Sunday, April 12, 2009

Sex, Drugs, and Rocky Road

As reported in Scientific American, according to the National Center for Health Statistics, which conducted a survey of more than 6,000 people (a largish sample for such purposes), ninety-six percent of U.S. residents have engaged in sex by the age of 20. The report notes various patterns based on ethnicity, education, income, and so on.

I'm not quite sure why this was considered a health issue per se, since sex is dangerous, so the old line goes, only if you do it right. With reasonable precautions one usually can escape injury, but the study didn't focus on precautions.

The study moved on to substance abuse.

"More than 19 percent of those aged 20 to 29 said they had tried cocaine, crack or another street drug, excluding marijuana. This rose to 27 percent for people aged 30 to 39 and nearly 26 percent for those in their 40s."

These figures probably are on the light side as people notoriously are reluctant to answer truthfully about misbehavior. It is hard to say how much they lie, but it is likely to be at least as much as they lie about tobacco and alcohol. We have some indication of this from a review of the Substance Abuse and Mental Health Services Administration:

"According to a White House briefing paper analyzing SAMHSA's figures regarding Americans' alcohol and tobacco use, respondents have historically underreported their usage of these two legal substances by as much as 30 to 50 percent. (Revenues from alcohol and tobacco taxes allow researchers to cross check respondents admitted usage patterns with actual annual consumption rates…)" – Paul Armentano, Federal Drug Use Surveys and Fuzzy Math

Nevertheless, even taking the figures at face value, it means about a quarter of adults commit rather serious drug offenses, even when excluding from consideration marijuana, the most commonly used illegal substance. By comparison, according to the 2003 National Health Interview Survey (NHIS), 21.6 percent of U.S. adults smoke cigarettes.

In this case I agree with the NCHS (it seems like there is some duplication of alphabet soup agencies, doesn't it?). Drug abuse is a health issue. So are the laws against it.

Drug warriors by and large are well-meaning people who honestly think they are doing good. It even is likely their efforts save a few people from themselves by scaring them with the threat of punishment. At the same time, the panache of illegality actually tempts others, just as illegal booze did in the old speakeasy days. The side effects have been massive . The drug warriors inadvertently have enriched gangs and dealers, undermined civil liberties, turned neighborhoods into war zones, and made a huge percentage (by some counts a majority) of our citizens criminals. The US has the highest prison population – both per capita and in absolute terms – of any nation on earth, and two-thirds of the inmates are there for drug related crimes.

Though drug prohibition dates back to World War One (and gathered steam in the 30s), Richard Nixon declared a full scale War on Drugs 38 years ago in 1971. It is obvious drugs won. It is time for another approach. Legalization combined with an offer of treatment may not reduce the number of abusers. Reducing drug abuse simply may not be possible – you can toss lifelines to people, but ultimately you can't make them grab on – but legalization would be a kinder alternative for users and for the rest of us, and it would be cheaper too. Nor is the approach entirely untried. The Swiss and Portuguese have decriminalized heroin (Swiss hospitals actually supply it to registered addicts), and both countries have reduced street crime and new AIDS cases without any noticeable uptick in use. When the Bourbons regained the French throne after Napoleon, it was said “they have learned nothing and forgotten nothing.” The results were unfortunate. When Kentucky bourbon was restored to American taverns in 1933 after Prohibition, we failed to learn or forget. We immediately reinforced prohibition on drugs other than alcohol with results just as unfortunate.

My personal addictions are more in the nature of various flavors of ice cream, which, fortunately, are not yet illegal and need not be bought on the street, though the NIH has much to say about substances such as these too. One day at a time.

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