This page contains the following writings by Dr. Mikuriya:
www.mikuriya.com/althealth/drugwars.html
Drug Wars: Menace to America
Medical Drug Control Act of 199X
Controlled Substances, A Public Health Model
Into the void, a new page with Dr. Mikuriya's unpublished letters to the editor has just been added.
Drug Wars: Menace to America
Tod Mikuriya, M.D
.
The escalating increasingly desperate authoritarian efforts to stem the rising tide of lawlessness caused by drug prohibition are held in check only by the limitations of shrinking budgets. These measures have failed by any standards.
Worse, the side effects harm the community through the overloading of the enforcement/corrections, social, and health services resources.
Individuals and society are victimized directly and indirectly by this harmful social policy.
At the core are ignorance and denial that afflict policy makers at all levels of government and society.
Denial takes many forms... from the economic- the usual free market mercantilists who fail to include these commodities in their spreadsheets and ignore these market forces... to the fundamentalist religious who shut out the facts with moralistic homilies. Authoritarian public officials facilitate these policies.
In this tricentennial of the Salem witch trials we are in the grips of another attack of the "American disease": Prohibition. The War on Drugs.
This collective moralistic delusion is seemingly unique in western civilization. Over a century ago America went through a painful civil war on drugs that culminated in prohibition of alcohol from 1919 to 1933.
The agitprop contemporary "War on Drugs" is even nastier and more intrusive than Prohibition. Added evils include:
International piracy
International kidnapping
Mining of harbors
Poisoning of forests with herbicides
De stabilization of Columbia, Peru, Panama, and Nicaragua
Funding anti-government terrorism
Iran-Contra Scandal
BCCI Scandal
Punishment of the user
Uropharmacomancy- divination of status and freedom by urine tests
Confiscation of property- civil forfeiture criminal abuse of civil law
Default vigilantism of neighbors forced into using small claims court
Funding of police operations with proceeds from seized property
Entrapment with police offering to buy drugs
Entrapment with police offering to sell drugs
Entrapment with police manufacturing drugs.
Encouraging children to turn parents in to police for drug involvement
Taking babies away from mothers who test positive for drugs
No-knock entry and other civil rights attenuation
Driver's license suspension for unrelated drug crimes
Warrantless systematic searches on public transportation
Mandatory minimum sentences derived from irrational formulae
Overcrowding jails, prisons, and probation
Surveillance of chemical and laboratory apparatus transactions
Reporting of cash transactions over $9,999
Confiscation of growing lights
Seizure of mailing lists from growing supplies stores
Setting up growing supplies stores to solicit and entrap cannabis growers.
Obtaining public utility records to target potential cannabis growers.
Militarization at state and federal levels- "Posse Comitatus"
Downgrading evidence requirements to "good faith" from probable cause.
Depriving students of federal loans and grants.
The corruption, violence, and divisive consequences appear to be lessons that we have forgotten today as social policy mistakes are repeated..
The bribing of police, prosecutors, attorneys, and judges
Capitalization of crime by a black marketplace: drugs for guns.
Subversion of International Law
Funding firearms for the young
Murder and mayhem facilitated
Materialism and alienation
Destruction of families
Abuse of children- robbed of childhood and trust
At the local level there is little more that can be done that can be paid for by the public. Vigilante activities while commendable in their initiative
have great potential for abuse. All pretext to due process and civil liberties are then hopelessly abandoned to the mob.
Structural emblematic efforts like school uniforms, anti drug rallies, and exhortations by public figures are feelgood exercises- Like inveighing
against Satan. All the while we do battle with the enemy- us.
The exercises in group think are not unlike the two minutes of hate rallies depicted in Orwell's 1984. Unlike the centrally controlled hermetic
authoritarian state such efforts are ineffectual. In the torrent of advertisements to self medicate anti-drug appeals are ineffectual or ironically
humorous.
The ignoring of the reasons and etiologies of the reasons for the involvement in illicit drugs will delay the solving the problems attached to a
situation is bad and getting worse.
Poisoning of the font of knowledge:
"He who pays the piper calls the tune"
A significant component is the special interest control of information. Until this problem is acknowledged and solved there can be no progress.
A drug craving and drug dependent society is facilitated and exploited by the drug industries.
Sales of over the counter and prescription drugs are stimulated by intensive advertising campaigns that "educate" the public starting at a young age.
Spuds MacKenzie and Joe Camel don't make it into the Partners for a Drug Free America ads as scapegoats. Most drug prevention education is ineffectual propaganda. Send them a signal rather than tell the truth. Beer advertisements encourage dangerous behavior. Some wine advertisements do not depict wine as a foodstuff. Over the counter drugs promotions set up a drug-craving public. No self-regulation skills are taught to children.
