Top Drug Warrior Distortions

Table of Contents:

Distortion 1: Drug Use Post-Prohibition

Distortion 2: Drug Use Estimates

Distortion 3: Needle Exchange

Distortion 4: Australia’s Harm Reduction policies

Distortion 5: Methadone Treatment

Distortion 6: Emergency Room Visits

Distortion 7: Gateway

Distortion 8: Ecstasy

Distortion 9: Cannabis As Medicine

Distortion 10: Young People and Drugs

Distortion 11: Marijuana Potency

Appendix

(NB: Assertions made by drug warriors are given in italic. Responses follow in bold. Cites are given afterward in plain text enclosed in brackets. Detail and background information are contained in attached appendix. Click on the link in the list at the top of the page to go directly to the assertion and response. Click on the link at the beginning of each response to go directly to the appendix.)

Distortion 1: If drugs were legalized there would be an explosion of drug use.
Incorrect. The available research, as affirmed by a recent Federal analysis of drug policy, indicates there would be little if any increase in use.

From 1972 to 1978, eleven states decriminalized marijuana possession (covering one-third of the US population) and 33 other states reduced punishment to probation with record erased after six months to one year. Yet, after 1978 marijuana use steadily declined for over a decade. Decriminalization did not increase marijuana use. (click for additional information)

[National Research Council, "Informing America’s Policy On Illegal Drugs: What We Don’t Know Keeps Hurting Us" (Washington, DC: National Academy Press, 2001), pp. 192-193.]

The Netherlands decriminalized possession and allowed small scale sales of marijuana beginning in 1976. Yet, marijuana use in Holland is half the rate of use in the USA. It is also lower than the United Kingdom which had continued to treat possession as a crime. The UK is now moving toward decriminalization.

[Center for Drug Research, "Licit and Illicit Drug Use in The Netherlands 1997" (University of Amsterdam, The Netherlands: CEDRO, 1999; Netherlands Ministry of Health, Welfare and Sport, "Drug Policy in the Netherlands: Progress Report Sept. 1997-Sept. 1999 (The Hague, The Netherlands: Ministry of Health, Welfare and Sport, Nov. 1999); US Dept. of Health and Human Services, Substance Abuse and Mental Health Services Administration, National Household Survey on Drug Abuse 1998, 1999, and 2000 (Washington, DC: SAMHSA).

According to the Center for Drug Research in its report Licit and Illicit Drug Use in The Netherlands 1997, past-year cannabis use in The Netherlands is estimated at 4.5% for the entire population; past-month use is 2.5%. In the United States, according to NIDA’s National Household Survey on Drug Abuse for 2000, past-year cannabis use is 8.3% of the US population 12 and older, and past-month use is 4.8%.]

If there is an increase in the reported rate of drug use after the end of prohibition, it may be due to an increased willingness to admit to being a drug user. Currently, such an admission means admitting to breaking the law, which social scientists point out discourages honesty.

[National Research Council, "Informing America's Policy On Illegal Drugs" (Washington, DC: National Academy Press, 2001): "It is widely thought that nonresponse and inaccurate response may cause surveys such as the NHSDA and MTF to underestimate the prevalence of drug use in the surveyed populations (Caspar, 1992)." (p. 93)]

Distortion 2: We are winning the ‘drug war.’ Regular drug use has been cut in half since 1979.

It is difficult to measure illicit drug use rates because this is an illegal activity. The government relies on surveys to determine the level of use, and under-reporting is common because illicit drug use is heavily stigmatized in the US. (click for additional information)

[National Research Council, "Informing America’s Policy On Illegal Drugs" (Washington, DC: National Academy Press, 2001): "It is widely thought that nonresponse and inaccurate response may cause surveys such as the NHSDA and MTF to underestimate the prevalence of drug use in the surveyed populations (Caspar, 1992)." (p. 93)]

Federal surveys show an increase in use, especially by adolescents, since 1990.

["Monitoring The Future: National Survey Results on Drug Use, 1975-2000, Volume 1: Secondary School Students" (Washington, DC: National Institute on Drug Abuse, 2001), p. 115, and and "Volume II: College Students and Young Adults Ages 19-40," p. 102.]

More reliable data on trends is overdose deaths and emergency room mentions of drugs. These numbers have escalated consistently since the 1980s, and both are at record highs.

[Office of Applied Studies, Substance Abuse and Mental Health Services Administration, US Dept. of Health and Human Services, "Year-End 2000 Emergency Room Data from the Drug Abuse Warning Network (Washington, DC: DHHS, July 2001), p. 2.]

Also, since 1979 the illicit market has created a host of new drugs, most notably crack, in addition to the proliferation of methamphetamine. Even if the survey data relied on were correct, the drug market has gotten more dangerous and drug abuse has become more widespread.

Distortion 3: Drug warriors claim that needle exchange increases drug use by citing Vancouver, Canada and claiming HIV rates are higher among participants in the needle exchange program (NEP) than among injecting drug users who do not participate; incidence of AIDS and hepatitis C virus has risen since NEP was introduced; age of drug users decreased since NEP introduced.

(sometimes cited: Office of National Control Policy 1998)

The authors of the Canadian studies specifically refuted ONDCP's claim in an op-ed published in The New York Times. [Julie Bruneau & Martin T. Schechter, "The Politics of Needles and AIDS," New York Times, April 9, 1998, p. 27.] (click for additional information)

All the research shows that needle exchange does not increase drug use, and it decreases the spread of HIV. The US Surgeon General and the US Secretary of Health and Human Services have both reached this conclusion.

[US Surgeon General Dr. David Satcher, Department of Health and Human Services, Evidence-Based Findings on the Efficacy of Syringe Exchange Programs: An Analysis from the Assistant Secretary for Health and Surgeon General of the Scientific Research Completed Since April 1998 (Washington, DC: Dept. of Health and Human Services, 2000), from the website of the Harm Reduction Coalition at http://www.harmreduction.org/surgreview.html; Varmus, Harold, Director of the National Institutes of Health, Press release from Department of Health and Human Services, (April 20, 1998); Bluthenthal, Ricky N., Kral, Alex H., Erringer, Elizabeth A., and Edlin, Brian R., "Drug paraphernalia laws and injection-related infectious disease risk among drug injectors", Journal of Drug Issues, 1999;29(1):1-16. Abstract available on the web at http://www.nasen.org/NASEN_II/research1.htm; Friedman, Samuel R. PhD, Theresa Perlis, PhD, and Don C. Des Jarlais, PhD, "Laws Prohibiting Over-the-Counter Syringe Sales to Injection Drug Users: Relations to Population Density, HIV Prevalence, and HIV Incidence," American Journal of Public Health (Washington, DC: American Public Health Association, May 2001), Vol. 91, No. 5, p. 793.]

Distortion 4: In Australia, where 'harm reduction' is the official policy, drug use is now at 52% among those 14 to 25. According to Australia's Federal Government, every second person arrested for any crime is under the influence of marijuana. (sometimes cited: United Nations World Drug Report)

The Australian government began studying the drug use of offenders in 1999. The 2000 World Drug Report mentions no such figure, and any report in the 1997 World Drug Report would have been based on anecdotes rather than science, according to researchers involved with the Drug Use Monitoring in Australia. (click for additional information)

[Makkai, Toni, et al., Australian Institute of Criminology, "Patterns of Drug Use Amongst Police Detainees: 1999-2000" by, Dec. 2000]

To put this in context, the US Justice Department reports that the United States (which does not have harm reduction as official policy) has much higher rates of drug use by offenders, and also very high rates of drug use in general.

[US: US Dept. of Justice, "Substance Abuse and Treatment, State and Federal Prisoners, 1997" (Bureau of Justice Statistics, Jan. 1999; Makkai, Toni, et al., Australian Institute of Criminology, "Patterns of Drug Use Amongst Police Detainees: 1999-2000" by, Dec. 2000, p. 3]

Note: Australia does tend to have higher rates of reported drug use, because Australians have a high level of trust in their government and a long tradition of social research.

[UN World Drug Report 2000 (New York, NY: UNDCP, 2001) notes: "Such high figures do point to high levels of consumption; but they may also have to do with the specific social and legal context in which studies take place. This results in the case of Australia (and some other countries with a long tradition of social research) in more readiness to admit to drug use, and thus far less under-reporting than in countries where drug users fear that such information could be used against them." (p. 74)]

Distortion 5: Methadone treatment is ineffective. In Hong Kong, after 24 years of government-sponsored methadone treatment programs, only 200 of over 10,000 heroin addicts have been successfully treated. (sometimes cited: South China Morning Post)

Methadone programs around the world have been found to be effective measures both in reducing harms arising from opiate use and in helping people stop using opiates. (click for additional information)

[Langendam, Miranda W., PhD, et al., "The Impact of Harm-Reduction-Based Methadone Treatment on Mortality Among Heroin Users," American Journal of Public Health, May 2001, Vol. 91, No. 5; "Effective Opiate Addiction Treatment - NIH Consensus Conference," Journal of the American Medical Association, Vol. 280, No. 22, Dec. 9, 1998, pp. 1936-1943.]

