Nov. 29, 2007 – Society’s attitudes toward different drugs and its ways of regulating them are often “inconsistent,” “incoherent” and ultimately unjust, says a new book by a team of University of Utah scholars.

The book says that to create a just drug policy, society must develop a consistent and coherent way of thinking about the entire gamut of drugs, from prescription and over-the-counter medicines to alternative and herbal remedies and supplements, sports-enhancing steroids, illegal recreational drugs, religious-use drugs such as peyote, and everyday fixes like alcohol, tobacco and caffeine.

“We must make significant changes, not merely cosmetic prunings, in the way we treat drugs – all drugs,” says “Drugs and Justice: Seeking a Consistent, Coherent, Comprehensive View,” published Nov. 30 and written by 11 philosophers, pharmaceutical scientists, lawyers, doctors and psychologists. “This means scrapping many of the laws now on the books and starting over.”

They write that making needed changes in the way drugs are treated means “resisting politically motivated enforcement and reform measures that have not been thought through with concern for their impact in all areas” of drugs – across the board.

The book decries the compartmentalization of drug policy and regulation, varying definitions of addiction and harm, the failure of drug experts in different fields to reach beyond their specialties, and – says publisher Oxford University Press – “inconsistencies that derive more from cultural and social values than from medical or scientific facts.”

“It’s the compartmentalization and the differing histories of regulation of different drugs that result in many of the apparent inconsistencies and injustices,” says the book’s first author, bioethicist Margaret Battin, a distinguished professor of philosophy at the University of Utah. “It’s not that some drugs don’t cause harm. Some cause serious harm or death. But the way in which we approach regulation and think about drugs doesn’t correspond to a thoughtful evaluation of their capacities for addiction, danger, or beneficial properties in reducing pain or producing pleasure.”

Inconsistencies and Injustices in Drug Policy
“Control of illegal drugs has been an immense focus of domestic and international policy, with enormous financial and human costs,” Battin says. “Yet we haven’t really examined our rationale for making some drugs illegal and others not.”

Some inconsistencies cited in the book include:

• “Is the rationale for restricting prescription drugs consistent with the absence of such restrictions for dietary supplements and herbal drugs?” And why aren’t dietary supplements and herbal medicines tested for safety when prescription drugs are tested?
• “Should risks of death count? Why is marijuana illegal if alcohol is not? Why is peyote illegal if tobacco is not?” In the book’s foreword, physician-lawyer Peter Cohen of Georgetown University Law Center asks: “Why do we allow the sale of alcohol and tobacco, both responsible for greater rates of mortality and morbidity than ‘illegal’ drugs? No doubt, among the many factors responsible for the disjunction between scientific fact and public policy are the overwhelming influences of money and lobbying.”
• Use of anabolic steroids by an Olympic athlete nets a one-year suspension for the first violation, yet National Football League players get only a four-game suspension.
• Under one accepted definition of addiction, someone who drinks numerous cups of coffee daily, craves it and suffers withdrawal headaches is considered “addicted.” Under another definition, he is “substance dependent.” Yet a weekend cocaine user is neither addicted nor substance dependent under the first definition and only in the less serious category of “substance abuser” under the other. The definitions – used primarily in medical and psychological spheres – disagree, but both define the coffee drinker as having a more serious disorder than the weekend cocaine user.
• “According to national surveys, it is about as easy for a high school student to obtain illegal drugs as it is to obtain alcohol. Ironically, the law will allow her to purchase alcohol in just a couple of years but will never permit her to buy or possess other drugs.”
• “Is there any good reason why the same amounts of crack cocaine and powder cocaine should result in vastly different criminal punishments?” Under federal law, possessing five grams of crack cocaine carries the same five-year minimum mandatory sentence as possessing 500 grams of powder cocaine – a problem now being addressed by the Federal Sentencing Commission.

The authors say that “some of these inconsistencies may turn out to be justified while others may not.” Longer sentences for crack may arise because it is linked to more violent crime and greater social harm, and also because it is more widely available – or they may be due to racism, since blacks are more likely to use crack than powder cocaine.

The history of drug policy has been shaped by politics, racism and fear of foreigners, with early opium, cocaine and marijuana laws, respectively, targeted at Chinese railroad workers, southern blacks and Mexicans, the book says.    

Justice: An Rx for Society and Drugs
The book’s authors say their objective “is to identify apparent inconsistencies in theory, policy and practice about drugs; to diagnose what is at the root of these inconsistencies and consider whether some may be justified while others not; and to show what would be involved in developing a coherent body of theory, policy and practice that … covers all pharmacologically active substances. Doing this will contribute to our ultimate goal, working toward greater justice in the way the world manages drugs.”

The researchers note that “virtually every drug has the potential to produce both benefit and harm,” and both must be considered. Yet today, which aspect gets emphasized depends on the specialty of the people talking about it.

“If we look at the use of narcotics in pain management we are typically looking at their benefits,” Battin says. “If we are looking at narcotics used on the street, we typically talk about the harm they cause.”

The authors began the interdisciplinary discussions their book endorses by forming a group at the University of Utah in 2003 “to consider issues of justice in the way that drugs are used and controlled in society,” they write.          

Most of the book’s seven main authors are at the University of Utah: Battin; Erik Luna, a professor of law; Arthur G. Lipman, a professor of pharmacotherapy and pain management expert; physician-anthropologist Paul M. Gahlinger; an adjunct professor of medicine and expert on religious drugs; Douglas E. Rollins, professor of pharmacology and toxicology and medical director of doping control for the 2002 Olympic Winter Games; Jeanette C. Roberts, a former Utah medicinal chemist and herbal drug expert now at the University of Wisconsin, Madison; and appellate attorney Troy L. Booher, also an adjunct professor of law and political science.

Contributors to the book are David G. Dick, a former Utah philosophy graduate student now at the University of Michigan; Dennis M. Fuchs, a retired Utah Third District judge known for his work on drug courts; and two University of Utah psychologists: substance abuse specialist Karol Kumpfer, a professor of health promotion and education; and addiction assessment expert Kelly J. Lundberg, clinical associate professor of psychiatry.