America’s War on Drugs:
Searching for Solutions
With Catherine Crier
Aired Thursday, April 6, 1995 by ABC News (#ABC-59)
ANNOUNCER: Illegal drugs, marijuana, cocaine, heroin- they’re a plague across America, a disease spreading crime and violence into every corner of our society. WILLIAM BENNETT, former Director, National Drug Control Policy: This is a deadly and poisonous activity. People should be imprisoned for long periods of time for doing it. ANNOUNCER: Each year America spends billions of our tax dollars trying to win the war on drugs, policing our borders, arresting the pushers, imprisoning the users. Judge JAMES GRAY, Orange County, California, Superior Court: The war on drugs has turned into a war on our people. We almost can’t do it worse than we are today. There’s got to be a better way. ANNOUNCER: In Europe they think they’ve found a better way. In Holland you can buy marijuana as easily as a cup of coffee and junkies can buy heroin from pushers right on the streets. And in Great Britain doctors prescribe heroin to addicts who just can’t quit. They believe it cuts crime and reduces the harm drugs cause to society. Could it work here? WILLIAM BENNETT: You will never persuade the citizens of this country – never – that they should legalize drugs. ANNOUNCER: But some Americans say that we’re losing the war, that we must search for new answers. Is it time for a change? ETHAN NADELMANN, Director, Lindesmith Institute: If that means providing him with heroin or morphine or injectable methadone, then we should do that. ANNOUNCER: “America’s War on Drugs: Searching for Solutions” with Catherine Crier. CATHERINE CRIER, ABC News: Good evening. Tonight we’ll take a very different look at the war on drugs. There’s not much disagreement that we’re losing it. What is just as striking as our lack of success is the lack of any widespread public debate about alternatives to our current policies.
Our purpose tonight is not to advocate any specific policy change. Rather it is to open up the discussion, to look at some very different – you might even say radical – approaches to fighting drugs, approaches which are based on experiments currently under way in other countries.
[voice-over] Approaches which might help America wage its fight against drugs more successfully.
1st POLICE OFFICER:
Search warrant! 2nd POLICE OFFICER: Search warrant! Police officer! 1st POLICE OFFICER: Down on the ground! 2nd POLICE OFFICER: Police officer! CATHERINE CRIER: [voice-over] It is the longest-running war in U.S. history- 3rd POLICE OFFICER:
Put your hands over your head!
CATHERINE CRIER: [voice-over] -a front line moving through the front yards of America. 3rd POLICE OFFICER:
Face forward and shut up!
CATHERINE CRIER: [voice-over]
Searched and seized and sent to jail, nothing has stopped Americans from using illegal drugs, a problem targeted by presidents for more than a generation.
Pres. RICHARD M. NIXON:
-total war against public enemy number 1 in the United States, the problem of dangerous drugs.
Pres. JIMMY CARTER:
I believe they are a devastating affliction on our society and ought to be eliminated, as much as we can.
Pres. RONALD REAGAN:
Just say no to drugs.
Pres. GEORGE BUSH:
This is crack cocaine.
CATHERINE CRIER: [voice-over]
And until America deals with its drug problem, it cannot deal with its crime problem.
4th POLICE OFFICER:
I don’t have anything!
CATHERINE CRIER: [voice-over]
On the street, the business of black market drug dealing brings in tens of billions of dollars each year. It has also brought alarming increases in crime and violence, AIDS and addicts, drug-addicted babies, prison overcrowdingand more. And you are paying. The total estimated cost to society for illegal drug use each year: almost $67 billion.
Today there are as many illegal drugs on the streets as ever and more Americans behind bars for drug violations than ever before, over 300,000. Some are dangerous drug dealers, but many are non-violent drug users, like Oklahoma auto mechanic Jim Montgomery, a 41-year-old paraplegic with no prior criminal record.
My worst violation, I think, is a speeding ticket. That’s about as out of hand as I get.
CATHERINE CRIER: [voice-over]
Montgomery smokes marijuana, he says, to relieve the pain of his broken back. But Oklahoma police seized his drugs from a couch behind his wheelchair and a jury gave him a life sentence for possession with intent to distribute two ounces of marijuana, an amount equal to the tobacco in two packs of cigarettes.
They attacked with a vigilance, accused me of just about being Manuel Noriega’s right-hand man. “Here’s his pot. Here’s his pipes. He runs a drug house. People, let’s get him.”
CATHERINE CRIER: [voice-over]
Montgomery is now in prison, with a reduced sentence of 10 years, still longer than the average time served in the U.S. for murder.
RABON MARTIN, Attorney:
Thirty-five million Americans, 15 percent of the population, smoke marijuana.
CATHERINE CRIER: [voice-over]
Rabon Martin is Jim Montgomery’s attorney. He says thousands of drug users are serving long, unjust sentences because Americans mistakenly believe the only place for drug users is in prisons- overcrowded prisons.