[Research and Library Services Division of the Hong Kong Legislative Council, titled "Methadone Treatment Programmes in Hong Kong and Selected Countries," available online at

http://www.legco.gov.hk/yr97-98/english/sec/library/956rp12.pdf]

The report was prepared during the run-up to Chinese take-over of the Hong Kong colony, and the methadone maintenance program was a holdover from British rule and as such was not regarded highly by the incoming Chinese government. The report, while critical of the Hong Kong methadone program, noted the success of methadone programs in the US and Australia.

The US National Institutes of Health highly recommends methadone maintenance as a preferred treatment for helping opiate addicts quit using.

[Langendam, Miranda W., PhD, et al., "The Impact of Harm-Reduction-Based Methadone Treatment on Mortality Among Heroin Users," American Journal of Public Health, Vol. 91,

No. 5; "Effective Opiate Addiction Treatment - NIH Consensus Conference," Journal of the American Medical Association, Vol. 280, No. 22, Dec. 9, 1998, pp. 1936-1943).]

Recently, the Chinese announced that they were establishing methadone programs on the mainland to deal with their growing population of heroin addicts.

South China Morning Post, "Landmark experiment a sign authorities are willing to tackle growing mainland epidemic," November 17, 2001, from scmp.com.

Distortion 6: In Wisconsin, marijuana overdose visits in emergency rooms equal to heroin or morphine, twice as common as Valium. (cited: Wisconsin Department of Justice)

Notably there are no numbers given, only comparisons. The rates in Wisconsin are similar to national averages as reported by the Drug Abuse Warning Network of the US Substance Abuse and Mental Health Services Administration. The federal DAWN report itself notes that reports of marijuana do not mean people are going to the hospital for a marijuana overdose, it only means that people going to the hospital for a drug overdose mention marijuana as a drug they use. Since marijuana is the most widely used illegal drug it is the most mentioned illicit drug when people come to the hospital for any reason. Also, alcohol-in-combination is a larger problem than any of the illicit drugs. (click for additional information)

[Substance Abuse and Mental Health Services Administration, US Dept. of Health and Human Services, DAWN Emergency Room Data Report, 2001]

Distortion 7: Marijuana is a gateway drug that leads to heroin and cocaine addiction.

The ‘gateway’ claim is a myth. Marijuana is the most widely used illicit drug so it is very likely that people who use less commonly-used drugs will have also tried marijuana. That does not mean marijuana led to hard drug use. The research indicates most marijuana users do not go onto use hard drugs; marijuana is more properly viewed as a strainer that catches most illicit drug users and they go no further. The numbers bear out these findings: According to the federal government 76.3 million people have tried marijuana, while only 2.78 million have ever tried heroin in their lifetimes and only 5.3 million have ever tried cocaine in their lives. The figures for monthly use are similar: 10.7 million Americans admit to being regular marijuana users, yet only 1.2 million admit to using cocaine each month – 1 for every 9 marijuana users – and 130,000 people use heroin monthly, or 1 for every 80 regular marijuana users. (click for additional information)

[Substance Abuse and Mental Health Services Administration, US Dept. of Health and Human Services, National Household Survey on Drug Use 2000 (Washington, DC: SAMHSA, 2001]

Distortion 8: Ecstasy is a widespread danger that is killing American youth.

It is possible that Ecstasy use has resulted in the deaths of some young people but it is an exaggeration that this is widespread. The Drug Abuse Warning Network estimates that ecstasy was involved in -- though not necessarily the cause of -- nine deaths in 1998. (click for additional information)

["Club Drugs," The DAWN Report, Drug Abuse Warning Network, Office of Applied Studies, Substance Abuse and Mental health Services Administration (Washington, DC: SAMHSA, December 2000), p. 4.]

One of the recent risks associated with Ecstasy is the possibility of obtaining adulterated drugs that may be more toxic than MDMA. Some of the reported deaths attributed to Ecstasy are likely caused by other, more dangerous drugs.

[Laboratory Pill Analysis Program, DanceSafe. For results visit www.DanceSafe.org. See also, Byard RW et al., "Amphetamine derivative fatalities in South Australia-is ‘Ecstasy’ the culprit?," American Journal of Forensic Medical Pathology, 1998 (Sep) 19(3): 261-5.]

Distortion 9: Cannabis is no better that codeine at controlling pain and because of its undesirable side effects it has no place in mainstream medicine. (cited: British Medical Journal)

In 2001, the British Medical Journal did publish two reviews of existing scientific studies on cannabinoids, one on pain management, the other on nausea control. These reviews did not include data on herbal cannabis, also called marijuana; instead, the studies reviewed examined only oral THC and two synthetic cannabinoids. (click for additional information)

[Campbell, Fiona A., Martin R. Tramer, et al., "Are cannabinoids an effective and safe treatment option in the management of pain? A qualitative systematic review," British Medical Journal 2001; 323:13, July 7, 2001; Tramer, Martin R., Dawn Carroll, et al., "Cannabinoids for control of chemotherapy induced nausea and vomiting: quantitative systematic review," British Medical Journal 2001;323:16, July 7, 2001.]

Other medical experts are more supportive of cannabis's therapeutic potential. In the US government’s Institute of Medicine report on medical marijuana in 1999, the authors conclude that "The accumulated data indicate a potential therapeutic value for cannabinoid drugs, particularly for symptoms such as pain relief, control of nausea and vomiting, and appetite stimulation."

[Joy, Janet E., Stanley J. Watson Jr., and John A. Benson Jr., "Marijuana and Medicine: Assessing the Science Base," Division of Neuroscience and Behavioral Research, Institute of Medicine, National Academy of Sciences (Washington, DC: National Academy Press, 1999).

See also: "Marijuana: federal smoke clears, a little," Canadian Medical Association Journal, May 15, 2001, Vol. 164, No. 10, p. 1397; Kassirer, Jerome P., MD, "Federal Foolishness and Marijuana," New England Journal of Medicine, Vol. 336, No. 5, Jan. 30, 1997, from the web at
http://www.mapinc.org/drugnews/v97/n000/a014.html]

Distortion 10: Current drug policy protects American youth.

Untrue. Current drug policy harms America's young people in many ways.

c) Young people are not provided information on how to prevent or treat an overdose from illegal drugs. As a result hundreds of young people die each year from causes that could have been prevented. Research shows that the drug war, because of its punitive approach, has resulted in young people being afraid to seek emergency medical services when they are needed.
[Sources: Minino, A.M., Smith, B.L., Centers for Disease Control, "Deaths: Preliminary Data for 2000," National Vital Statistics Reports, Vol. 49, No. 12 (Hyattsville, MD: National Center for Health Statistics, Oct. 9, 2001), p. 17, table 2, from the web at http://www.cdc.gov/nchs/data/nvs49_12.pdf; Office of Applied Studies, Substance Abuse and Mental Health Services Administration, US Dept. of Health and Human Services, "Drug Abuse Warning Network Annual Medical Examiner Data 1999" (Rockville, MD: SAMHSA, December 2000), p. 35, Table 2.02, and p. 37, Table 2.04; Sporer, Karl A., MD, "Acute Heroin Overdose," Annals of Internal Medicine (Washington, DC: American College of Physicians/American Society of Internal Medicine, April 6, 1999), Vol. 130, No. 7, p. 585; Zador, Deborah, Sandra Sunjic and Shane Dark, "Heroin-related deaths in New South Wales, 1992; toxicological findings and circumstances," Medical Journal of Australia, 1997, from the web at http://www.mja.com.au; Darke, Shane and Deborah Zador, "Fatal heroin 'overdose': A review," Addiction, 1996, Vol. 91, No. 12, pp. 1765-1772.] (Click for additional information)

d) The drug war divides families. Nearly two million young people in the US have one or both parents incarcerated, many for non-violent drug offenses. This results in many young people being put into the foster care system and increases the likelihood of delinquency. Incarceration also results in children being unable to visit parents as more than half of parents incarcerated are over 100 miles away from their last residence.
[Sources: Greenfield, Lawrence A., and Snell, Tracy L., US Department of Justice, Bureau of Justice Statistics, Women Offenders (Washington, DC: US Department of Justice, December 1999), p. 8, Table 18. Mumola, Christopher J., US Department of Justice Bureau of Justice Statistics, Incarcerated Parents and Their Children (Washington, DC: US Department of Justice, August 2000), p. 2. Mumola, Christopher J., US Department of Justice Bureau of Justice Statistics, Incarcerated Parents and Their Children (Washington, DC: US Department of Justice, August 2000), p. 5] (Click for additional information)