Solutions
Development of legalized drugs available through non profit pharmacy-based drug users' cooperatives eliminates "crack houses" or "shooting galleries". Drug dealers would disappear from the streets. Criminal enterprise zones are obsolete.
Restoration of the infrastructure of sports, arts, and music needs to be top priority.
Jobs and educational opportunity are required to fulfill dreams instead of the need to distract from or suppress frustrated, angry, and hopeless feelings.-
Drug abusers are unhappy. They suffer from waking perpetual nightmares of disempowerment.
It is high irony that the illicit free market has brought money into the minority communities where the federal programs have failed. It is blind stupidity to ignore the connection between illicit drugs and guns. If drugs were legalized their meaning are redefined from expensive forbidden fruit to affordable commodity. Coca derivatives are then like the other stimulant, caffeine. There would undoubtedly be some abusive use, but of a more treatable nature.
The side effects of the imposition of the moralistic model of the "War on Drugs have been far worse than the drugs themselves. This illicit mercantile enterprise creates nightmares that primarily affects the poor. The failure of leaders at all levels to address this economic reality must be blamed for this growing social problem.
Treatment for drug abuse would be available upon demand if it were supported by transaction fees from the sale of drugs. A harmfulness tax (Grinspoon) or pricing structure commensurate with potential toxicity would provide additional income for treatment and abuse prevention.
Advertising of drugs rather than censored by government should be from self-discipline by the industry. Removal of the exemption from product liability laws for alcohol and tobacco would insure self discipline in advertising.
Institutionalized or socialized use behavior will minimize abusive use. The concept of the "designated driver" is exemplary of the kind of custom that facilitates alcohol risk management.
Foreign policy
The economically irrational prohibitionist policy suborns the Monroe Doctrine with the inadvertent empowerment of authoritarian regimes that are hostile to the United States. Their hostility is beyond economic control of the OAS or the World Bank since they are now funded by the illicit drugs. Good-bye United Fruit. Hello unnamed successors to Medellin and Cali cartels.
The Sendero Luminosa despite the capture of their leader and the corrupt military in Peru has set back the emergence of democracy. The Drug Enforcement Administration and their "advisors" continue to aggravate the situation. throughout Latin America.
Columbia continues to suffer terrorism and destruction of their judiciary. the economy hammered by undercutting the coffee market.
Panama escalates the money laundering and transshipment. Business as usual even though president George Bush captured General Manuel Noriega, former friend and CIA and Drug Enforcement Administration employee. Operation "Just Cause" perpetrated urban undevelopment and "installation" (like a new motor in an old car) of a "new" government.
The Iran-Contra guns for drugs scandal continues to attenuate the legitimacy and efficacy in both foreign and domestic policy. Besides the embargo and mining of the tiny poor country of Nicaragua with illegal support of the guerrilla army, Lt. Colonel Oliver North lied to Congress to support former president Ronald Reagan and his vice president George Bush, commander designate of the War Against Drugs.
Mexico continues to suffer U.S. raids and interference with their government by the DEA. Border traffic continues to suffer disruption and human rights abuses from the drug law enforcement.
American drug prohibition dims the future of democracy in the hemisphere. America exports criminal mercantile opportunity.
Prohibitionism, the American Disease
American recurrent Prohibitionism is a peculiar majoritarian auto immune social disease regarded with perplexity by the rest of the world. With all the exemplary features of America, this anachronistic problem sadly detracts from world leadership.
American drug prohibition darkens the prospects for the country's future. Demagogues facilitated by profit driven special interest groups create policy and laws that erodes evermore rights of their citizens. Gradually, and by small increments what protections were once taken for granted have disappeared.
Lulled into a narcotism induced by television and materialism, the Trojan horse of authoritarianism has breached the gates of the city, its moralistic armed clergy busily snuffing out pockets of critical thinking- ever striving to make the world safe for profitable hypocrisy.
Alexis de Toqueville's warning of an all pervasive tutelary power ruling through the manipulation of a distracted materialistic populace becomes an approaching reality.
THM 12-3-92
Back to Top
Medical Drug Control Act of 199X
Tod H. Mikuriya, M.D.
The MDCA transfers control of all prescribed drugs to Health and Human Services from the Department of Justice.
While acknowledging the Herculean and often unappreciated effort, it is clear the criminal justice system's moral models have failed. Current drug classification is unscientific and irrational. Flawed collective perceptions of comparative harmfulness spawn harmful laws and policies. The result: excessive expectations on public institutions ill-equipped to deal with health problems. The criminal justice systems' resources are overwhelmed. Taxpayers are realizing the costs of these expectations have adverse impacts on other Government programs. The worst and longest lasting adverse effect on America is the decline of utilitarian government into authoritarianism. The attack upon the individual with the usurpation of privacy by both public and private authority is of most concern. It attacks the vitals of democracy. Transition to medical/social approaches represent the only effective alternative to Prohibition.