When you shove somebody in the front door for possessing two ounces of marijuana and you pop a rapist or a murderer, or a child molester, out the back door- you know, they don’t want to see that, though. They- they say, “This person’s a dope dealer. We want him to go to prison and our minds are closed and we’re not going to think about anything else. We’re not going to think about the cost. We’re not going to think about the consequences. We’re not going to think about who might be released.
Judge JAMES GRAY, Orange County, California, Superior Court:
The war on drugs, I regret to say, has turned into a war on our people.
CATHERINE CRIER: [voice-over]
California Superior Court Judge JAMES GRAY says America must find alternatives to simply locking up drug users.
Judge JAMES GRAY:
You cannot get anything worthwhile by putting drug-dependent people into prison. We don’t accomplish anything beneficial and we spend enormous amounts of money in the effort. And again, I’m convinced that if we were to use the money for treatment instead of incarceration, we’d have fewer people using these drugs tomorrow than are using them today.
CATHERINE CRIER: [voice-over]
Judge Gray is part of a growing movement talking about a radical new drug policy for America, one that includes some form of drug legalization and of government distribution of drugs directly to the junkies who abuse them. If you think the judge is smoking something, think again.
Judge JAMES GRAY:
I am a conservative. I’ve never used this garbage in my life.
CATHERINE CRIER: [voice-over]
And listen to his startling suggestion.
Judge JAMES GRAY:
Well, I personally would have a program of the regulated distribution of heroin, cocaine and marijuana, where people, adults, could go to a government package store and purchase these. You would also have warning labels, similar to those of cigarettes. Inside you would have drug information, treatment information- “Hey, are you tired of using this garbage yet? Call 1-800-such-and-such. We have a treatment program for you.”
This is pretty radical stuff.
Judge JAMES GRAY:
Nobody advocates the use or abuse of these drugs, but we can reduce the harm that will flow from them enormously.
Judge Gray’s idea is just one being debated as part of a controversial new approach called “harm reduction,” which combines legal and medical strategies. The idea is this: If America cannot win the war on drugs, it should try instead to reduce the harm associated with drug abuse.
The main goal is to keep addicts functioning in society. Give them treatment, not punishment. Give them clean needles. Legalize marijuana. And even, under supervision, give hard-core addicts their drugs.
[voice-over] All of this, aimed at keeping drug users away from the black market in drug dealers and, by cutting down the profits of the drug trade, reducing the harm done to the rest of us. Mayor KURT SCHMOKE, Baltimore: The biggest problem is that the current approach makes it very profitable to distribute drugs at the street level.
You got a problem, huh? Yeah. All right. They’ll take care of you there.
CATHERINE CRIER: [voice-over] Baltimore Mayor Kurt Schmoke supports “harm reduction.” A former prosecutor, Mayor Schmoke has studied the drug problem on the streets where, he says, it is critical to eliminate the profits from drug dealing. Mayor KURT SCHMOKE: Most of the people that are doing all these shootings out here are not folks that have taken the drugs and then gone crazy and started shooting. It’s a war over money at the street level. And so, what I’m suggesting is that we have an approach that takes the profit out of distributing drugs at the street level. CATHERINE CRIER: [voice-over] It is one of “harm reduction’s” boldest gambles- make the government the official distributor of drugs so there will be no profit to make on the street. And with no drug profits, the reasoning goes, there will be no drug dealers. Judge JAMES GRAY: They would be out of business and hooray for that. We could do that and we could focus our attention upon drug education, which does work, and also for drug treatment, which does work. We will be far, far ahead. CATHERINE CRIER: [voice-over] But treatment, which is critical for drug abusers, is rarely available. Only about 20 percent of America’s estimated three million hard-core addicts can get help. NICK PASTORE, Chief of Police, New Haven, Connecticut: No violence. That’s the big thing. No violence. We can talk as long as we put the guns away, you know what I mean? CATHERINE CRIER: [voice-over] In New Haven, Connecticut, a city hard hit by hard drugs, police chief Nick Pastore preaches “harm reduction” to anyone he can. Chief NICK PASTORE: And my friend, my best friend, died with the needle in his arm- heroin. You understand? CATHERINE CRIER: [voice-over] Pastore believes that by monitoring addicts with treatment and government-supplied drugs, harm and crime will be reduced. Chief NICK PASTORE: The thing that I feel good about is that that heroin addict is not preying on society, is not killing somebody, not banging somebody on the head, not breaking into your or my home. They’re getting help. CATHERINE CRIER: What happens when you have drug abusers on the street that don’t want treatment and continue to bring about violence- Chief NICK PASTORE: Yes. CATHERINE CRIER: -in society? Chief NICK PASTORE: Lock them up and throw the keyaway. CATHERINE CRIER: [voice-over] But if reformers are to succeed in changing the war on drugs, they will first have to fight a war of words. Mayor KURT SCHMOKE: If I say “I’d like to talk to you about legalizing drugs tonight,” my audience immediately draws conclusions that people have their own sense of, in their own mind, of what legalization means and you don’t get to the next step. TEACHER: What happens to the person that ends up doing drugs? CATHERINE CRIER: [voice-over] In fact, most people believe that any form of legalization would be dangerous to society and would dramatically increase drug use, particularly among children. WILLIAM BENNETT, former Director, National Drug Control Policy: You will never persuade the citizens of this country – never – that they should legalize drugs. CATHERINE CRIER: [voice-over]
WILLIAM BENNETT, national drug czar during the Bush administration, is adamant that the war on drugs is an ongoing battle and that America must never admit defeat.