e) Many young Americans have their lives ruined by drug enforcement. The number of offenders under age 18 admitted to prison for drug offenses increased twelvefold between 1985 to 1997. [Source: Strom, Kevin J., US Department of Justice, Bureau of Justice Statistics, Profile of State Prisoners Under Age 18, 1985-1997 (Washington, DC: US Department of Justice, February 2000), p. 4]
Under federal law, young people convicted of a drug offense lose their right to federal college loans - 43,000 students were affected by this provision in 2001 -increasing the likelihood that they will be undereducated and unable to compete for good jobs.
[Source: Associated Press, Drug Convictions Still Bar Federal Student Loans, Dec. 29, 2001.] (Click for additional information)

f) Many young people get involved in drug selling because there are no other job opportunities available, not to finance their own drug use. US Department of Justice research shows that MANY would gladly give up drugs for a legitimate job, even at relatively low wages, if one were available.
[Source: Huff, C. Ronald, National Institute of Justice, Research In Brief, "Comparing the Criminal Behavior of Youth Gangs and At-Risk Youths" (Washington, DC: US Dept. of Justice, Oct. 1998), p. 2]
Research funded by the Wisconsin Policy Research Institute shows that drug dealing plays a substantial role in the local economies of poorer urban neighborhoods because of the lack of other job opportunities.
[Hagedorn, John M., PhD, "The Business of Drug Dealing in Milwaukee" (Milwaukee, WI: Wisconsin Policy Research Institute, 1998), p. 3] (Click for additional information)

Distortion 11: "Parents are often unaware that today's marijuana is different from that of a generation ago, with potency levels 10 to 20 times stronger than the marijuana with which they were familiar." US Drug Czar John Walters, "The Myth of 'Harmless' Marijuana," Washington Post, May 1, 2002, p. A25.

Untrue. Federal research shows that the average potency of cannabis in the US has increased very little.

Even the Drug Enforcement Administration concedes ( "Drug Intelligence Brief: The Cannabis Situation in the United States, December 1999") that "According to University of Mississippi analyses, the THC content of commercial-grade marijuana has risen slowly over the years from an average of 3.71 percent in 1985 to an average of 5.57 percent in 1998. These analyses also show a corresponding rise in sinsemilla THC content from 7.28 percent in 1985 to 12.32 percent in 1998." More recently, the US National Drug Intelligence Center's "National Drug Threat Assessment 2002 " report, released December 2001, stated that "Overall, potency, as characterized by THC content, is still increasing. According to data from the Potency Monitoring Project, the THC content of commercial-grade marijuana increased from 1997 to 2000 for commercial-grade (4.25% to 4.92%) and for sinsemilla (11.62% to 13.20%)." (Click for additional information)

For additional information, please visit our website at http://www.drugwarfacts.org in addition to our primary website at http://www.csdp.org.

Appendix
Distortion 1: If drugs were legalized there would be an explosion of drug use.

"Most cross-state comparisons in the United States (as well as in Australia; see McGeorge and Aitken, 1997) have found no significant differences in the prevalence of marijuana use in decriminalized and nondecriminalized states (e.g., Johnston et al., 1981; Single, 1989; DiNardo and Lemieux, 1992; Thies and Register, 1993). Even in the few studies that find an effect on prevalence, it is a weak one. For example, using pooled data from the National Household Survey of Drug Abuse for 1988, 1990 and 1991, Saffer and Chaloupka (1995) found that marijuana decriminalization increased past-year marijuana use by 6 to 7 percent and past-month use by 4 to 5 percent. Using Monitoring The Future survey data for 1982 and 1989, Chaloupka et al. (1998) estimated that decriminalizing marijuana in all states would raise the number of youths using marijuana in a given year by 4 to 5 percent compared with the number using it when marijuana use is criminalized in all states; however, they also found no relationship between decriminalization and past-month use or frequency of use."

Source: National Research Council, "Informing America’s Policy on Illegal Drugs" (Washington, DC: National Academy Press, 2001) pp. 192-193

Sources: Center for Drug Research, "Licit and Illicit Drug Use in The Netherlands 1997" (University of Amsterdam, The Netherlands: CEDRO, 1999; Netherlands Ministry of Health, Welfare and Sport, "Drug Policy in the Netherlands: Progress Report Sept. 1997-Sept. 1999 (The Hague, The Netherlands: Ministry of Health, Welfare and Sport, Nov. 1999); US Dept. of Health and Human Services, Substance Abuse and Mental Health Services Administration, Summary of Findings from the 2000 National Household Survey on Drug Abuse (Washington, DC: SAMHSA).

"Still, several broad conclusions about misreporting have been drawn. At the most basic level, there appears to be consistent evidence that some respondents misreport their drug use behavior. More specifically, valid self-reporting of drug use appears to depend on the timing of the event and the social desirability of the drug. Recent use may be subject to higher rates of bias. Misreporting rates may be higher for stigmatized drugs, such as cocaine, than for marijuana. False negative reports seem to increase as drug use becomes increasingly stigmatized. The fraction of false negative reports appears to exceed the fraction of false positive reports, although these differences vary by cohorts. Finally, the validity rates can be affected by the data collection methodology. Surveys that can effectively ensure confidentiality and anonymity and that are conducted in noncoerced settings will tend to have relatively low misreporting rates." (NRC, "Informing America’s Policy on Illegal Drugs," pp. 99-100)

Distortion 2: We are winning the ‘drug war.’ Regular drug use has been cut in half since 1979.

"The years 1978 and 1979 marked the crest of a long and dramatic rise in marijuana use among American high school seniors (and, for that matter, among young people generally). As Tables 5-2 through 5-3 and Figure 5-4a illustrate, annual and 30-day prevalence of marijuana use leveled between 1978 and 1979, following a steady rise in the preceding years. In 1980, both statistics dropped for the first time and continued to decline every year through 1992, except for a brief pause in 1985. Following this twelve-year decline, annual use among twelfth graders began to rise sharply beginning in 1993. In all, it nearly doubled between 1992 and 1997, from 22% to 39%. Thirty-day use also rose significantly, doubling from the 1992 level of 12% to 24% in 1997. It was not until 1998 that these statistics turned around, although neither declined by a significant amount, and neither declined any further in 1999."

Source: Johnston, Lloyd D. PhD, Patrick M. O’Malley, PhD, and Jerald G. Bachman, PhD, Institute for Social Research, "Monitoring The Future: National Survey Results on Drug Use, 1975-2000, Volume 1: Secondary School Students" (Washington, DC: National Institute on Drug Abuse, 2001), p. 115.

"Longer term declines among young adults in the annual prevalence of a number of drugs appeared to end in 1992 (see Table 5-2). Among the 19- to 28-year-old young adult sample this was true for the use of any illicit drug, any illicit drug other than marijuana, marijuana, amphetamines, and crack. In 1993 and 1994, annual prevalence for most drugs remained steady. Cocaine other than crack leveled in 1993 after a period of substantial decline. In 1995, there were modest increases (a percentage point or less) in the annual prevalence of almost all of the drug classes in Table 5-2, some of which were statistically significant. Thus, it is clear that by 1992 the downward secular trend observable in all of these age strata (as well as among adolescents) was over."

Source: Johnston, Lloyd D. PhD, Patrick M. O’Malley, PhD, and Jerald G. Bachman, PhD, Institute for Social Research, "Monitoring The Future: National Survey Results on Drug Use, 1975-2000, Volume II: College Students and Young Adults Ages 19-40" (Washington, DC: National Institute on Drug Abuse, 2001), p. 102.

"From 1990 to 2000, total drug-related episodes increased 62 percent, from 371,208 to 601,776 (Figure 1). Mentions of the four major illicit drugs increased from 1990 to 2000 as follows: marijuana/hashish (514%, from 15,706 to 96,446), heroin/morphine (187%, from 33,884 to 97,287), methamphetamine/speed (158%, from 5,236 to 13,513), and cocaine (118%, from 80,355 to 174,896) (Figure 2)."

Source: Office of Applied Studies, Substance Abuse and Mental Health Services Administration, US Dept. of Health and Human Services, "Year-End 2000 Emergency Room Data from the Drug Abuse Warning Network (Washington, DC: DHHS, July 2001), p. 2.