* The moral models are binary. The drug is good or the drug is bad- based upon its legal status. The medical model is based on costs vs benefits.
* The moral model of prohibition provides for a restricted response as compared with the medical models with their spectrum of options. Prohibition has created a toxic swamp of criminality, feeding on the materialism of America. Prohibition creates a dumbing down of America with prisons spent for instead of universities. Good-bye to global competitiveness; hello to more international crime.
The Surgeon General is responsible for developing, implementing, and maintaining drug control policy and programs. Department of Health and Human Services shall administer the National Drug Control Program. through the Public Health, Food and Drug Administration. Department of Justice will cooperate in the enforcement of the NDCP.
Funding by specific drug taxes earmarked for prevention and treatment with morbidity-based rates- A "pick up after yourself" policy. Each drug must be considered separately. Devotees and vendors of each drug generally rationalize it to be benign and less harmful or noxious than those of others. Connections between actual and perceived consequences require institutionalizing. Special interest groups fight to maintain their profitable niches based upon self serving denial.
Each drug- including alcohol and nicotine- may have some adverse effects. It is both fair and prudent that costs from the use of the drug be paid for by the users, industry, and marketplace. Currently, the non users are obliged to subsidize the users and their suppliers.
Excise and sales taxes from alcohol and nicotine products go, for the most part, into the general fund that motivates Government to encourage consumption.
Individual and group freedom requires informed responsibility and accountability
To be free one must have knowledge and understanding for what one is responsible and accountable. Groups and institutions are subject to the same expectations. The marketplace, industry, and users share this implicit social contract. No more exemptions for alcohol and tobacco products from product liability law. Drug advertising is drug "education". Industry, bereft of this unique privileged protection, will exert restraint to minimize risk. As it is there is minimal antidote to the manipulative imagery that preys upon human frailty to sell drugs. The public will cease to be as disinformed about comparative harm from drugs. Utilitarian drug policy- a responsive spectrum of options.
The ideal of non-intervention must be balanced with the interests of others affected. For the vast number of users of all drugs that utilize them effectively as personal tools without adverse effect no intervention is needed or justified except for morbidity-based taxation.
* Pharmacy based drug users cooperatives
Supported by transaction fees, the user is admitted to the cooperative by examination and screening. Drugs are dispensed upon showing appropriate identification.
* Addiction control specialists
Individuals at risk for abuse or history of misuse are referred to addiction specialists for supervision and individualized plans.
* Maintenance clinics
For those needing closer scrutiny and control, clinics with supportive services provide more intensive services.
The Criminal Justice System
Control must be exerted from within or it must be controlled from without.. Misbehavior from drug misuse requires intervention. Coercive and restrictive institutional response is justified and appropriate for misbehavior.
* Drug testing
* Quarantine
* Civil commitment
* Jail and prisons
Control is a reasonable alternative to Prohibition.
User fees, sales, and taxes to support control and compensation for specific drug morbidity and casualty losses are reasonable alternatives to the usurpation of our inalienable rights through Prohibition.
Draft 1 9/27/94
Controlled Substances, A Public Health Model
Tod H. Mikuriya. M.D.
The underlying assumption of a public health model is the optimization of benefits versus costs or risks for the individual and society.
A second premise is that users, producers, and the marketplace be accountable to themselves, family, and society in general.
Awareness of connections between costs and benefits must be institutionalized. Existing product liability laws and other safeguards of purity, efficacy, and strength provide one feedback mechanism.
Resulting industry restraint would obviate the need to censor advertising.
Earmarking of tax revenues for treatment and casualty losses instead of to the general fund provides another functional social reality check. The current inherent conflict of interest arrangement encourages government acting at cross purposes.
Accountable and self-supporting:
Voluntary Drug Users Cooperatives (VDUC)
Accountability is demonstrated by "picking up after oneself". Transaction fees and all drug taxes are earmarked to support administration of pharmacy based drug users' co-operatives. Contracting community treatment providers treat the inevitable abusers needing services are paid for by the program.
It has been estimated that some 10% of users are abusers of alcohol. It would not be unreasonable for the 9 users to pay for the 1 abuser's problems should that be the experience of the program.
Maximize Individual Responsibility. Minimize Intervention.
A major assumption is that the informed user will exert responsibility and common sense and require minimal intervention.
No intervention unless there is evidence of dysfunction. Costs would be lower than a clinic or physician visit type of maintenance program. This lower level of control and services for problem-free users would support a spectrum of services for those suffering drug-related illness or dysfunction.
Harm and Risk Management
A salient emphasis of the VDUC would be the minimizing unsafe drug use through education starting with the program entry testing and continuing with periodic health screens and user information updates.
Needle exchange and safe practices are an important part of the education program.
The VDUC's provide incentives for the use of low concentration psychoactive preparations over high concentration drugs.