WILLIAM BENNETT: This is a deadly and poisonous activity. It should be against the law. People should be imprisoned for long periods of time for doing it. It’s- it’s a matter of right and wrong. Judge JAMES GRAY: Just because we discuss our options does not mean we condone drug abuse. We can deal with this very significant problem with these very dangerous drugs much more promisingly through the medical system and through our social system. We almost can’t do it worse than we are today. There’s got to be a better way. CATHERINE CRIER: Reformers like Judge Gray are looking to Europe, where some countries have already adopted a radically different approach to the war on drugs. [voice-over] And when we come back, we’ll take you to a Dutch coffee shop and show you how the legalization of the use of marijuana has become the cornerstone of their approach to fighting the war on drugs. [Commercial break]
Today the drug crisis is exploding all over the world and some European countries, including Italy, Spain, Germany and France, are searching for new solutions. But nowhere in Europe is this movement for change further along than in Holland, where a policy of punishment has been replaced by a policy of tolerance. [voice-over] This is a coffee shop in the city of Amsterdam and this is a scene that today could never take place anywhere in the United States: young people smoking marijuana openly and in public. For almost 20 years, the sale and possession of small quantities of soft drugs – marijuana and hashish – has not been a crime in the Netherlands. Anybody over the age of 16 can buy up to 30 grams, about 15 marijuana cigarettes, without having to worry about being arrested and going to prison. Rob Hessing is chief of police in Rotterdam and a critic of the tough law -and-order approach used in America.
ROB HESSING, Chief of Police, Rotterdam:
If one should have the idea that the police or the authorities should solve this problem by law, then they make a big mistake. CATHERINE CRIER: [voice-over] The Dutch have long believed that society cannot stop, but can only control the illegal use of drugs. They believe there has always been and always will be a problem with addiction and have rejected America’s war on drugs in favor of a broad harm reduction strategy based on tolerance, a strategy that looks at the drug crisis as a health problem and not a criminal problem. And the key to their approach is that policy that legalizes the use of marijuana. Bob Keizer is head of addiction at the Ministry of Health.
BOB KEIZER, Ministry of Health:
We believe that if young people are interested in taking drugs, with this system they can just buy it in a more or less open atmosphere. There’s no secrecy so they are not forced to get into contact with all the criminal figures who are more interested in offering hard drugs to them. CATHERINE CRIER: [voice-over] By legalizing the use of marijuana, the Dutch say, they have successfully prevented kids from experimenting with hard drugs. And while some studies in America do show that smoking marijuana may lead to the use of other drugs, the Dutch do not believe that marijuana is a gateway, a stepping stone to heroin, cocaine or amphetamines. BOB KEIZER: And statistics show that this policy works because the number of hard drug users has stabilized for more than 10 years in the Netherlands. CATHERINE CRIER: So that’s telling you that young people are not moving into that. BOB KEIZER: Exactly. The stepping stone theory doesn’t work. CATHERINE CRIER: [voice-over] The Dutch also spend very little money policing the coffee shop scene because, they say, there’s virtually no crime associated with the use of marijuana.
But there are problems, especially in border towns where foreign tourists come to buy soft drugs that are illegal in their countries. The Dutch spend most of their law enforcement budget trying to control the crime and violence associated with their hard core drug problem. They’ve even adopted a harm reduction strategy when it comes to their heroin addicts.
Chief ROB HESSING:
A lot of users are not criminals. They are working, have a job, are not unemployed. What we fight is against the dealers, the traffickers, the organized crime, and very hard. We don’t hunt the users. CATHERINE CRIER: [voice-over] Unlike the United States, in Holland the war on drugs is waged almost entirely against the big drug dealers. Addicts can buy and sell up to a half gram of heroin, cocaine or amphetamines and the police will look the other way.
[interviewing] If I’m a hard drug addict and I am not stealing to support my habit- I’ve got a job, I-
Exactly. CATHERINE CRIER: Is anybody going to arrest me? BOB KEIZER: No. CATHERINE CRIER: No? BOB KEIZER: Usage is not prohibited by law. Drug usage is not illegal in the Netherlands. CATHERINE CRIER: You’ve still got addicts on the street- Chief ROB HESSING: Yes. CATHERINE CRIER: -needing drugs from the black market. Chief ROB HESSING: Yes. CATHERINE CRIER: How have your policy changes lowered the crime rate? Chief ROB HESSING: Because we know the market. We know the people. And we are not only repressive, as a police organization, but try to help the drug addicts to fight their problems, to look for solutions and to try to get any results. CATHERINE CRIER: [voice-over] The police say that by knowing the market and the people, they can keep addicts out of trouble and reduce crime. They believe that you cannot force hard core junkies to stop taking drugs until they want to. The police have worked with Dutch policy makers to develop what’s probably the most important part of their harm reduction strategy, a comprehensive drug treatment program that focuses on the addict and public health.