"Whether the subject of interest is prevalence, frequency, or quantity consumed, questions about the quality of self-reports of drug use are inevitable. The usefulness of the data obtained from a survey is reduced if some sampled individuals fail to answer one or more questions on the survey (nonresponse) or give incorrect answers (inaccurate response). In particular, nonresponse and inaccurate response may lead investigators to draw incorrect conclusions from the data provided by a survey. Response problems occur to some degree in nearly all surveys but are arguably more severe in surveys of illegal activities. For example, some individuals may be reluctant to admit that they engage in illegal behavior, whereas others may brag about such behavior or exaggerate it. It is widely thought that nonresponse and inaccurate response may cause surveys such as the NHSDA and MTF to underestimate the prevalence of drug use in the surveyed populations (Caspar, 1992)." (p. 93)

"Consider, for instance, drawing inferences on the levels and trends in annual prevalence of use rates for adolescents during the 1990s. Data from MTF imply that annual prevalence rates for students in 12th grade increased from 29 percent in 1991 to 42 percent in 1997. Data from the NHSDA indicate that the annual prevalence rates of use for adolescents ages 12 to 17 increased from 13 percent in 1991 to 19 percent in 1997. Both series suggest that from 1991 to 1997, the fraction of teenagers using drugs increased by nearly 50 percent. Does the congruence in the NHSDA and MTF series for adolescents imply that both surveys identify the trends, if not the levels, or does it merely indicate that both surveys are affected by response problems in the same way?" (p. 94)

"Approximately 15 percent of the students surveyed by MTF fail to respond to the questionnaire and approximately 25 percent fail to respond to the NHSDA." (p. 95) (footnote: "The 25 percent nonresponse rate for the NHSDA includes both unit (household) and element (person) nonresponse. The 15 percent nonresponse rate cited for MTF includes student nonresponse only. Schools that refuse to participate in the MTF survey are replaced by similar schools.") (p. 95)

"Caspar (1992) used a shortened questionnaire and monetary incentives to elicit responses from 40 percent of the nonrespondents to the 1990 NHSDA in the Washington, DC area. He found that nonrespondents have higher prevalence rates than do respondents. It is not known whether this finding applies to all nonrespondents or only those who responded to Caspar's survey. Rather than impose the missing-at-random assumption, it might be sensible to assume that the prevalence rate of nonrespondents is no less than the observed rate for respondents. Maintaining this assumption, Pepper obtained bounds on prevalence (Appendix D). The lower bound results if prevalence among nonrespondents equals that among respondents. The upper bound results if all nonrespondents use illegal drugs. True prevalence is within these bounds. Using data from MTF, Pepper found that annual prevalence for 12th graders lies between 29 and 40 percent in 1991 and between 42 and 51 percent in 1997. Thus, the data place prevalence within about a 10 percentage point range." (pp. 96-97)

"A few studies have attempted to evaluate misreporting in broadbased representative samples. However, lacking direct evidence on misreporting in the national probability surveys, these studies make strong, unverifiable assumptions to infer validity rates. Biemer and Witt (1996) analyzed misreporting in the NHSDA under the assumption that smoking tobacco is positively related to illegal drug use and independent of valid reporting. They found false negative rates (that is, the fraction of users who claim to have abstained) in the NHSDA that vary between 0 and 9 percent. Fendrich and Vaughn (1994) evaluated denial rates using panel data on illegal drug use from the National Longitudinal Survey of Youth (NLSY), a nationally representative sample of individuals who were ages 14 to 21 in the base year of 1979. Of the respondents to the 1984 survey who claimed to have ever used cocaine, nearly 20 percent denied use and 40 percent reported less frequent lifetime use in the 1988 follow-up. Of those claiming to have ever used marijuana in 1984, 12 percent later denied use and just over 30 percent report less lifetime use. These logical inconsistencies in the data are informative about validity only under the assumption that the original 1984 responses are correct. Both of these studies require unsubstantiated assumptions to draw conclusions about validity. Arguably, smokers and nonsmokers may have different reactions to stigma and thus may respond differently to questions about illegal behavior. Arguably, the self-reports in the 1984 National Longitudinal Survey of Youth are not all valid. Thus, neither study can be used to draw strong conclusions about validity rates. Still, several broad conclusions about misreporting have been drawn. At the most basic level, there appears to be consistent evidence that some respondents misreport their drug use behavior. More specifically, valid self-reporting of drug use appears to depend on the timing of the event and the social desirability of the drug. Recent use may be subject to higher rates of bias. Misreporting rates may be higher for stigmatized drugs, such as cocaine, than for marijuana. False negative reports seem to increase as drug use becomes increasingly stigmatized. The fraction of false negative reports appears to exceed the fraction of false positive reports, although these differences vary by cohorts. Finally, the validity rates can be affected by the data collection methodology. Surveys that can effectively ensure confidentiality and anonymity and that are conducted in noncoerced settings will tend to have relatively low misreporting rates. Without knowledge of the fraction of respondents who misreport their drug use, it is not possible to identify either prevalence levels or trends. Johnston et al. (1998) argue that invalid reporting rates in the national surveys are low and vary little from year to year so that the data can be used to infer trends. Pepper discusses some potentially plausible assumptions about incorrect response that make it possible to bound prevalence level (Appendix D). It is not known, however, whether either Johnston's or Pepper's assumptions are correct. Concerns about inaccurate response in the NHSDA and MTF are not new." (pp. 99-100)

Distortion 3: Drug warriors claim that needle exchange increases drug use by pointing to Vancouver, Canada and claiming HIV rates are higher among participants in the needle exchange program (NEP) than among injecting drug users who do not participate: incidence of AIDS and hepatitis C virus has risen since NEP was introduced; age of drug users decreased since NEP introduced.

(usually cited: Office of National Control Policy 1998)

On March 26, 1998, ONDCP Director Barry McCaffrey gave testimony to a House subcommittee in which he misinterpreted the results of two Canadian needle exchange studies in order to justify his opposition to syringe exchange. The study authors, Julie Bruneau (assistant professor of psychiatry at the University of Montreal) and Martin T. Schechter (professor of epidemiology at the University of British Columbia) wrote an op-ed in the New York Times on April 9, 1998 to rebut McCaffrey's assertion, and to explain their results.

According to the authors, among other factors, in Canada syringes can be purchased legally, while they could only be purchased with prescriptions in the US. Therefore, unlike in US studies, the populations in the Canadian studies were less likely to include the more affluent and better functioning addicts who could purchase their own needles and who were less likely to engage in the riskiest activities. Thus, it was not surprising that participants in the study had higher rates of HIV than those who did not, because the Canadian users forced to use needle exchanges were a much higher-risk population.

The following is an excerpt from Julie Bruneau & Martin T. Schechter, "The Politics of Needles and AIDS," New York Times, April 9, 1998, p. 27, from the web at

http://www.mapinc.org/drugnews/v98/n258/a05.html

"In a letter to Congress, Barry McCaffrey, who is in charge of national drug policy, cited two Canadian studies to show that needle-exchange plans have failed to reduce the spread of HIV, the virus that causes AIDS, and may even have worsened the problem. Congressional leaders have cited these studies to make the same argument.

"As the authors of the Canadian studies, we must point out that these officials have misinterpreted our research. True, we found that addicts who took part in needle exchange programs in Vancouver and Montreal had higher HIV infection rates than addicts who did not. That's not surprising. Because these programs are in inner-city neighborhoods, they serve users who are at greatest risk of infection. Those who didn't accept free needles often didn't need them since they could afford to buy syringes in drug stores. They also were less likely to engage in the riskiest activities.

"Also, needle-exchange programs must be tailored to local conditions. For example, in Montreal and Vancouver, cocaine injection is a major source of HIV transmission. Some users inject the drug up to 40 times a day. At that rate, we have calculated that the two cities we studied would each need 10 million clean needles a year to prevent the re-use of syringes. Currently, the Vancouver program exchanges two million syringes annually, and Montreal, half a million.

"A study conducted last year and published in The Lancet, the British medical journal, found that in 29 cities worldwide where programs are in place, HIV infection dropped by an average of 5.8 percent a year among drug users. In 51 cities that had no needle-exchange plans, drug-related infection rose by 5.9 percent a year. Clearly these efforts can work."

More support for syringe exchange:

"After reviewing all of the research to date, the senior scientists of the Department and I have unanimously agreed that there is conclusive scientific evidence that syringe exchange programs, as part of a comprehensive HIV prevention strategy, are an effective public health intervention that reduces the transmission of HIV and does not encourage the use of illegal drugs."

Source: US Surgeon General Dr. David Satcher, Department of Health and Human Services, Evidence-Based Findings on the Efficacy of Syringe Exchange Programs: An Analysis from the Assistant Secretary for Health and Surgeon General of the Scientific Research Completed Since April 1998 (Washington, DC: Dept. of Health and Human Services, 2000), from the website of the Harm Reduction Coalition at

http://www.harmreduction.org/surgreview.html.

According to Dr. Harold Varmus, Director of the National Institutes of Health, "An exhaustive review of the science in this area indicates that needle exchange programs can be an effective component in the global effort to end the epidemic of HIV disease."

Source: Varmus, H., Director of the National Institutes of Health, Press release from Department of Health and Human Services, (April 20, 1998).

According to a study in 1996, "Drug paraphernalia laws in 47 U.S. states make it illegal for injection drug users (IDUs) to possess syringes." The study concludes, "decriminalizing syringes and needles would likely result in reductions in the behaviors that expose IDUs to blood borne viruses."