Informed Consent/Entry
Users gain entry by taking a test to demonstrate knowledge of drug effects, side effects, and risks. This same test would be prima facie evidence of informed consent and understanding of responsibilities and consequences of violating program rules.
A special program identification card is presented at any contracting pharmacy to verify authorization to purchase up to a month's supply of drugs. Information from the transaction is sent to the program's office. Any unusual increase warrants inquiry from the office.
Users of high risk groups such as mentally ill, substance abusers, alcoholics, or developmentally disabled are under closer supervision by contracting addiction specialists.
Non-profit community board
The huge revenues at stake with inherent risks of greed necessitates oversight.
A non-profit community board is mandated to protect the users from avoidable harm, exploitation and the public from health and safety risks. Users, Pharmacists, Public Health, general community and district attorney are represented.
Abusers referred to treatment or enforcement
Privileges are suspended and the abuser is referred to police or district attorney if furnished to a minor, used to poison, incapacitate, or impair someone else. Driving while impaired, endangering others, fighting, or being a danger to others is generally handled by enforcement.
Abusers are referred to detoxification and treatment program providers if the abuser is not a danger to others.
If the user exhibits dysfunctional behavior or impaired health that does not directly harm someone else then he/she is referred to an appropriate substance abuse program. Reports from hospitals, emergency rooms, physicians offices, health facilities, workplace, family, or other source initiates intervention of the program. The pharmacy identification card is suspended and the abuser referred to the assessment team.
Evaluation
Experienced substance abuse specialists "triage" to determine the sorts of intervention appropriate to the individual problem.
Referral for specialized treatment
A spectrum of outpatient and in-patient service is available as contractors to the program for intervention in cases of drug abuse.
Continuing Research and Education
The continuing study at Framingham, Massachusetts provided us with definitive information concerning the connection between smoking, lung cancer, heart, and other circulatory diseases. Unbiased and extensive morbidity information is collected from participating health resources for policy refinement.
Psychoactive drugs with the lesser harm are developed and marketed to substitute for more toxic drugs. Crude coca products are made available to compete with the concentrated smokeable forms. Combination drugs like disulfiram or neuroleptics with opiates are evaluated.
Infectious intercurrent disease would utilize opioids, stimulants, and sedatives combined with antibiotics to improve compliance with treatment of illnesses like tuberculosis.
In order to restore a source of legitimate and undistorted medical information as to the connections between drugs and their hazards, treatments, and prevention, ongoing studies are required on a large scale.
Suggested Reading
2 U.S. Studies Criticize Plan To Ease Access to Methadone Associated Press in the New York Times A11, August 4, 1989
Dole, V.P., Nyswander, M., and Kreek, M.J. Narcotic Blockade Archives of Internal Medicine 118 October 1966, 304-309.
Dole, V.P. and Nyswander, M. Heroin Addiction- A Metabolic Disease, Archives of Internal Medicine 120 July 1967 19-20. Heroin Addicts
Goodman and Gilman's The Pharmacological Basis of Therapeutics 7th Edition
Macmillan New York 1985 1839 pp
Grinspoon, L. The Harmfulness Tax: A proposal for regulation and taxation of Drugs Unpublished. Address to International Meeting on Antiprohibitionism
Brussels September 29, 1989 11 pp.
King, R. The Drug Hangup; America's Fifty-Year Folly. Charles C. Thomas Springfield IL 1972 389 pp
The Merck Manual Fifteenth Edition. Merck, Sharp and Dohme Research Laboratories Rahway, NJ 1987 2,696 pp
Mikuriya, T.H. Taming drug-dependency with a credit card Medical World News Dec 12, 1980 P 100
_____________ Physical, Mental, and Moral Effects of Marijuana: The Indian Hemp Drugs Commission Report. Internat J. Addictions vol 3 No 2, Fall 1968
253-270
Nadelmann, E.A. Drug Prohibition in the United States: Costs, Consequences, and Alternatives Science 245: September 1, 1989, 939-947
Report of the Indian Hemp Drugs Commission 1893-94 Simla, India: Government Central Printing House, 1894, 7 Vols 3,281 pp.
_____________ Supplementary Vols 1 & 2: 417 pp (Classified military data published separately)
Syllabus for the Psychopharmacology Course Harvard Medical School Sept 30 Oct 2, 1988 Harvard Medical School Department of Continuing Education, Boston, MA 514 pp.
Terry, C.E. and Pellens, M. The Opium Problem. Bureau of Social Hygiene New York 1928 1045 pp (Reprinted by Patterson Smith, Montclair NJ 1970)
Trebach, A.S. The Heroin Solution Yale University Press, New Haven, CT 1982 331 pp
____________ The Great Drug War Macmillan, New York 1987 401 pp
Tod H. Mikuriya, M.D.
