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Uncle Sam, Drug Scold

Editor's Note: We held onto this item for a bit as all hell broke loose with Senator Daschle and then with the stimulus bill. Substance abuse policy often takes a back seat to more visible matters, but we don't want this little story to get less than its due. Harold Pollack--for those of you who don't know yet--is a public health policy researcher at the University of Chicago's School of Social Service Administration, where he is faculty chair of the Center for Health Administration Studies. He is a regular contributor to The Treatment.

Americans are inclined to goad, cajole, and lecture others about how they should go about their business. The State Department routinely grades other nations on human rights, economic efficiency, human trafficking, and who knows what else. I understand the temptation, since we speak with genuine (albeit dwindling) authority in these areas.

We bring that same spirit to the regulation of illicit drugs. But here our proselytizing is puzzling, given our lamentable track record in substance abuse policy. We spend billions on supply-side interdiction and other police efforts. We now incarcerate roughly 500,000 people for drug offenses, more than the European Union incarcerates for all crimes. Despite these prodigious efforts, U.S. street prices of heroin and cocaine have plummeted since the early 1980s. We spend significant sums on drug abuse programs such as DARE, despite accumulating evidence that these efforts don't work. Nearly 200,000 American injection drug users (along with thousands of other drug users) have died of AIDS.

In light of all this, one might think that we would look to others that pursued more successful policies, or that we would at least respect the diverse policy approaches and interventions employed around the world. In fact, the opposite is true. Countries around the world have tried, with great success, various "harm reduction" policies--that is, policies such as needle exchange that reduce the harm of drug use without necessarily or immediately reducing drug use itself. But the U.S. has resisted such programs on moral grounds. For a long time, we have used our leverage abroad to squelch efforts that might have have spread such policies to more places that need them.

Consider: The United Nations is now updating the global policy framework established by 1998 General Assembly Special Session (UNGASS) on drug policy. A meeting is now occurring in Vienna, with results expected in March. I'd be surprised if one percent of Americans know or care, but this work is actually important. The United Nations Office on Drugs and Crime (UNODC) plays a modest but important role in global drug policy. Alas, the U.S. is the UNODC's largest and most adamant donor.

The Bush administration--and its predecessors--have not hesitated to apply the heavy hand in opposing efforts to legitimize or acknowledge harm reduction efforts. And even though the Bush Administration is gone, down a few levels in the federal bureaucracy the old attitude remains. As of last week, American diplomats at UNGASS were opposing efforts, by European Union representatives, to make explicit reference in the assembly's new report to "harm reduction" measures.

John Walsh, Senior Associate of the Washington Office on Latin America, emailed me the contested description of "drug demand reduction policies and programmes providing a continuum of prevention and care." Below is the EU's proposed text—more precisely, a footnote--American diplomats found unacceptable:

For a number of countries, this comprehensive package of prevention and care includes harm reduction measures, which are identified as measures undertaken in full compliance with the drug conventions and in accordance with national legislation, to reduce the related health and social harms of drug abuse. Harm reduction measures should not be provided in isolation, but as part of a comprehensive package of services aimed at protecting the health of drug users, their families and communities, and facilitating a process of treatment and rehabilitation, with the ultimate goal of social reintegration."

I've read that several times now. I remain baffled by our objection. The objection is even harder to understand now that White House website endorses federal funding for needle exchange.

Representatives Jose Serrano, Henry Waxman, and Barbara Lee are baffled, too. They wrote to UN Ambassador Susan Rice, alerting her to the "apparent disconnect." Serrano, Waxman, and Lee object to an American negotiating stance that opposes "evidence-based policies that protect public health." They're certainly correct. Mike Lillis at the Washington Independent tells the story well.

Many progressives are angered by this imbroglio because they want our drug policies here at home to follow the spirit of that asterisked passage. Indeed, but there is a broader issue, too. Our country expends surprising amounts of time, treasure, and political capital trying to constrain other countries' drug policies, often regarding domestic matters such as needle exchange or medical marijuana that have little direct impact on us. In a terrific forthcoming article in American Interest, Peter Reuter notes that our propensity to scold close allies, our high-handed rejection of harm reduction, and our excessive pursuit of supply-side interdiction and eradication bring real costs to ourselves and to others.

One might ask: Why are we doing that? Much of our federal drug policy bureaucracy has spent the past 25 years avoiding this question. After the carrier pigeon reaches Vienna with news of November's election, we have housecleaning to do. From Europe to Afghanistan to the Andes, we must start listening, and we need to do better.

--Harold Pollack