Source: Bluthenthal, Ricky N., Kral, Alex H., Erringer, Elizabeth A., and Edlin, Brian R., "Drug paraphernalia laws and injection-related infectious disease risk among drug injectors", Journal of Drug Issues, 1999;29(1):1-16. Abstract available on the web at http://www.nasen.org/NASEN_II/research1.htm.

"The data in this report offer no support for the idea that anti-OTC laws prevent illicit drug injection. However, the data do show associations between anti-OTC laws and HIV prevalence and incidence. In an ongoing epidemic of a fatal infectious disease, prudent public health policy suggests removing prescription requirements rather than awaiting definitive proof of causation. Such action has been taken by Connecticut, by Maine, and, recently, by New York. After Connecticut legalized OTC sales of syringes and the personal possession of syringes, syringe sharing by drug injectors decreased. Moreover, no evidence showed increased in drug use, drug-related arrests, or needlestick injuries to police officers."

Source: Friedman, Samuel R. PhD, Theresa Perlis, PhD, and Don C. Des Jarlais, PhD, "Laws Prohibiting Over-the-Counter Syringe Sales to Injection Drug Users: Relations to Population Density, HIV Prevalence, and HIV Incidence," American Journal of Public Health (Washington, DC: American Public Health Association, May 2001), Vol. 91, No. 5, p. 793.

"Anti-OTC laws are not associated with lower population proportions of IDUs. Laws restricting syringe access are statistically associated with HIV transmission and should be repealed."

The Australian government began studying the drug use of offenders in 1998. The 2000 World Drug Report mentions no such figure, and any report in the 1997 World Drug Report would have been based on anecdotes rather than science, according to researchers involved with the Drug Use Monitoring in Australia.

As noted in the Australian Institute of Criminology's publication "Patterns of Drug Use Amongst Police Detainees: 1999-2000" by Toni Makkai et al., Dec. 2000:

"Drug Use Monitoring in Australia (DUMA) is the only project in Australia that is routinely monitoring the use of illicit drugs by people detained by police. Although there are many anecdotal stories about the use of drugs by detainees, this is the first authoritative research to both document and monitor use amongst this important group in the community. The collection began in January 1999 and the results presented here describe the extent of illicit drug use every three months in four sites across Australia. These data are comparable with international collections in a number of countries, including the United States and England. Until now, such cross-cultural comparisons have not been possible." (p. 1)

It is true that in Australia, as in many other countries, drug use among detainees is rather high. The DUMA report shows:

"Detainees are most likely to test positive to cannabis (see Figure 1). This is consistent with the National Drug Strategy Household Survey data which showed that cannabis was the most commonly used illicit drug in the general community in 1998. Across the general population, around 39 per cent self-reported they have tried cannabis and 18 per cent reported using it in the past 12 months. Amongst this sample of detainees, the average number testing positive to cannabis use in the past 30 days was 63 per cent in Southport, 61 per cent in East Perth, 52 per cent in Parramatta and 47 per cent in Bankstown." (p. 3)

Arrestees in the US also show high rates of drug use -- much higher rates than in Australia. According to the US Justice Department in its 1999 Annual Report of the Arrestee Drug Abuse Monitoring program (National Institute of Justice, June 2000), "In 27 of the 34 sites, more than 60 percent of the adult male arrestees tested positive for the presence of at least one of the NIDA-5* drugs, ranging from 50 percent in San Antonio to 77 percent in Atlanta. For female adult arrestees, the median rate for use of any drug was 67 percent in 1999 compared to 64 percent in 1998. In 22 of the 32 sites, more than 60 percent of the adult female arrestees tested positive for at least one drug, ranging from 22 percent in Laredo to 81 percent in New York City. The median rate for use of any drug among male adult arrestees for both 1998 and 1999 was 64 percent." (p. 1)

(*note: " ‘NIDA-5’ refers to the following five drugs: cocaine, marijuana, methamphetamine, opiates, and PCP.")

Australia does tend to have higher rates of *reported* drug use, because Australians have a high level of trust in their government and a long tradition of social research. According to the UN's World Drug Report 2000, published in early 2001, "Such high figures do point to high levels of consumption; but they may also have to do with the specific social and legal context in which studies take place. This results in the case of Australia (and some other countries with a long tradition of social research) in more readiness to admit to drug use, and thus far less under-reporting than in countries where drug users fear that such information could be used against them." (p. 74)

Australia performs an annual survey of drug use. The most recent, "Statistics on drug use in Australia 2000," published in May 2001, reports that:

"Nearly half of all Australians aged 14 years and over have used illicit substances at least once in their life, while 23% report having used an illicit drug in the preceding 12 months (Table 4.1). The most widely used illicit substance in Australia in 1998 was marijuana, with lifetime use of 39% and recent use of 18%. The prevalence of lifetime use of pain-killers/analgesics (for non-medical purposes) was 12%, followed by hallucinogens (10%) and amphetamines (9%). Only 2% of the Australian population had ever used heroin, with 1% reporting recent usage. The prevalence of cocaine use was slightly higher, with lifetime use in 4% of the respondents and recent use in 1%.

The mean age of initiation for marijuana was 18.8 years, which was only slightly higher than the age of initiation for inhalants (17.5 years) and hallucinogens (18.4 years). The highest age of initiation was for tranquillisers/sleeping pills for non-medical purposes at 23.3 years, followed by ecstasy/designer drugs at 22.5 years and cocaine at 22.2 years." (p. 17)

Comparison: US drug use in general is very high. According to the US Centers for Disease Control, among high school students in the US (grades 9-12), 47.2% have tried marijuana, and 26.7% are current users. A total of 50% are current alcohol users, with 31.5% engaging in "episodic heavy drinking." (source: Youth Risk Behavior Survey, reported in Morbidity and Mortality Weekly Report, June 9, 2000, Vol. 49, No. SS-5, p. 60, Table 20). Another federal measure of drug use, the National Household Survey, reports that in 2000, among persons 18-25, 51.2% admit to having used an illicit drug in their lifetime, with 27.9% admitting to being a current user.

A UN report issued in mid-2001, "Global Illicit Drug Trends 2001," reports on the number of users of illicit drugs in the prison populations of several nations. According to this report, in Australia in 1998, 50% of prisoners were illicit drug users (though there is no indication of whether the drug use was a contributing factor or merely incidental). The report indicates that in the US in 1994, 70% of the prison population were illicit drug users.

The number of US prisoners who were using either alcohol or other drugs at the time of their arrest may be even higher now, according to the US Dept. of Justice's "Substance Abuse and Treatment, State and Federal Prisoners, 1997" (Bureau of Justice Statistics, Jan. 1999):

"In the 1997 Survey of Inmates in State and Federal Correctional Facilities, over 570,000 of the Nation’s prisoners (51%) reported the use of alcohol or drugs while committing their offense. While only a fifth of State prisoners were drug offenders, 83% reported past drug use and 57% were using drugs in the month before their offense, compared to 79% and 50%, respectively, in 1991. Also, 37% of State prisoners were drinking at the time of their offense, up from 32% in 1991.

Among Federal prisoners the reports of substance abuse increased more sharply. Although the proportion of Federal prisoners held for drug offenses rose from 58% in 1991 to 63% in 1997, the percentage of all Federal inmates who reported using drugs in the month before the offense rose more dramatically from 32% to 45%. A fifth of Federal prisoners reported drinking at the time of their offense in 1997, up from a tenth in 1991." (p. 1)

Methadone programs have been found to be effective measures both in reducing the harms from opiate use and in helping people stop using opiates.