12-17-92
www.mikuriya.com/althealth/drugwars.html
Drug Wars: Menace to America
Medical Drug Control Act of 199X
Controlled Substances, A Public Health Model
Into the void, a new page with Dr. Mikuriya's unpublished letters to the editor has just been added.
Drug Wars: Menace to America
Tod Mikuriya, M.D
.
The escalating increasingly desperate authoritarian efforts to stem the rising tide of lawlessness caused by drug prohibition are held in check only by the limitations of shrinking budgets. These measures have failed by any standards.
Worse, the side effects harm the community through the overloading of the enforcement/corrections, social, and health services resources.
Individuals and society are victimized directly and indirectly by this harmful social policy.
At the core are ignorance and denial that afflict policy makers at all levels of government and society.
Denial takes many forms... from the economic- the usual free market mercantilists who fail to include these commodities in their spreadsheets and ignore these market forces... to the fundamentalist religious who shut out the facts with moralistic homilies. Authoritarian public officials facilitate these policies.
In this tricentennial of the Salem witch trials we are in the grips of another attack of the "American disease": Prohibition. The War on Drugs.
This collective moralistic delusion is seemingly unique in western civilization. Over a century ago America went through a painful civil war on drugs that culminated in prohibition of alcohol from 1919 to 1933.
The agitprop contemporary "War on Drugs" is even nastier and more intrusive than Prohibition. Added evils include:
International piracy
International kidnapping
Mining of harbors
Poisoning of forests with herbicides
De stabilization of Columbia, Peru, Panama, and Nicaragua
Funding anti-government terrorism
Iran-Contra Scandal
BCCI Scandal
Punishment of the user
Uropharmacomancy- divination of status and freedom by urine tests
Confiscation of property- civil forfeiture criminal abuse of civil law
Default vigilantism of neighbors forced into using small claims court
Funding of police operations with proceeds from seized property
Entrapment with police offering to buy drugs
Entrapment with police offering to sell drugs
Entrapment with police manufacturing drugs.
Encouraging children to turn parents in to police for drug involvement
Taking babies away from mothers who test positive for drugs
No-knock entry and other civil rights attenuation
Driver's license suspension for unrelated drug crimes
Warrantless systematic searches on public transportation
Mandatory minimum sentences derived from irrational formulae
Overcrowding jails, prisons, and probation
Surveillance of chemical and laboratory apparatus transactions
Reporting of cash transactions over $9,999
Confiscation of growing lights
Seizure of mailing lists from growing supplies stores
Setting up growing supplies stores to solicit and entrap cannabis growers.
Obtaining public utility records to target potential cannabis growers.
Militarization at state and federal levels- "Posse Comitatus"
Downgrading evidence requirements to "good faith" from probable cause.
Depriving students of federal loans and grants.
The corruption, violence, and divisive consequences appear to be lessons that we have forgotten today as social policy mistakes are repeated..
The bribing of police, prosecutors, attorneys, and judges
Capitalization of crime by a black marketplace: drugs for guns.
Subversion of International Law
Funding firearms for the young
Murder and mayhem facilitated
Materialism and alienation
Destruction of families
Abuse of children- robbed of childhood and trust
At the local level there is little more that can be done that can be paid for by the public. Vigilante activities while commendable in their initiative
have great potential for abuse. All pretext to due process and civil liberties are then hopelessly abandoned to the mob.
Structural emblematic efforts like school uniforms, anti drug rallies, and exhortations by public figures are feelgood exercises- Like inveighing
against Satan. All the while we do battle with the enemy- us.
The exercises in group think are not unlike the two minutes of hate rallies depicted in Orwell's 1984. Unlike the centrally controlled hermetic
authoritarian state such efforts are ineffectual. In the torrent of advertisements to self medicate anti-drug appeals are ineffectual or ironically
humorous.
The ignoring of the reasons and etiologies of the reasons for the involvement in illicit drugs will delay the solving the problems attached to a
situation is bad and getting worse.
Poisoning of the font of knowledge:
"He who pays the piper calls the tune"
A significant component is the special interest control of information. Until this problem is acknowledged and solved there can be no progress.
A drug craving and drug dependent society is facilitated and exploited by the drug industries.
Sales of over the counter and prescription drugs are stimulated by intensive advertising campaigns that "educate" the public starting at a young age.
Spuds MacKenzie and Joe Camel don't make it into the Partners for a Drug Free America ads as scapegoats. Most drug prevention education is ineffectual propaganda. Send them a signal rather than tell the truth. Beer advertisements encourage dangerous behavior. Some wine advertisements do not depict wine as a foodstuff. Over the counter drugs promotions set up a drug-craving public. No self-regulation skills are taught to children.