Ton Quadt is the coordinator of all drug treatment programs in Rotterdam.
TON QUADT, Drug Rehabilitation Coordinator:
It’s not one miracle policy. You have to take a lot of small steps to find different solutions for different kinds of people- small steps, custom-made solutions for people who can relate to that solution. CATHERINE CRIER: [voice-over] The Dutch begin by trying to help even the most desperate junkies. There are almost 25,000 users here and even though it’s hard to draw comparisons between the number of heroin addicts in Holland and the United States, it is clear the Dutch spend a higher percentage of their $100 million drug budget trying to prevent addicts from harming themselves as well as others. One of the programs they’ve launched is free needle exchange to stop the spread of AIDS. HIV infection is the biggest health problem in the heroin community and one of the main reasons, the Dutch say, they expanded their harm reduction strategy. TON QUADT: So if you put in enough clean syringes and needles, people don’t have to use dirty needles, so the risk of getting HIV is lessened. And I think the Dutch number will prove it. CATHERINE CRIER: [voice-over] Since the needle exchange program was first introduced almost 10 years ago, the HIV infection rate among injecting drug users in cities like Amsterdam has dropped from 11 percent to 4 percent and is now one of the lowest in the world. But Holland’s harm reduction strategy doesn’t only focus on keeping its junkies healthy. There are many drug treatment programs all over the country to help addicts kick their habits. BOB KEIZER: We have a system of free methadone. Everybody who wants can get free methadone. The effect is that people are seen very regularly by the health care system. TON QUADT: By seeing them nearly every day, we can watch over them- how are they doing? Whenever somebody, anybody, is giving the sign of “I want to stop using drugs,” we are there. So we can pick them out of our maintenance programs and we can put them in a rehabilitation program. CATHERINE CRIER: [voice-over] This, too, seems to be working. A recent study in Amsterdam shows that many junkies are now in rehabilitation, learning a trade, and that over 75 percent of the city’s heroin addicts are on methadone maintenance, living relatively normal, crime-free lives. But despite these successes, Holland’s black market in hard drugs continues to thrive. Cocaine and now crack are causing more violence and some critics say they don’t want to see junkies who openly shoot heroin on the streets.
[interviewing] There is certainly the view that Dutch society’s very permissive, that it’s crumbling, from a moral point of view. Is that a fair perspective?
No, it’s not. CATHERINE CRIER: Why not? BOB KEIZER: Because it works, our system, compared to other systems. Of course we have problems, but I don’t believe drug policy will ever be a success story. It’s just a matter of keeping the problem within certain limits. CATHERINE CRIER: [voice-over] Today some Dutch policy makers believe their harm reduction strategy doesn’t go far enough, that until the laws are changed and all drugs are legalized, the black market trade in drugs, with all its crime and violence, will never go away. Chief ROB HESSING: In the end, we had to legalize because more police, more courts, more prisons- they don’t solve the problem. They didn’t and they will not. CATHERINE CRIER: [voice-over] So the Dutch continue to debate the future of their drug policy and continue to question America’s tough law-and-order approach. BOB KEIZER: The United States has still this strong belief in the war on drugs and, of course, the United States is a very big and very powerful country and the Netherlands is a very small country. So we don’t have the illusion to change your policy, but maybe you have the illusion to change our policy. CATHERINE CRIER: The Dutch feel pressured to adopt a tougher law-and-order approach at every international meeting on the drug crisis. So do the British, whose harm reduction strategy even allows doctors to prescribe drugs to addicts.
[voice-over] It’s called “heroin maintenance.” In the United States, doctors could go to jail for doing it. In Britain, doctors say, it’s a weapon critical to winning the war on drugs. How does it work? We’ll show you when we come back.
“America’s War on Drugs: Searching for Solutions” continues, with Catherine Crier. CATHERINE CRIER: The British, like the Dutch, are also looking at harm reduction as an alternative to America’s war on drugs. They too have a system of free methadone and an extensive needle exchange program. But the British, unlike the Dutch, are also experimenting with a radical approach to treatment called “heroin maintenance.” It’s not for all addicts, but targets a small group of long-term junkies who have repeatedly tried but just can’t stop taking drugs. TIM: I romanticized junkies, I suppose- you know, pop stars like Richards and Lennon. But no, at no point did I think, “God, in 10 years time, I’m going to be a junkie.” CATHERINE CRIER: [voice-over] Tim is a hard core heroin addict. He’s 29 years old and has been shooting heroin for over a decade. TIM: You know, on a hit, I’m steady as anything, I’m clear as a bell. CATHERINE CRIER: And without it? TIM: Without it, I just turkey, just withdrawal, don’t want to know, don’t want to talk, just want to lay on a bed, no energy. CATHERINE CRIER: [voice-over] Although he’s always worked as a building surveyor, he has spent every penny shooting heroin up his arm. He’s tried quitting dozens of times, but has always failed.