The American Journal of Public Health reported in May 2001 (Langendam, Miranda W., PhD, et al., "The Impact of Harm-Reduction-Based Methadone Treatment on Mortality Among Heroin Users," American Journal of Public Health, May 2001, Vol. 91, No. 5) that:

"Our results support the hypothesis that harm-reduction-based methadone maintenance treatment decreases the risk of natural-cause and overdose mortality. Furthermore, our data suggest that in harm-reduction-based methadone programs, being in methadone treatment is important in itself, independent of the pharmacologic effect of methadone dosage. To decrease mortality among drug users, prevention measures should be expanded for those who dropout of treatment." (p. 779)

The Journal of the American Medical Association reported the NIH Consensus Statement on opiate addiction treatment in December 1998 ("Effective Opiate Addiction Treatment - NIH Consensus Conference," Journal of the American Medical Association, Vol. 280, No. 22, Dec. 9, 1998, pp. 1936-1943), which calls for expansion of methadone services. According to it:

"Conclusions.-Opiate dependence is a brain-related medical disorder that can be effectively treated with significant benefits for the patient and society, and society must make a commitment to offer effective treatment for opiate dependence to all who need it. All persons dependent on opiates should have access to methadone hydrochloride maintenance therapy under legal supervision, and the US Office of National Drug Control Policy and the US Department of Justice should take the necessary steps to implement this recommendation. There is a need for improved training for physicians and other health care professionals. Training to determine diagnosis and treatment of opiate dependence should also be improved in medical schools. The unnecessary regulations of methadone maintenance therapy and other long-acting opiate agonist treatment programs should be reduced, and coverage for these programs should be a required benefit in public and private insurance programs." (p. 1936)

It is true that in 1996 The South China Morning Post reported on discussion of a report on Hong Kong’s methadone program by the Research and Library Services Division of the Hong Kong Legislative Council. The report by the Research and Library Services Division of the Hong Kong Legislative Council, "Methadone Treatment Programmes in Hong Kong and Selected Countries," is available online at

http://www.legco.gov.hk/yr97-98/english/sec/library/956rp12.pdf

The report was prepared during the run-up to Chinese take-over of the Hong Kong colony, and the methadone maintenance program was a holdover from British rule and as such was not regarded highly by the incoming Chinese government. Methadone programs around the world have been found to be effective measures both for reducing the harm from opiate use as well as for helping people stop using opiates. According to the report in question:

"52. In the past five years, the number of registered methadone patients as at the end of each year maintained at about 9,000-11,000. Almost all of them received maintenance instead of detoxification treatment." (p. 9)

The programs themselves have a high dropout rate, and a low attendance rate:

"53. Patients who fail to attend the programme for twenty-eight consecutive days are considered as drop out. If they choose to join the programme again, they have to undergo the readmission process. In each of the past five years, about 9,000 drug addicts dropped out and over 80% of the registered patients were readmitted drug addicts, indicating large mobility of patients. (Appendix 5)

54. Each registered patient is allowed to receive methadone treatment once per day. The average daily attendance had decreased from 8,035 in 1991 to 6,401 in 1994. However, such figure bounced back to 7,002 in 1995, representing 71% of the average effective registered patients in that year. (Appendix 5)" (p. 9)

The programs are cost-effective in a sense, but since they are intended for maintenance, the report notes, they have a low graduation rate:

"60. Since there is no information on the duration of a methadone patient staying in the programme, it is difficult to estimate the total cost spent on each methadone patient in order to keep them away from drugs. As the average attendance is about 70%, the cost to maintain each patient in the programme is estimated to be HK$4,000 per year. As methadone programme in Hong Kong is chiefly for maintenance purpose, the number of patients successfully detoxified since the introduction of the programme was only 227." (p. 10)

Overall, the report was quite critical of HK's methadone maintenance program:

"72. According to the information provided by the Narcotics Division, only 227 methadone patients had been successfully detoxified since the implementation of the programme. A one-day survey conducted in July 1995 by the Department of Health also indicates that almost 50% of methadone patients had stayed in the programme for more than fifteen years. While it is noted that the present programme is basically for maintenance instead of detoxification purpose, the large number of drop-out cases and readmissions suggests that the patients are not maintained in the programme in a stable manner." (p. 13)

"74. The present methadone treatment programme cannot help drug addicts to achieve a drug-free state. It is also not known to what extent opiate dependence is reduced through participation in this programme. To evaluate the effectiveness of the programme in this respect, results of the urine tests taken on methadone patients by the Department of Health would be extremely useful. It is regrettable that such data are not published nor provided to the researcher." (p. 14)

On the other hand, the report notes there are pragmatic reasons why HK's methadone program can be seen as useful and effective:

"75. It can be noted from the analysis in paragraphs 64-74 that methadone treatment programme is not particularly helpful to drug addicts themselves in improving their employment status, reducing the use of needles and abstaining from drugs. However, as there is a strong correlation between the price of heroin and programme attendance, there appears to be a need for the availability of an easily accessible means of substitute in case of an upsurge in heroin price.

76. As the unemployment rate among drug abusers is high, and over $200 on drugs per day is spent by each drug addict, some addicts may be driven to committing crime if methadone is not available. There will be a marked deterioration in the crime situation even if a small proportion of methadone patients engage in crime, as indicated by the comparison of the number of quick-cash crime and registered methadone patients below." (p. 14)

The report also notes that other countries have had better results with their methadone programs. For example, the US:

"79. Research conducted on the US programmes indicates that the effectiveness of methadone treatment varies greatly with the dose prescribed and the competence of the counselling services. It is found that the longer the patients remain in treatment, the lower the use of heroin, HIV seroprevalence and criminal behaviour. There is also marked improvement in the general health and nutritional status of the patients. Since criminality and risk of HIV/AIDS exposure has reduced, methadone treatment effectively reduces economic and social burdens." (p. 15)

and Australia:

"80. In Australia, it is estimated that 30,000-50,000 individuals regularly and 60,000 individuals occasionally abuse heroin. The number of methadone patients was about 1,000 in the early 1980s, but had increased to over 7,000 in 1990. The increase is due to the fact that methadone is now perceived as an effective intervention to prevent the spread of HIV infection among drug abusers. As a result, there has been a remarkable increase in methadone maintenance services and additional funding has been allocated to improve staff training for methadone programmes. Although methadone is the main drug approved for the management of heroin dependence, on occasions, other drugs such as codeine, dextramoramide, buprenorphine or oxycodone may also be prescribed." (p. 15)

More Current Information on Methadone:

Again, this report and the negative press occurred in 1996. Contrast this attitude with a recent report in the South China Morning Post on November 17, 2001: "Landmark experiment a sign authorities are willing to tackle growing mainland epidemic," abstract from scmp.com: "China is to launch its first project using methadone to help drug-users beat their addictions, state media reported yesterday, in a further sign the mainland is taking its Aids crisis more seriously."

A report in the South China Morning Post from July 24, 2000, indicates that buprenorphine may replace methadone as a preferred treatment (on the web at http://www.mapinc.org/drugnews/v00/n1042/a04.html, "Study Finds Near Perfect Drug Addiction Remedy"). Note particularly that the success rate for methadone treatment in Hong Kong is given here as 70%, though with a caveat.

"A medicine used as a painkiller has a near total success rate in helping heroin addicts quit and could become a replacement for methadone, researchers have reported.

Dr Dominic Lee Tak-shing, an associate professor at the Chinese University's department of psychiatry, co-ordinated the study, which found that buprenorphine worked on 109 out of 110 addicts. The trial involved patients at the new Caritas Wong Yiu Nam Drug Abusers' Rehabilitation Centre, which opened in April.

The success rate of methadone treatment in Hong Kong is about 70 per cent, but the figures do not take into account those who relapse over a period of time after treatment.

Dr Lee said the subjects were free of addiction after three days of treatment, which costs $100 per patient, and showed milder degrees of withdrawal symptoms such as vomiting, pain in the bones and tiredness. The methadone treatment takes three weeks."

Another article in the South China Morning Post, from June 20, 2000, "Amnesty for Addicts to Register," available at:

http://www.mapinc.org/drugnews/v00/n842/a10.html

notes that China now admits that it has a huge and growing drug use problem:

"China’s chief anti-drug official reported in March that China had 681,000 drug addicts last year, a 14 per cent increase over the previous year."

Distortion 6: In Wisconsin, marijuana overdose visits in emergency rooms equal to heroin or morphine, twice as common as Valium. (cited: Wisconsin Department of Justice)

First an explanation of terminology: the federal entity which collects data on drug mentions in emergency department and medical examiner reports, the Drug Abuse Warning Network or DAWN, explains the difference between emergency room visits and emergency room drug mentions thus:

"Drug Episodes vs. Drug Mentions

"Drug-Related Episode: A drug or ED episode is an ED visit that was induced by or related to the use of an illegal drug(s) or the nonmedical use of a legal drug for patients age 6 years and older.

"Drug Mention: A drug mention refers to a substance that was mentioned during a drug-related ED episode. Because up to 4 drugs can be reported for each drug abuse episode, there are more mentions than episodes cited in this report." (p. 1)

Source: "Year-End 2000 Emergency Department Data from the Drug Abuse Warning Network," Office of Applied Studies, Substance Abuse and Mental Health Services Administration, US Dept. of Health and Human Services, July 2001.

Important Note: Mention of a drug in an emergency department visits does not mean that the drug was the *cause* of the visit. The DAWN report for 2000 says, regarding mentions of marijuana/hashish:

"Marijuana/hashish mentions related to all motives were stable from 1999 to 2000 (Table 26). ED contacts due to chronic effects increased 25 percent (from 6,891 to 8,621), and contacts due to patients seeking detoxification increased 18 percent (from 11,908 to 14,110). However, 2 important caveats must be kept in mind. First, the drug use motive and reason for ED contact were frequently unknown or reported as ‘other’ (24% and 23% of mentions, respectively). Second, drug use motive and reason for ED contact pertain to the episode, not a particular drug. Since marijuana/hashish is frequently reported in combination with other drugs, the reason for the ED contact may be more relevant to the other drug(s) involved in the episode." (p. 21)

Nationally, the number of marijuana/hashish mentions is nearly equal to that of heroin/morphine. The DAWN year-end 2000 report indicates that:

"In 2000, there were 601,776 drug-related ED episodes in the coterminous U.S. with 1,100,539 drug mentions (on average, 1.8 drugs per episode). There was no statistically significant change between 1999 and 2000 in the number of ED episodes (from 554,932 to 601,776) or ED drug mentions (from 1,015,206 to 1,100,539) (Table 2 and Figure 1).