Solutions
Development of legalized drugs available through non profit pharmacy-based drug users' cooperatives eliminates "crack houses" or "shooting galleries". Drug dealers would disappear from the streets. Criminal enterprise zones are obsolete.
Restoration of the infrastructure of sports, arts, and music needs to be top priority.
Jobs and educational opportunity are required to fulfill dreams instead of the need to distract from or suppress frustrated, angry, and hopeless feelings.-
Drug abusers are unhappy. They suffer from waking perpetual nightmares of disempowerment.
It is high irony that the illicit free market has brought money into the minority communities where the federal programs have failed. It is blind stupidity to ignore the connection between illicit drugs and guns. If drugs were legalized their meaning are redefined from expensive forbidden fruit to affordable commodity. Coca derivatives are then like the other stimulant, caffeine. There would undoubtedly be some abusive use, but of a more treatable nature.
The side effects of the imposition of the moralistic model of the "War on Drugs have been far worse than the drugs themselves. This illicit mercantile enterprise creates nightmares that primarily affects the poor. The failure of leaders at all levels to address this economic reality must be blamed for this growing social problem.
Treatment for drug abuse would be available upon demand if it were supported by transaction fees from the sale of drugs. A harmfulness tax (Grinspoon) or pricing structure commensurate with potential toxicity would provide additional income for treatment and abuse prevention.
Advertising of drugs rather than censored by government should be from self-discipline by the industry. Removal of the exemption from product liability laws for alcohol and tobacco would insure self discipline in advertising.
Institutionalized or socialized use behavior will minimize abusive use. The concept of the "designated driver" is exemplary of the kind of custom that facilitates alcohol risk management.
Foreign policy
The economically irrational prohibitionist policy suborns the Monroe Doctrine with the inadvertent empowerment of authoritarian regimes that are hostile to the United States. Their hostility is beyond economic control of the OAS or the World Bank since they are now funded by the illicit drugs. Good-bye United Fruit. Hello unnamed successors to Medellin and Cali cartels.
The Sendero Luminosa despite the capture of their leader and the corrupt military in Peru has set back the emergence of democracy. The Drug Enforcement Administration and their "advisors" continue to aggravate the situation. throughout Latin America.
Columbia continues to suffer terrorism and destruction of their judiciary. the economy hammered by undercutting the coffee market.
Panama escalates the money laundering and transshipment. Business as usual even though president George Bush captured General Manuel Noriega, former friend and CIA and Drug Enforcement Administration employee. Operation "Just Cause" perpetrated urban undevelopment and "installation" (like a new motor in an old car) of a "new" government.
The Iran-Contra guns for drugs scandal continues to attenuate the legitimacy and efficacy in both foreign and domestic policy. Besides the embargo and mining of the tiny poor country of Nicaragua with illegal support of the guerrilla army, Lt. Colonel Oliver North lied to Congress to support former president Ronald Reagan and his vice president George Bush, commander designate of the War Against Drugs.
Mexico continues to suffer U.S. raids and interference with their government by the DEA. Border traffic continues to suffer disruption and human rights abuses from the drug law enforcement.
American drug prohibition dims the future of democracy in the hemisphere. America exports criminal mercantile opportunity.
Prohibitionism, the American Disease
American recurrent Prohibitionism is a peculiar majoritarian auto immune social disease regarded with perplexity by the rest of the world. With all the exemplary features of America, this anachronistic problem sadly detracts from world leadership.
American drug prohibition darkens the prospects for the country's future. Demagogues facilitated by profit driven special interest groups create policy and laws that erodes evermore rights of their citizens. Gradually, and by small increments what protections were once taken for granted have disappeared.
Lulled into a narcotism induced by television and materialism, the Trojan horse of authoritarianism has breached the gates of the city, its moralistic armed clergy busily snuffing out pockets of critical thinking- ever striving to make the world safe for profitable hypocrisy.
Alexis de Toqueville's warning of an all pervasive tutelary power ruling through the manipulation of a distracted materialistic populace becomes an approaching reality.
THM 12-3-92
Back to Top
Medical Drug Control Act of 199X
Tod H. Mikuriya, M.D.
The MDCA transfers control of all prescribed drugs to Health and Human Services from the Department of Justice.
While acknowledging the Herculean and often unappreciated effort, it is clear the criminal justice system's moral models have failed. Current drug classification is unscientific and irrational. Flawed collective perceptions of comparative harmfulness spawn harmful laws and policies. The result: excessive expectations on public institutions ill-equipped to deal with health problems. The criminal justice systems' resources are overwhelmed. Taxpayers are realizing the costs of these expectations have adverse impacts on other Government programs. The worst and longest lasting adverse effect on America is the decline of utilitarian government into authoritarianism. The attack upon the individual with the usurpation of privacy by both public and private authority is of most concern. It attacks the vitals of democracy. Transition to medical/social approaches represent the only effective alternative to Prohibition.