[interviewing] Did you ever try methadone?
TIM: Yeah, I was doing methadone for quite a few months. CATHERINE CRIER: How was it? TIM: It never took the place of heroin. CATHERINE CRIER: Why not? TIM: It just hasn’t- it’s not the same thing. It’s like really feeling like a big feed and somebody giving you half a sandwich. You know, it’s food and it goes into your stomach, but it hasn’t done the trick. CATHERINE CRIER: [voice-over] Tim is now one of about 400 heroin addicts in Great Britain who are part of a small, experimental treatment program that most of us in America cannot even imagine. It’s called “heroin maintenance” and it’s part of Britain’s harm reduction approach to fighting the war on drugs.
Dr. Jeffrey Marks is the chief psychiatrist at the Cheltenham Drug Service and one of dozens of doctors who practice heroin maintenance.
[interviewing] Tell me how the program works.
Dr. JEFFREY MARKS, Chief Psychiatrist, Cheltenham Drug Service:
If we have a patient presenting to our clinic who is injecting heroin and who makes it clear that he’s not yet ready to stop taking opiate drugs, we are willing to provide for those people controlled amounts of pharmaceutical heroin. CATHERINE CRIER: [voice-over] It’s called diamorphine [sp?] and it comes in several forms. Tablets, liquid, powder or smokable heroin is given to long-term junkies with the goal of trying to stabilize their addiction.
Jeremy Clitherow is the former head of the National Pharmaceutical Association and one of Britain’s leading experts on heroin maintenance. He says there are dozens of studies that show it’s the other substances, from brick dust to plaster, used to dilute illegal heroin that destroy the physical health of the addict.
JEREMY CLITHEROW, former Chairman, National Pharmaceutical Association:
In small doses and in pure composition, heroin is, according to textbook, a remarkably safe drug. Dr. JEFFREY MARKS: Yes, they are addicted to it and have to have it to feel normal, but you can give somebody heroin for the rest of their lives and it will do them no harm at all. It has no long-term, serious side effects at all. CATHERINE CRIER: [voice-over] Pharmaceutical heroin has always been legal in Great Britain. It was routinely prescribed to control addiction until the mid-1960s when the government decided to strictly regulate the practice after doctors were convicted of illegally selling the drug on the black market. The prescribing of pharmaceutical heroin almost ended during this period and it was not until 1988 and the AIDS epidemic that doctors once again began experimenting with heroin maintenance to help control adictts.
[interviewing] When someone comes in to you and says, “I am an injectable heroin user,” what’s to say this isn’t someone who simply would like a free ride? Or does it even matter?
Dr. JEFFREY MARKS:
It does matter. I think it would be very wrong to give someone like that heroin, in which case, we wouldn’t give it to them. It has to be someone who can use the program constructively.
Right. Now we need to review Tim on the ward.
Yes. Dr. JEFFREY MARKS: How’s he been? CLINIC STAFFER: He is withdrawing, quite visibly. Dr. JEFFREY MARKS: Yes. CLINIC STAFFER: I mean, he’s suffering, really. CATHERINE CRIER: [voice-over] Tim was carefully selected by Dr. Marks as a candidate for heroin maintenance. He was closely monitored by a team of experts as they tried to transition him from street heroin to pharmaceutical heroin. Dr. JEFFREY MARKS: The dose of heroin that we give isn’t a dose that will make them high. We’re not giving them a free high. We are giving them just enough heroin to keep the withdrawal symptoms at bay, but to keep them at a state where they’re not intoxicated. TIM: I expected it to be a bit of an easier time than the last week’s been. The last week’s been tough because, obviously, there’s got to be a certain amount of me withdrawing and them seeing to what extent I’m withdrawing and- and giving me enough heroin to stop me withdrawing, which is what they’ve done. But it’s a pretty painful process. CATHERINE CRIER: [voice-over] All addicts who enter the heroin maintenance program at the Cheltenham Drug Service go through this same process of evaluation. It would take Dr. Marks two weeks to find the right dose of heroin to stabilize Tim. Today he’s out of the clinic and picking up his prescription each morning at a pharmacy. He’s attending weekly therapy sessions and trying to rebuild his life.
[interviewing] Do you sort of see a life cycle of addiction in people?