"In 2000, drug abuse-related ED visits occurred at the rate of 243 ED episodes per 100,000 population in the coterminous U.S. (Table 30).

"Cocaine continued to be the most frequently mentioned illicit drug, comprising 29 percent of episodes (174,896 mentions) in 2000. Cocaine was followed in frequency by heroin/morphine (16%, 97,287 mentions), marijuana/hashish (16%, 96,446 mentions), amphetamine (3%, 16,189 mentions), and methamphetamine/speed (2%, 13,513 mentions) (Table 2 and Figure 2).

"During 2000, the highest rates of ED drug mentions occurred for: alcohol-in-combination (83 mentions per 100,000 population), cocaine (71), heroin/morphine (39), and marijuana/hashish (39) (Table 30).

"Alcohol-in-combination was mentioned in 34 percent (204,524) of ED drug episodes in 2000 and remains the most common substance reported by DAWN EDs (Table 2). Note that alcohol is only reported to DAWN when present in combination with another reportable drug.

"Mentions of the narcotic analgesics oxycodone and hydrocodone are relatively infrequent (mentioned in 2% and 3% of episodes, respectively), but revealed significant increases. From 1999 to 2000, mentions of drugs containing oxycodone increased 68 percent (from 6,429 to 10,825), and mentions of drugs containing hydrocodone increased 31 percent (from 14,639 to 19,221). Mentions of oxycodone were 108 percent higher in 2000 than in 1998, and mentions of hydrocodone were 53 percent higher than in 1998." (p. 11)

Additionally:

"Mentions of the antidepressants trazodone (9,798, 2% of episodes), amitriptyline (6,446, 1%), fluoxetine (7,938, 1%), doxepin (1,552, 0.3%), and imipramine (564, 0.1% of episodes) showed no statistically significant changes between 1999 and 2000 (Table 2).

"Mentions of the benzodiazepines alprazolam (22,105, 4% of episodes), clonazepam (18,005, 3%), diazepam (12,090, 2%), lorazepam (10,671, 2%), and triazolam (362, 0.1%) remained stable from 1999 to 2000 (Table 2). Since 1993, mentions of clonazepam have increased 77 percent, and mentions of triazolam have decreased 71 percent." (p. 26)

According to DAWN, nationally in 2000 there were a total of 264,240 emergency room department drug episodes arising from overdose (table 18, p. 77), in which there were 518,654 drug mentions (table 20, p. 79). There were 18,734 marijuana/hashish 'mentions' in emergency room visits attributed to overdose in 2000 (table 26, p. 85), cocaine accounted for 27,794 such mentions (table 22, p. 81), and heroin another 16,999 (table 24, p. 83).

Distortion 7: Marijuana is a gateway drug that leads to heroin and cocaine addiction.

According to the federal government it takes 76.3 million people have tried marijuana, while only 2.78 million have ever tried heroin in their lifetimes and only 5.3 million have ever tried cocaine in their lives. The figures for monthly use are similar: 10.7 million Americans admit to being regular marijuana users, yet only 1.2 million admit to using cocaine each month, and 130,000 use heroin.

Source: Substance Abuse and Mental Health Services Administration, US Dept. of Health and Human Services, National Household Survey on Drug Use 2000 (Washington, DC: SAMHSA, 2001).

The Institute of Medicine in 1999 also dismissed the ‘gateway’ theory:

"There is no conclusive evidence that the drug effects of marijuana are causally linked to the subsequent abuse of other illicit drugs."

Source: Joy, Janet E., Stanley J. Watson Jr., and John A. Benson Jr., Division of Neuroscience and Behavioral Research, Institute of Medicine, "Marijuana and Medicine: Assessing the Science Base (Washington, DC: National Academy Press, 1999).

The IOM report went further:

"Patterns in progression of drug use from adolescence to adulthood are strikingly regular. Because it is the most widely used illicit drug, marijuana is predictably the first illicit drug most people encounter. Not surprisingly, most users of other illicit drugs have used marijuana first. In fact, most drug users begin with alcohol and nicotine before marijuana – usually before they are of legal age."

Source: IOM, "Marijuana and Medicine: Assessing the Science Base," 1999.

Distortion 8: Ecstasy is a widespread danger that is killing American youth.

The Drug Abuse Warning Network estimates that ecstasy was involved in -- though not necessarily the cause of -- nine deaths in 1998.

Source: "Club Drugs," The DAWN Report, Drug Abuse Warning Network, Office of Applied Studies, Substance Abuse and Mental health Services Administration (Washington, DC: SAMHSA, December 2000), p. 4.

Source: Laboratory Pill Analysis Program, DanceSafe. For results visit www.DanceSafe.org. See also, Byard RW et al., "Amphetamine derivative fatalities in South Australia-is ‘Ecstasy’ the culprit?," American Journal of Forensic Medical Pathology, 1998 (Sep) 19(3): 261-5.

Distortion 9: Cannabis is no better that codeine at controlling pain and because of its undesirable side effects "It has no place in mainstream medicine". (cited: British Medical Journal)

In 2001, the British Medical Journal published two reviews of existing scientific studies on cannabinoids, one on pain management, the other on nausea control. These reviews did not include data on herbal cannabis, also called marijuana; instead, the studies reviewed examined only oral THC and two synthetic cannabinoids.

The reviews found that "Cannabinoids are no more effective than codeine in controlling pain and have depressant effects on the central nervous system that limit their use," and "In selected patients, the cannabinoids tested in these trials may be useful as mood enhancing adjuvants for controlling chemotherapy related sickness. Potentially serious adverse effects, even when taken short term orally or intramuscularly, are likely to limit their widespread use."

Sources: Campbell, Fiona A., Martin R. Tramer, et al., "Are cannabinoids an effective and safe treatment option in the management of pain? A qualitative systematic review," British Medical Journal 2001; 323:13, July 7, 2001; Tramer, Martin R., Dawn Carroll, et al., "Cannabinoids for control of chemotherapy induced nausea and vomiting: quantitative systematic review," British Medical Journal 2001;323:16, July 7, 2001.)

Other medical experts support cannabis's therapeutic potential. According to the Canadian Medical Association Journal:

"Health Canada’s decision to legitimize the medicinal use of marijuana is a step in the right direction. But a bolder stride is needed. The possession of small quantities for personal use should be decriminalized. The minimal negative health effects of moderate use would be attested to by the estimated 1.5 million Canadians who smoke marijuana for recreational purposes. The real harm is the legal and social fallout. About half of all drug arrests in Canada are for simple possession of small amounts of marijuana: about 31,299 convictions in 1995 alone."

Source: "Marijuana: federal smoke clears, a little," Canadian Medical Association Journal, May 15, 2001, Vol. 164, No. 10, p. 1397.

In an editorial in the New England Journal of Medicine in 1997, Dr. Jerome Kassirer wrote:

"Federal authorities should rescind their prohibition of the medicinal use of marijuana for seriously ill patients and allow physicians to decide which patients to treat. The government should change marijuana's status from that of a Schedule 1 drug (considered to be potentially addictive and with no current medical use) to that of a Schedule 2 drug (potentially addictive but with some accepted medical use) and regulate it accordingly. To ensure its proper distribution and use, the government could declare itself the only agency sanctioned to provide the marijuana. I believe that such a change in policy would have no adverse effects. The argument that it would be a signal to the young that 'marijuana is OK' is, I believe, specious."

Source: Kassirer, Jerome P., MD, "Federal Foolishness and Marijuana," New England Journal of Medicine, Vol. 336, No. 5, Jan. 30, 1997, from the web at

http://www.mapinc.org/drugnews/v97/n000/a014.html

In the US government's Institute of Medicine report on medical marijuana in 1999, the authors conclude:

"The accumulated data indicate a potential therapeutic value for cannabinoid drugs, particularly for symptoms such as pain relief, control of nausea and vomiting, and appetite stimulation."

Source: Joy, Janet E., Stanley J. Watson Jr., and John A. Benson Jr., "Marijuana and Medicine: Assessing the Science Base," Division of Neuroscience and Behavioral Research, Institute of Medicine, National Academy of Sciences (Washington, DC: National Academy Press, 1999).

Distortion 10: Current drug policy protects American youth.