* The moral models are binary. The drug is good or the drug is bad- based upon its legal status. The medical model is based on costs vs benefits.
* The moral model of prohibition provides for a restricted response as compared with the medical models with their spectrum of options. Prohibition has created a toxic swamp of criminality, feeding on the materialism of America. Prohibition creates a dumbing down of America with prisons spent for instead of universities. Good-bye to global competitiveness; hello to more international crime.
The Surgeon General is responsible for developing, implementing, and maintaining drug control policy and programs. Department of Health and Human Services shall administer the National Drug Control Program. through the Public Health, Food and Drug Administration. Department of Justice will cooperate in the enforcement of the NDCP.
Funding by specific drug taxes earmarked for prevention and treatment with morbidity-based rates- A "pick up after yourself" policy. Each drug must be considered separately. Devotees and vendors of each drug generally rationalize it to be benign and less harmful or noxious than those of others. Connections between actual and perceived consequences require institutionalizing. Special interest groups fight to maintain their profitable niches based upon self serving denial.
Each drug- including alcohol and nicotine- may have some adverse effects. It is both fair and prudent that costs from the use of the drug be paid for by the users, industry, and marketplace. Currently, the non users are obliged to subsidize the users and their suppliers.
Excise and sales taxes from alcohol and nicotine products go, for the most part, into the general fund that motivates Government to encourage consumption.
Individual and group freedom requires informed responsibility and accountability
To be free one must have knowledge and understanding for what one is responsible and accountable. Groups and institutions are subject to the same expectations. The marketplace, industry, and users share this implicit social contract. No more exemptions for alcohol and tobacco products from product liability law. Drug advertising is drug "education". Industry, bereft of this unique privileged protection, will exert restraint to minimize risk. As it is there is minimal antidote to the manipulative imagery that preys upon human frailty to sell drugs. The public will cease to be as disinformed about comparative harm from drugs. Utilitarian drug policy- a responsive spectrum of options.
The ideal of non-intervention must be balanced with the interests of others affected. For the vast number of users of all drugs that utilize them effectively as personal tools without adverse effect no intervention is needed or justified except for morbidity-based taxation.
* Pharmacy based drug users cooperatives
Supported by transaction fees, the user is admitted to the cooperative by examination and screening. Drugs are dispensed upon showing appropriate identification.
* Addiction control specialists
Individuals at risk for abuse or history of misuse are referred to addiction specialists for supervision and individualized plans.
* Maintenance clinics
For those needing closer scrutiny and control, clinics with supportive services provide more intensive services.
The Criminal Justice System
Control must be exerted from within or it must be controlled from without.. Misbehavior from drug misuse requires intervention. Coercive and restrictive institutional response is justified and appropriate for misbehavior.
* Drug testing
* Quarantine
* Civil commitment
* Jail and prisons
Control is a reasonable alternative to Prohibition.
User fees, sales, and taxes to support control and compensation for specific drug morbidity and casualty losses are reasonable alternatives to the usurpation of our inalienable rights through Prohibition.
Draft 1 9/27/94
Controlled Substances, A Public Health Model
Tod H. Mikuriya. M.D.
The underlying assumption of a public health model is the optimization of benefits versus costs or risks for the individual and society.
A second premise is that users, producers, and the marketplace be accountable to themselves, family, and society in general.
Awareness of connections between costs and benefits must be institutionalized. Existing product liability laws and other safeguards of purity, efficacy, and strength provide one feedback mechanism.
Resulting industry restraint would obviate the need to censor advertising.
Earmarking of tax revenues for treatment and casualty losses instead of to the general fund provides another functional social reality check. The current inherent conflict of interest arrangement encourages government acting at cross purposes.
Accountable and self-supporting:
Voluntary Drug Users Cooperatives (VDUC)
Accountability is demonstrated by "picking up after oneself". Transaction fees and all drug taxes are earmarked to support administration of pharmacy based drug users' co-operatives. Contracting community treatment providers treat the inevitable abusers needing services are paid for by the program.
It has been estimated that some 10% of users are abusers of alcohol. It would not be unreasonable for the 9 users to pay for the 1 abuser's problems should that be the experience of the program.
Maximize Individual Responsibility. Minimize Intervention.
A major assumption is that the informed user will exert responsibility and common sense and require minimal intervention.
No intervention unless there is evidence of dysfunction. Costs would be lower than a clinic or physician visit type of maintenance program. This lower level of control and services for problem-free users would support a spectrum of services for those suffering drug-related illness or dysfunction.
Harm and Risk Management
A salient emphasis of the VDUC would be the minimizing unsafe drug use through education starting with the program entry testing and continuing with periodic health screens and user information updates.
Needle exchange and safe practices are an important part of the education program.
The VDUC's provide incentives for the use of low concentration psychoactive preparations over high concentration drugs.