Oh, there is, without a doubt. People mature out of addiction. Dr. JEFFREY MARKS: That’s part of the thinking behind our program. We are willing to prescribe heroin to buy time, to get them out of criminal behavior, to get them to be functioning in society so that when they do come through that cycle, they have a normal life to latch onto. CATHERINE CRIER: But what about- what about on the days when you’re really having trouble? [voice-over] David is another of those addicts, like Tim, who’s trying to come through that cycle of addiction and build a productive life. David has been part of Britain’s heroin maintenance experiment for over two years. He’s committed no crimes, bought no heroin on the black market and is now working part-time in an insurance office. He’s prescribed heroin-laced cigarettes called “reefers” and smokes five of them each day. DAVID: I wake up in the morning and I’ll smoke a reefer before I go to work. And I’ll get dressed for work, have a shave, get ready, and then I’ll smoke another one on me way to work. While I’m at work, it’s not too bad because I’ve got work to do and- and I know that when I come home at night, it’s going to be there. CATHERINE CRIER: [voice-over] No longer on the streets looking for his next fix, David says he’s planning for the future, attending college, working toward a degree in nursing. DAVID: Because I’ve had this prescription, I’ve been able to get me life back in order, so that prescription has given me a second chance and so that’s- that’s why I think it’s important that the heroin prescription should be there. CATHERINE CRIER: [voice-over] Many doctors and law makers in Great Britain say that heroin maintenance is an important part of their harm reduction strategy. And while there have been no major studies, small, anecdotal studies like this one show a 15-fold reduction in criminal convictions amongst the addicts on maintenance and that the heroin dealer has slowly but surely abandoned the streets.
[interviewing] Doctor, do you consider the program a success?
Dr. JEFFREY MARKS:
I do. I have no doubt that it is successful. We have plenty of people who previously we would have called hopeless cases who would never stop taking drugs, who would never stop committing crimes, and who would probably kill themselves, who have now come off and are leading drug-free lives and who are happy. CATHERINE CRIER: [voice-over] But there are critics in Great Britain, critics who say there’s no real proof that heroin maintenance works, that some addicts who’ve been stabilized still buy heroin on the black market and that others, just like those doctors in the 1960s, routinely sell their prescriptions to make a profit. [interviewing] Are you worried, though, about the mixed message that, “Don’t ever start, but if you do, we, in fact, will maintain you with your problem”?
These are different messages to different parts of the environment and different parts of the community. CATHERINE CRIER: But kids are hearing that. JEREMY CLITHEROW: Yes. CATHERINE CRIER: Don’t you think? JEREMY CLITHEROW: They are. We must get the message across to them. The down side of using the drugs is far worse than the short-term pleasurable up side. CATHERINE CRIER: [voice-over] Today other countries are beginning to look at Britain’s heroin maintenance strategy. The Swiss are in the middle of a three-year scientific study involving 700 addicts and the Dutch, who have already legalized the use of marijuana and hashish, are reviewing plans to launch an experiment of their own.
The British, too, are debating the future of heroin maintenance. And even though some government policy makers would like to see tougher anti-drug laws, many of the police on the streets wouldrather see heroin maintenance greatly expanded.
Phil Williams, head of the drug squad in Cheshire County:
PHIL WILLIAMS, Cheshire County Drug Squad:
We’ve got a drug problem in the country, as it is in the rest of the world. Somebody has to do something about it and this is one method that we’ve found that is working. CATHERINE CRIER: [voice-over] Jeremy Clitherow agrees. JEREMY CLITHEROW: We are now just tapping the reservoir of users. There must be so many more people though who could be helped. My personal view is it’s an investment we must make. CATHERINE CRIER: A drug treatment center in London is now in the process of setting up its own scientific study on heroin maintenance. The study involves about 125 hard-core addicts and should be completed in about a year.
[voice-over] So the question now is, should America be experimenting with heroin maintenance and some of the other harm reduction strategies we’ve shown you? We’ll talk about that when we come back.
For decades there’s been a broad American consensus against changing the tough law-and-order approach to our drug crisis. In part, that’s because American policy makers don’t believe that harm reduction or heroin maintenance really work, that these policies only encourage addicts to keep on using drugs. Moreover, they believe that America already has the answer on how to cure addiction, through our own brand of treatment.
[voice-over] This is a group therapy session at Phoenix House, one of the most well-known drug treatment centers in this country. And this is the key to America’s drug treatment strategy: getting addicts to stop taking drugs.
1st GROUP MEMBER:
You know, you’re stuffing a lot of feelings. You need to use your groups and you need to confront those feelings that you’re stuffing! CATHERINE CRIER: [voice-over] Here drug addiction is considered to be symptomatic of other problems, so addicts – heroin, cocaine, amphetamine addicts – are all forced to come to grips with themselves in sessions that are often confrontational. 2nd GROUP MEMBER: I suggest you use this game and talk about it. Let it out. Let us know what’s going on or let me know what’s going on. CATHERINE CRIER: [voice-over] Many do not come by choice. Some have been forced here by parents, others by friends, but most by the criminal justice system. Dr. Mitchell Rosenthal heads Phoenix House. If there is one problem that upsets him almost as much as addiction, it’s America’s lack of commitment to treatment. MITCHELL ROSENTHAL, Director, Phoenix House Foundation: This country should be embarrassed about the fact that it has so little in the way of treatment resources. CATHERINE CRIER: What do you say to those people who respond, “This is not my life. I don’t take drugs. These people are committing crimes, endangering me. Lock them up, get them off the street, and I don’t want to hear any more about them”? MITCHELL ROSENTHAL: I think those people are right. They should be stopped by locking them up. But what we ought to do is see that prison is the first part of a treatment plan. CATHERINE CRIER: [voice-over] But today few prisoners get treatment, nor do most addicts on the street, because most of the drug budget is spent on our tough law-and-order approach. And there are other problems. Treatment doesn’t always work. Addicts who’ve gone through it frequently relapse. The success rate at even some of the best treatment facilities is only 25 percent.
