Should California “Medicalize” Illegal Drugs?
Monday, June 1, 2009
SAN DIEGO The effort to legalize drugs remains on the periphery of our political landscape. A San Francisco lawmaker, for instance, has sponsored a bill to legalize marijuana. Some doctors who deal with drug addiction say a better model may be medicalization. That means allowing addicts to use drugs under a doctor's supervision. But KPBS Health reporter Tom Fudge says attempts to change the legal status of drugs raises serious questions that don't have simple answers.
There may be no drug policy critic in California more outspoken or better credentialed than Jim Gray. He served as a district court judge in Orange County for 25 years. But he decided, long ago, that the war on drugs was a failure.
Drug use, he says, should not be seen as a criminal matter.
"It makes as much sense to me to put this gifted actor Robert Downey Jr. in jail for his cocaine problem, as it would have to jail Betty Ford for her alcohol problem," he says.
The idea of treating drug addiction as a medical problem enjoys wide support. And some people who work with addicts propose that we medicalize addictive drugs. Clark Smith is medical director of Sharp Vista Pacifica, a drug and alcohol treatment hospital. He says providing addicts with the drugs they crave, under a doctor's supervision, is a promising model that could take the profit out of the illegal drug trade.
"This sounds pie in the sky and idealistic," he says. "But huge amounts of money are being spent for illegal drugs. And if we could divert even ten percent of that money toward medicalized treatment and drug rehabilitation treatment, I think we're going to see this problem go away."
The example often cited of medicalization is one in Zurich, Switzerland. There, heroin addicts are allowed to use the drug with a prescription. Smith says the program means addicts don't have to commit crimes to get their drugs, and treatment remains an option.
"Now it's possible that they may choose to use heroin on a regulated basis. I think that would still be preferable to the system we have now," says Smith.
Medicalization, as Smith describes it, isn't the only option for changing the system. Legalizing drugs could mean treating cocaine and heroin as we treat alcohol or tobacco. Decriminalization usually means legalizing the use, though not necessarily the production and sale of drugs.
"People who propose legalization… essentially they say we failed in keeping drugs illegal. That's why let's legalize it."
Igor Koutsenok is a psychiatrist and drug addiction specialist at UCSD.
"Okay let's fantasize," he says. "Even if it's legal tomorrow morning it means a huge governmental involvement. Since you just said the government has failed in keeping it illegal what makes you think the government will be successful in making it legal and controlling it effectively?"
Koutsenok is also very skeptical of the existing models for legalization and medicalization. The Swiss example? Koutsenok points out that it's a highly controlled program that serves only about 200 heroin addicts in Zurich. He also wonders… why keep addicts on heroin when methadone has proven to be an effective, safe substitute?
And what about the Dutch experiment, in which Amsterdam allows marijuana to be used in certain districts? Koutsenok says supporters claimed that this would hurt the illegal drugs trade.
"In fact, what happened the entire drug trafficking has been rerouted to Amsterdam. And the groups, the organized crime groups, have made a remarkable profit because, practically, what you get here is a clear indication of where the market is," says Koutsenok.
Even people like Clark Smith, who favor medicalization of drugs, have serious misgivings about legalizing marijuana. It's a drug Smith considers to be addictive and potentially destructive to a young person's development.
Addiction specialists say the urge to alter consciousness is fundamental to the human experience. Like it or not, that means people will use drugs and some will become addicted. That raises the question: What role should the criminal justice system play, visa vi the medical establishment, when it comes to controlling the destructive potential of drugs. So far, there's no easy answer.