Informed Consent/Entry
Users gain entry by taking a test to demonstrate knowledge of drug effects, side effects, and risks. This same test would be prima facie evidence of informed consent and understanding of responsibilities and consequences of violating program rules.
A special program identification card is presented at any contracting pharmacy to verify authorization to purchase up to a month's supply of drugs. Information from the transaction is sent to the program's office. Any unusual increase warrants inquiry from the office.
Users of high risk groups such as mentally ill, substance abusers, alcoholics, or developmentally disabled are under closer supervision by contracting addiction specialists.
Non-profit community board
The huge revenues at stake with inherent risks of greed necessitates oversight.
A non-profit community board is mandated to protect the users from avoidable harm, exploitation and the public from health and safety risks. Users, Pharmacists, Public Health, general community and district attorney are represented.
Abusers referred to treatment or enforcement
Privileges are suspended and the abuser is referred to police or district attorney if furnished to a minor, used to poison, incapacitate, or impair someone else. Driving while impaired, endangering others, fighting, or being a danger to others is generally handled by enforcement.
Abusers are referred to detoxification and treatment program providers if the abuser is not a danger to others.
If the user exhibits dysfunctional behavior or impaired health that does not directly harm someone else then he/she is referred to an appropriate substance abuse program. Reports from hospitals, emergency rooms, physicians offices, health facilities, workplace, family, or other source initiates intervention of the program. The pharmacy identification card is suspended and the abuser referred to the assessment team.
Evaluation
Experienced substance abuse specialists "triage" to determine the sorts of intervention appropriate to the individual problem.
Referral for specialized treatment
A spectrum of outpatient and in-patient service is available as contractors to the program for intervention in cases of drug abuse.
Continuing Research and Education
The continuing study at Framingham, Massachusetts provided us with definitive information concerning the connection between smoking, lung cancer, heart, and other circulatory diseases. Unbiased and extensive morbidity information is collected from participating health resources for policy refinement.
Psychoactive drugs with the lesser harm are developed and marketed to substitute for more toxic drugs. Crude coca products are made available to compete with the concentrated smokeable forms. Combination drugs like disulfiram or neuroleptics with opiates are evaluated.
Infectious intercurrent disease would utilize opioids, stimulants, and sedatives combined with antibiotics to improve compliance with treatment of illnesses like tuberculosis.
In order to restore a source of legitimate and undistorted medical information as to the connections between drugs and their hazards, treatments, and prevention, ongoing studies are required on a large scale.
Suggested Reading
2 U.S. Studies Criticize Plan To Ease Access to Methadone Associated Press in the New York Times A11, August 4, 1989
Dole, V.P., Nyswander, M., and Kreek, M.J. Narcotic Blockade Archives of Internal Medicine 118 October 1966, 304-309.
Dole, V.P. and Nyswander, M. Heroin Addiction- A Metabolic Disease, Archives of Internal Medicine 120 July 1967 19-20. Heroin Addicts
Goodman and Gilman's The Pharmacological Basis of Therapeutics 7th Edition
Macmillan New York 1985 1839 pp
Grinspoon, L. The Harmfulness Tax: A proposal for regulation and taxation of Drugs Unpublished. Address to International Meeting on Antiprohibitionism
Brussels September 29, 1989 11 pp.
King, R. The Drug Hangup; America's Fifty-Year Folly. Charles C. Thomas Springfield IL 1972 389 pp
The Merck Manual Fifteenth Edition. Merck, Sharp and Dohme Research Laboratories Rahway, NJ 1987 2,696 pp
Mikuriya, T.H. Taming drug-dependency with a credit card Medical World News Dec 12, 1980 P 100
_____________ Physical, Mental, and Moral Effects of Marijuana: The Indian Hemp Drugs Commission Report. Internat J. Addictions vol 3 No 2, Fall 1968
253-270
Nadelmann, E.A. Drug Prohibition in the United States: Costs, Consequences, and Alternatives Science 245: September 1, 1989, 939-947
Report of the Indian Hemp Drugs Commission 1893-94 Simla, India: Government Central Printing House, 1894, 7 Vols 3,281 pp.
_____________ Supplementary Vols 1 & 2: 417 pp (Classified military data published separately)
Syllabus for the Psychopharmacology Course Harvard Medical School Sept 30 Oct 2, 1988 Harvard Medical School Department of Continuing Education, Boston, MA 514 pp.
Terry, C.E. and Pellens, M. The Opium Problem. Bureau of Social Hygiene New York 1928 1045 pp (Reprinted by Patterson Smith, Montclair NJ 1970)
Trebach, A.S. The Heroin Solution Yale University Press, New Haven, CT 1982 331 pp
____________ The Great Drug War Macmillan, New York 1987 401 pp
Tod H. Mikuriya, M.D.
12-17-92