Once again, former drug czar WILLIAM BENNETT.
I’m all for effective drug treatment, but one thing I learned for sure from drug treatment is it’s best not to get in this, in the first place. It’s best not to get involved in drugs, in the first place. And the way that works, I think, is through prevention efforts and law enforcement is a very effective kind of prevention effort for most people. CATHERINE CRIER: [voice-over] But as we have seen, that tough law enforcement and minimal treatment approach is not working. So some cities are beginning to adopt some of the European experiments in harm reduction. In Baltimore, as in Holland, they use methadone maintenance and mobile vans to help addicts stabilize their lives. And in a few cities, like San Francisco, there is free needle exchange so that addicts won’t transmit AIDS. All attempts to control the harm addicts cause to themselves and others
But these programs are rare. Ethan Nadelmann heads the Lindesmith Institute, founded to study alternative solutions to America’s drug policy. He is passionate about the need for more tolerance to addicts.
ETHAN NADELMANN, Director, Lindesmith Institute: Somehow, our war on drugs says that it’s immoral to give junkies clean needles, as if the more moral message is to let them get AIDS and die and, before they die, to bring down their children and their lovers and their friends with them, and meanwhile, costing everybody who doesn’t use drugs billions of dollars in hospital costs and emergency room costs and what have you. MITCHELL ROSENTHAL: I don’t think we have any data yet that is compelling that needle exchange is making a difference. CATHERINE CRIER: [voice-over] But Nadelmann says the proof is there. In Holland, as we’ve already shown you, needle exchange is effective. And a recent study of addicts in New York confirmed it yet again. The HIV infection rate dropped from 6 percent to 2 percent for those getting clean needles.
[interviewing] If it is so clearly the right thing to do for all of these reasons, why the objections in this country?
Why? Because people focus on the first message: “You’re giving a junkie a needle to take drugs with.” That’s a bad thing, therefore we shouldn’t do it. CATHERINE CRIER: [voice-over] Harm reduction experts argue tens of thousands of junkies and former addicts with AIDS, and others who have been unknowingly infected by them, could have been saved by needle exchange. But as we said, American policy makers don’t believe in it, nor do they believe in this, Great Britain’s experimental heroin maintenance program, where addicts like Tim and David are given prescriptions of heroin. MITCHELL ROSENTHAL: Heroin maintenance is a bust and any treatment that is looking at fixing a complicated human problem from a pure pharmacologic and drug method, that they’re going to fix this mess by adding a drug, is doomed to failure. CATHERINE CRIER: [voice-over] And other policy makers believe maintenance could never work here because of America’s much larger heroin problem. But Ethan Nadelmann is not as negative and feels we, too, should be experimenting with heroin maintenance. ETHAN NADELMANN: What we’re saying is, “Show me a junkie who can’t quit and who’s at risk of AIDS and who’s committing crimes- let’s reduce that crime. Let’s reduce that AIDS. Let’s reduce the vulnerability to disease. Let’s try to help him get his life together. If that means providing him with heroin or morphine or injectable methadone, then we should do that.” CATHERINE CRIER: [voice-over] And like heroin maintenance, this, too, is hard for Americans to accept. It is the Netherlands’ liberal approach to marijuana. American policy makers worry when they see sights like this. After all, if we allow the legalization of small quantities of marijuana, could we be encouraging a future generation of marijuana smokers? WILLIAM BENNETT: You know, we don’t need a drug that makes kids stupider. We don’t need this more widely used. This is not our problem is that our kids are overly smart and we need to destroy their memory. Dr. LESTER GRINSPOON, Harvard Medical School: It’s irrational. CATHERINE CRIER: [voice-over] Dr. Lester Grinspoon is professor of psychiatry at Harvard Medical School. He, too, used to worry about the dangers of marijuana, but 20 years of research has changed his mind. Dr. LESTER GRINSPOON: But if we accept the fact that people are always going to use something, I would far rather people used marijuana than any of the other drugs. CATHERINE CRIER: And yet this country has prohibited marijuana and one of the main reasons is it’s a “gateway” drug. It’s going to lead people to harder drugs. Dr. LESTER GRINSPOON: There is no evidence for that whatsoever. That is another myth about cannabis. It has nothing to do with any inherent property of the drug, that one will go on to use another drug. CATHERINE CRIER: [voice-over] Remember, though, there are some studies that suggest marijuana may lead to the use of hard drugs. But other reports, U.S. government reports, have repeatedly come to the opposite conclusion about not only the gateway theory, but marijuana itself. COMMISSION OFFICIAL: We also firmly believe that criminalizing the vast majority of users is unjustified and unwarranted. CATHERINE CRIER: [voice-over] In 1972, the Schaefer [sp?] Commission, a blue-ribbon panel of experts appointed by President Richard Nixon, recommended that possession and sale of small amounts of marijuana should no longer be an offense. California adopted that strategy and, according to this study, saved well over a billion dollars in law enforcement costs from 1976 to 1986 and close to another billion dollars since then. But even considering those savings, some believe the Schaefer Commission’s recommendations have been purposely ingorned by our nations leaders.