Untrue. Current drug policy harms America's young people in many ways.

a) Drug policy fails to keep drugs away from children. More than half of high school students in the US graduate having tried an illegal drug. It is common for high schools in the USA and many middle schools to have multiple drug dealers operating in the school, and nearly 90% of young people say it is easy or fairly easy to buy illegal drugs.
[Source: Office of National Drug Control Policy, National Drug Control Strategy: Budget Summary (Washington DC: US Government Printing Office, 1992), pp. 212-214; Office of National Drug Control Policy, National Drug Control Strategy: 2000 Annual Report (Washington DC: US Government Printing Office, 2000), p. 97, figure 4-2; Johnston, L., Bachman, J. & O'Malley, P., Monitoring the Future: National Survey Results on Drug use, 1975-2000, Volume 1: Secondary School Students (Bethesda, MD: NIDA, 2001), p. 341, Table 9-6.]

b) American youth are not provided with adequate information to prevent drug abuse. The most common drug education program - DARE - has been shown to be ineffective and counterproductive, encouraging drug use among certain populations, yet it continues to receive large amounts of federal funding.
[Source: Lynam, Donald R., Milich, Richard, et al., "Project DARE: No Effects at 10-Year Follow-Up", Journal of Consulting and Clinical Psychology (Washington, DC: American Psychological Association, August 1999), Vol. 67, No. 4, 590-593 ("Our results are consistent in documenting the absence of beneficial effects associated with the DARE program. This was true whether the outcome consisted of actual drug use or merely attitudes toward drug use.... Thus, consistent with the earlier Clayton et al. (1996) study, there appear to be no reliable short-term, long-term, early adolescent, or young adult positive outcomes associated with receiving the DARE intervention."); see also Ennett, S.T., et al., "How Effective Is Drug Abuse Resistance Education? A Meta-Analysis of Project DARE Outcome Evaluations," American Journal of Public Health, 84: 1394-1401 (1994); and Rosenbaum, Dennis, Assessing the Effects of School-based Drug Education: A Six Year Multilevel Analysis of Project DARE, Abstract (April 6, 1998).]

c) Young people are not provided information on how to prevent or treat an overdose from illegal drugs. As a result hundreds of young people die each year from causes that could have been prevented. The drug war, because of its punitive approach, has resulted in young people being afraid to seek emergency medical services when they are needed.
[source: Sporer, Karl A., MD, "Acute Heroin Overdose," Annals of Internal Medicine (Washington, DC: American College of Physicians/American Society of Internal Medicine, April 6, 1999), Vol. 130, No. 7, p. 585; Zador, Deborah, Sandra Sunjic and Shane Dark, "Heroin-related deaths in New South Wales, 1992; toxicological findings and circumstances," Medical Journal of Australia, 1997, from the web at http://www.mja.com.au; Darke, Shane and Deborah Zador, "Fatal heroin 'overdose': A review," Addiction, 1996, Vol. 91, No. 12, pp. 1765-1772.]
The CDC reported a total of 15,852 "drug-induced" deaths in 2000. According to the Drug Abuse Warning Network's report, "Annual Medical Examiner Data 1999," 61.6% of drug abuse deaths were from overdose. The DAWN report, which details 11,651 drug abuse deaths in 1999, found that 53 young people aged 6-17 died of an overdose; additionally, 587 young people aged 18-25 died of overdose that year.
[Source: Minino, A.M., Smith, B.L., Centers for Disease Control, "Deaths: Preliminary Data for 2000," National Vital Statistics Reports, Vol. 49, No. 12 (Hyattsville, MD: National Center for Health Statistics, Oct. 9, 2001), p. 17, table 2, from the web at http://www.cdc.gov/nchs/data/nvs49_12.pdf; Office of Applied Studies, Substance Abuse and Mental Health Services Administration, US Dept. of Health and Human Services, "Drug Abuse Warning Network Annual Medical Examiner Data 1999" (Rockville, MD: SAMHSA, December 2000), p. 35, Table 2.02, and p. 37, Table 2.04.]

d) The drug war divides families. Nearly two million young people in the US have one or both parents incarcerated, many for non-violent drug offenses. This results in many young people being put into the foster care system and increases the likelihood of delinquency. Incarceration also results in children being unable to visit parents as more than half of parents incarcerated are over 100 miles away from their last residence.
[source: Greenfield, Lawrence A., and Snell, Tracy L., US Department of Justice, Bureau of Justice Statistics, Women Offenders (Washington, DC: US Department of Justice, December 1999), p. 8, Table 18. Mumola, Christopher J., US Department of Justice Bureau of Justice Statistics, Incarcerated Parents and Their Children (Washington, DC: US Department of Justice, August 2000), p. 2. Mumola, Christopher J., US Department of Justice Bureau of Justice Statistics, Incarcerated Parents and Their Children (Washington, DC: US Department of Justice, August 2000), p. 5

e) Many young Americans have their lives ruined by drug enforcement. The number of offenders under age 18 admitted to prison for drug offenses increased twelvefold between 1985 to 1997. Under federal law, young people convicted of a drug offense lose their right to federal college loans - 43,000 students were affected by this provision in 2001 -increasing the likelihood that they will be undereducated and unable to compete for good jobs.
[Source: Strom, Kevin J., US Department of Justice, Bureau of Justice Statistics, Profile of State Prisoners Under Age 18, 1985-1997 (Washington, DC: US Department of Justice, February 2000), p. 4; Associated Press, Drug Convictions Still Bar Federal Student Loans, Dec. 29, 2001.]

f) Many young people get involved in drug selling because there are no other job opportunities available, not to finance their own drug use. US Dept. of Justice research shows that MANY would gladly give up drugs for a legitimate job, even at relatively low wages, if one were available.
[Source: Huff, C. Ronald, National Institute of Justice, Research In Brief, "Comparing the Criminal Behavior of Youth Gangs and At-Risk Youths" (Washington, DC: US Dept. of Justice, Oct. 1998), p. 2 ("Neither gang nor nongang drug sellers reported using the profits to buy drugs, except in Broward County, where gang members spent 20 percent of their earnings and nongang interviewees spent 5 percent of their profits to buy drugs. Both gang members and at-risk youth reported that it would require average wages of $15 to $17 an hour to get them to stop selling drugs. While this figure reflected the median, it should be noted that about 25 percent of those sampled would accept wages of about $6 to $7 per hour -- not much more than many fast-food restaurants pay today. They are tired of living with the fear that accompanies drug sales. However, as these young people often pointed out, it is difficult for them to find full-time work with one employer. It is also true, of course, that once one has a criminal record, it is more difficult to obtain regular employment.")
Research funded by the Wisconsin Policy Research Institute shows that drug dealing plays a substantial role in the local economies of poorer urban neighborhoods because of the lack of other job opportunities.
[Source: Hagedorn, John M., PhD, "The Business of Drug Dealing in Milwaukee" (Milwaukee, WI: Wisconsin Policy Research Institute, 1998), p. 3 ("At least 10% of all male Latinos and African-Americans aged 18-29 living in these two [surveyed] neighborhoods are supported to some extent by the drug economy.")]

Distortion 11: "Parents are often unaware that today's marijuana is different from that of a generation ago, with potency levels 10 to 20 times stronger than the marijuana with which they were familiar." US Drug Czar John Walters, "The Myth of 'Harmless' Marijuana," Washington Post, May 1, 2002, p. A25.

Untrue. Federal research shows that the average potency of cannabis in the US has increased very little. Even the Drug Enforcement Administration concedes ( "Drug Intelligence Brief: The Cannabis Situation in the United States, December 1999") that "According to University of Mississippi analyses, the THC content of commercial-grade marijuana has risen slowly over the years from an average of 3.71 percent in 1985 to an average of 5.57 percent in 1998. These analyses also show a corresponding rise in sinsemilla THC content from 7.28 percent in 1985 to 12.32 percent in 1998." More recently, the US National Drug Intelligence Center's "National Drug Threat Assessment 2002 " report, released December 2001, stated that "Overall, potency, as characterized by THC content, is still increasing. According to data from the Potency Monitoring Project, the THC content of commercial-grade marijuana increased from 1997 to 2000 for commercial-grade (4.25% to 4.92%) and for sinsemilla (11.62% to 13.20%)."

As noted by the DEA in its "Drug Intelligence Brief: The Cannabis Situation in the United States, December 1999"), "The Cannabis Potency Monitoring Project, sponsored by the National Institute on Drug Abuse (NIDA) and conducted by the Research Institute of Pharmaceutical Sciences at the University of Mississippi, is the indicator program that tracks changes in the delta-9-tetrahydrocannabinol (THC) content (the potency) of cannabis (marijuana, hashish, and hashish oil) seized in the United States. THC, one of the 61 cannabinoids among more than 400 compounds found in the cannabis plant, is the principal psychoactive component in the plant. Potency is expressed as the percentage of THC per dry weight of plant material." The following table is from the DEA site, last accessed May 5, 2002: