has achieved its objectives and whether the moral, political, economic, and personal costs of protracted policies of drug prohibition outweigh liberalization. It also refers to John Walters, director of the White House Office of National Drug Control Policy under George W. Bush, who recruited core American values to defend the drug war. The chapter discusses the conservative view on drugs, which was reiterated by the Temperance and Prohibition movements as part of the Progressive reform wave that swept the United States at the turn of the twentieth century. It points out how pervasive drug use in America is a signal of moral decline, and prohibition is the only solution.

Reagan’s War

This chapter discusses how the U.S. nation witnessed a second heroin epidemic in the second half of the 1970s that terrified politicians and tore open the social fabric of inner cities across America. It mentions the National Household Survey on Drug Abuse that began using a new metric in the early 1970s that included a question about drug use in the “last month.” It also recounts how cocaine that was supplied by enterprising and ruthless Colombian traffickers came to grip America like no other drug before it, referencing magazines like Newsweek that characterized cocaine as the status symbol of the American middle-class pothead. The chapter talks about how Ronald Reagan, who took the further step of establishing a new agency, the Drug Abuse Policy Office, which became the White House's Office of National Drug Control Policy. It explains Operation Pipeline, which escalated “pretextual traffic stops” and “consent searches” to leverage consent to search for drugs.

Pharmacological Puritanism and the War on Drugs: All the King’s Horses and All the King’s Men . . .

H. L. Mencken, arguably the leading satirist of the 20th century, said that American puritanism is characterized by the haunting fear that someone, somewhere, may be happy. If the source of that happiness is a drug, we might call it pharmacological puritanism. Followers of that faith abound, but I will mention just few. “There’s no such thing as recreational drug use” were the words of William Weld, head of the criminal division of the Attorney General’s office in 1988. A year later, in the midst of a cocaine epidemic, William Bennett, the first director of the Office of National Drug Control Policy (ONDCP) under President George H. W. Bush, expressed dual goals. The first was to construct 95,000 more federal prison cells for drug abusers and the second to make Washington, D.C., a drug-free city. He believed that calls for legalization of any psychoactive drug to be “morally scandalous.” John Walters, director of the ONDCP during George W. Bush’s tenure as president, believed that religion is the answer to drug abuse. Lest we think that pharmacological puritanism is a dying faith, we need only recall Attorney General Jeff Sessions’ comment in 2016 that “Good people don’t smoke marijuana.” It does make me wonder where, on the good–bad spectrum, lie the tens of millions of Americans who live in states and in the District of Columbia where marijuana is legal for recreational use. Among the general population, pharmacological puritanism appears to be uncommon. A survey of American college students found that the prime motives for drug use were to help with concentration, to increase alertness, and to get high. From the United Kingdom, David Nutt, chairman of the Department of Neuropsychopharmacology at Imperial College London, put it this way: “Drugs are taken for pleasure.” Whatever their numbers today or in the past, it is believers in pharmacological puritanism, with the absolutism which accompanies that faith, who are major contributors to the failure of our most recent war on drugs, now nearly a half-century old.

THE PRICE OF COCAINE AND THE COLOMBIAN PESO: AN EMPIRICAL INVESTIGATION

While the underground economy is not explicitly included in the measure of (GDP), the cocaine trade has been a major source of revenue for Colombia. Using quarterly cocaine prices from 1982 to 2007 published by the Office of National Drug Control Policy, this paper uses vector error correction and forecast error variance decomposition methods to look at the relationship between cocaine prices and the peso/$ nominal exchange rate. Our results indicate cocaine prices affect the value of the Colombian peso, which leads to some interesting policy implications.

Behavioral Health Workforce Development in the United States

Mental health and substance use conditions are among the most prominent causes of illness and disability in the U.S. Yet less than half of the individuals with these conditions receive treatment (Substance Abuse and Mental Health Services Administration [SAMHSA], 2011; Office of National Drug Control Policy [ONDCP], 2013). While there are many impediments to accessing care, the absence of a workforce that is of sufficient size and adequately trained is a significant factor (Olfson, 2016). This chapter provides an overview of the U.S. behavioral health workforce and describes seven strategic areas in which activity has been undertaken to strengthen it. The initiatives of the Annapolis Coalition on the Behavioral Health Workforce are presented to highlight these strategic areas, which include assessment and planning; competency identification and development; roles for persons in recovery and family members; integrated care and interprofessional collaboration; workforce development in substance use; diversity and cultural competency; and knowledge dissemination and adoption of best practices.

Trauma Trainees’ Multiple Competing Goals in Opioid Prescription Communication

Prescription opioids and heroin account for more than half of all drug overdose fatalities, costing an estimated 115 American lives every day. The ongoing opioid epidemic devastates communities and represents a tremendous burden to the national economy and health care system. In 2016, the Centers for Disease Control and Prevention and the White House Office of National Drug Control Policy proposed action to train prescribers on the proper dispensing of opioids, which are indispensable pharmacologic resources for treating acute pain resulting from a traumatic injury or surgery. Trauma surgeons who prescribe opioids for severe pain embark on patient consultations with multiple and conflicting goals respective to their roles as a healers of the suffering, regulators of illicit substances, members of a greater medical system working to contain an opioid epidemic, and moral beings with a distinct set of preferences, experiences, social norms, and practice philosophies. Semistructured interviews with 17 trauma and surgical residents and fellows at a southeastern academic medical center in the United States generated descriptive data regarding prescribing practices and patient communication. Guided by the multiple goals framework, the current research presents three prominent themes depicting the problematic convergence of identity, task, and relational goals during opioid-prescribing conversations between trauma trainees and their patients.

Behavioral Health Workforce Development in the United States

Mental health and substance use conditions are among the most prominent causes of illness and disability in the U.S. Yet less than half of the individuals with these conditions receive treatment (Substance Abuse and Mental Health Services Administration [SAMHSA], 2011; Office of National Drug Control Policy [ONDCP], 2013). While there are many impediments to accessing care, the absence of a workforce that is of sufficient size and adequately trained is a significant factor (Olfson, 2016). This chapter provides an overview of the U.S. behavioral health workforce and describes seven strategic areas in which activity has been undertaken to strengthen it. The initiatives of the Annapolis Coalition on the Behavioral Health Workforce are presented to highlight these strategic areas, which include assessment and planning; competency identification and development; roles for persons in recovery and family members; integrated care and interprofessional collaboration; workforce development in substance use; diversity and cultural competency; and knowledge dissemination and adoption of best practices.

THE SOCIAL JUSTICE IMPLICATIONS OF THE US DRUG WAR

In this paper, the authors outline key facts pertaining to the US drug war, including its stated goals and objectives, and then offer an assessment of the empirical evidence related to its (in)effectiveness in achieving these goals. Data illustrate that drug use is not down, that availability of drugs is not down, that the price of drugs is not down, that access to drug treatment has not increased, and that deaths and illnesses associated with drugs use are not down. The authors also identify major costs associated with national drug control policy and weigh these against its benefits. This analysis permits a conclusion with regard to whether the drug war is a good or bad policy. Finally, the authors utilize major theories of justice to identify whether the drug war is consistent with social justice. The analysis shows that the drug war does not commonly accepted definitions of social justice.