[interviewing] Why is this happening? What’s the rationale?
Dr. LESTER GRINSPOON:
It’s- it’s a fear of- of having to admit, “Well, maybe we were wrong about this,” because once marijuana is legalized, they will look back and they will say, “What in the world? Why did we spend so much energy in the 20th century arresting people for marijuana, putting them in jail, and so forth?” There- this is less of a problem than alcohol or tobacco by orders of magnitude. CATHERINE CRIER: [voice-over] But of course, if there’s opposition to legalizing marijuana, can you imagine the reaction to our government distributing hard drugs, that package store plan we told you about earlier? WILLIAM BENNETT: Supposing government subsidizes drugs so that people can get it cheap. You will then have, I would estimate, 40 to 50 million heavy users of drugs in the United States. That is- that’s not a scenario the American people are interested in. Judge JAMES GRAY: That is real fear mongering. There is absolutely no information anywhere that says that if we were to make these drugs available under a different system that everybody would go out and use these drugs. I wouldn’t use these drugs. I’m sure you wouldn’t, either. And if I were going to, I’m sure I’d be using them already. CATHERINE CRIER: If drugs were legal, would you run out and begin taking drugs? WILLIAM BENNETT: No. CATHERINE CRIER: Why do we think that the world is different? WILLIAM BENNETT: There are lots of people in America who live on the margin. There are lots of people in America who live on the margin who would try things, were it- were- were they not fearful that they might get in trouble with the law or their job or something. And the temptation to use drugs like this is- is rather- rather strong in such circumstances. CATHERINE CRIER: [voice-over] But the real fear is for America’s children. Remember those public service announcements? TELEVISION COMMERCIAL: You better know what you’re jumping into. CATHERINE CRIER: [voice-over] For a while, these warnings prepared by the Partnership for a Drug-Free America had great impact and the number of kids trying all kinds of drugs declined during the 1980s. But today, with not enough money to teach kids about the dangers of drugs, recent figures suggest that drug use among young kids is up dramatically. So what would happen if drugs were even more available, as Judge Gray has suggested? Wouldn’t it lead to more kids experimenting with drugs and make a bad situation that much worse. Judge JAMES GRAY: Today we have people that are out there on our high school and junior high school campuses pushing this garbage. The kids know where the drugs are. They’re choosing, a lot of them, not to use them. They would continue to choose not to use them under my system. Would some get through? Sure. But we’re just trying to reduce this harm. We’re certainly never going to get rid of it. CATHERINE CRIER: [voice-over] It is that fact – we’ll never completely get rid of drugs- and the crime, the destruction of human lives, the disease- that has inspired many to look for new solutions. While supporters of harm reduction do acknowledge there will be an increase in drug use, they still believe we must look at those experiments in Holland and Great Britain. Mayor KURT SCHMOKE: I believe that we’ll end up with safer cities- CATHERINE CRIER: [voice-over] And at the very least, reformers like Baltimore Mayor Kurt Schmoke say, we must not repeat the errors of our past. Mayor KURT SCHMOKE: I think that the war on drugs is domestic Vietnam. And didn’t we learn from Vietnam that, at a certain point in the war, we should stop and rethink our strategy, ask “Why are we here, what are we doing, what’s succeeded, what’s failed?” And we ought to do that with the domestic Vietnam, which is the war on drugs. CATHERINE CRIER: At the moment, America shows few signs of rethinking its drug strategy. The government continues to spend more money on law enforcement,more money on building new prisons, more money on fighting the war on drugs. When we come back, some final thoughts.
Tonight we’ve examined a very different and controversial approach to America’s drug problem called “harm reduction.” Could it work here? The answer is unclear.
[voice-over] The European experiments we’ve shown you are small in number. The cultures are very different from ours. The ultimate benefits of the experiments have not been conclusively evaluated. Yet, as we’ve seen in each of the countries we visited, law enforcement and medical officials seem convinced that these experiments are working.
[on camera] Again, our purpose tonight is not to advocate any specific policy, but rather to suggest that as we search for solutions, we need to consider all of the alternatives. To simply eliminate some approaches because they may seem at first glance too radical or too different from policies we have followed for decades cannot be in our best interest. Whether the alternative strategies will ultimately work for America is an open question, but it’s a question which deserves a fair, spirited and serious debate.
To continue that very discussion, please join us for a special edition of Nightline following your local news. For all of us at ABC News, I’m Catherine Crier. Thank you for joining us and good night.
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