Wednesday, April 22, 2009

Why do drug epidemics happen?

Drugs are widely available. Why do drug epidemics happen?

Michael Agar developed trend theory to answer this question. His excellent book, Dope Double Agent: The Naked Emperor on Drugs, published by Lulu Books in 2006, uses trend theory to explain the 1960s heroin epidemic, the 1980s crack epidemic and the 1990s Ecstasy epidemic.

(The book has much, much more than these three case histories. It is an enormously important, elegantly written book. It is part memoir, part expose, part cri de coeur. Dope Double Agent is a window into the official world of drug abuse policy and research. It is equally a window into drug treatment centers and to bars and shooting galleries of New York City junkies.)

An essential point of trend theory is that the idea that drug use is simply driven by demand is false. Thinking about drugs in primarily along a public health or disease model is wrong. Use does not simply spread from user to user like an infection. Drug epidemics -- periods of rapid growth in use are part of periods of rapid changes -- among user and in the two components of supply -- sources of production and in the retail networks. In thinking about drug epidemics, it is more instructive to think about drugs as products in a market.

I think his analysis makes sense. And applying his analysis to the current situation leaves me frightened. I shared my thoughts with Courtland Milloy, The Washington Post's most perceptive columnist, when it comes to substance abuse issues, and he wrote about it today.

We face the potential for an enormous drug epidemic. The global recession is going to transform economies and governments around the world. In scores of countries, the production of drugs will become attractive as traditional economic markets are blown away by changing demand. Crafts produced for tourists are worth nothing when there are no tourists. Crafts produced for gift shops in the developed world are worthless when those shops have gone out of business. Shippers and exporters unable to make a living with legal goods will apply their expertise to other products that can generate income, such as drugs. Farmers who face falling demand for their produce will consider switching to cannabis, opium or coca. Government officials, dependent upon bribes from legitimate businesses, will lose income as legitimate business shrinks. They, too, will be receptive to the income that the illegal drug trade can provide. We can reasonably anticipate a revolution in the production and global shipment of drugs.

In the United States, the recession is a growing devastation. We all see the headlines and the data. Luckily, in prior recessions, I was insulated. Even in 1976, when I knew young lawyers who were unable to get a job, I never knew anyone who lost a job. In other economic contractions, again, I do not remember that I knew anyone who was laid off. But in this recession, two close friends have been laid off, and a parent of one of my daughter's classmates lost his. This recession is hitting really hard. I don't yet know anyone who has lost their house. But the largest portion of the Washington Post's classified section are ads for home foreclosure sales.

When you are unemployed and when you are at risk of losing the home that your family lives in, your desperation is irresistible. To your conscience, the crime of illegal drug selling is easily justified. And to your wallet, the profit potential is unmistakable. The number of people who will supplement their unemployment compensation by selling drugs so that they do not become homeless is growing by leaps and bounds. To the opportunistic criminal, the challenge to organize eager potential drug sellers in a dramatic expansion of illegal drug sales awaits, if it is not already being met. The tools of texting, cell phones, and Facebook, give the creative dealers enormous opportunities to distribute drugs less ostentatiously than standing on street corners. The facts of our economic contraction are going to create a powerful incentive for persons to sell drugs to keep a roof over their head and food on the table.

The questionable morality of the bailout of the financial system that led us into this crisis erodes at resistance to breaking the drug laws. Selling drugs is just another form of capitalism. The seller is not a pusher; the buyers are eager to find the connection. A dealer can easily avoid selling to youth or obviously pregnant women.

Which is "more evil?" Selling drugs to a peer eager to get high or desperate to get right because they are dopesick in withdrawal. Or evicting a family from their home because the laid-off parents can no longer pay every dime of the mortgage. The ugly consequences of our economic collapse diminish the "ugliness" of selling drugs.

And finally, there is a growing population of despair. The hope of 2008 and the excitement that culminated on January 20 is going to fade. Our embrace of "hope" and "change" and "Yes, We Can!" was a mania. Naomi Klein, writing in The Nation, is already struggling to find the vocabulary that describes the scale of the loss of hope.

For many African-Americans, a White House inhabited by Michelle, Sasha, Malia and Barack Obama is the fulfillment of a dream of a transformed world. Essential to that dream is that each of us, individually, is a tangible beneficiary of that transformation. The reality for most people in America, and for most African-Americans, however, is that in the coming months and years things are going to get worse. Jobs will continue to be lost. Family members will become homeless. Disease will be inadequately treated, if treated at all.

Aside from the private catastrophes, the public sector is going to shrink too. Every state and city and county is cutting back.

In the foreseeable future, almost none of the poor are going to see something tangibly positive from the election of Barack Obama. Disaster is going to trickle down. Tangibly, their recreation centers and libraries will close, their classrooms will get more crowded, their streets will be dirtier, their waits at the hospital longer. Redevelopment will stop. Houses won't get painted. Abandoned homes and buildings will get broken into, and then burned, and then sit. Weeds will grow and lawns will be unmowed. Broken streetlights won't get replaced.

For thousands, indeed millions, whose hopes were on wings in 2007 and 2008 -- some money in the bank, a job, and an African-American family in the White House, -- emotional desolation is in store. For millions of Americans, their distress will be profound, and drugs will be used widely to bring their relief.

In recent months, the violence in Mexico has been a continuing page one story. Mexico has been visited by Secretary of State Hillary Clinton, Homeland Security Secretary Janet Napolitano, Attorney General Eric Holder, and President Barack Obama. The committees Congress have held a dozen hearings about the violence in Mexico and its implications. Former "drug Czar," Gen. Barry McCaffrey, has been peddling a paper warning that Mexico is in danger of becoming a "failed state."

What will happen in Mexico? The violence is going to have political consequences. Quite likely, in the next presidential election, in 2012, the exhaustion with the violence will lead to a rejection of President Calderon's PAN party, and the return to power of the PRI, the party that held power for 70 years. PRI is the party of institutional corruption, and likely to accommodate the drug trafficking gangs. The drug trafficking organizations are likely to form a genuine cartel -- an alliance of erstwhile competitors to fix prices and limit competition.

(The labeling of drug trafficking organizations as cartels was a journalistic/political creation for its alliterative power when paired with cocaine --hence the "Colombian cocaine cartels" of the 1980s. I vividly remember economist Peter Reuter speaking to the Senate International Drug Control Caucus in the early 1980s, and Senator Alphonse "Pothole" D'Amato (R-NY) scratching his head in befuddlement when Peter explained that the cocaine "cartels" were weak -- because they were ineffective in accomplishing the prime goal of a cartel which is keeping prices high and excluding competition.)

Creating a real drug cartel fulfills Mexico's opportunity to become a more peaceful staging ground to supply cocaine, heroin, methamphetamine and marijuana to the United States, which will help rebuild the Mexican economy that is reeling from recession too.

Analyzing the three elements of Agar's trend theory all point toward the danger of a drug epidemic in the next few years.

Are we ready? Don't make me laugh.
In 2001, a Committee on Data and Research for Policy on Illegal Drugs of the National Research Council issued a report, Informing America's Policy on Illegal Drugs: What We Don't Know Keeps Hurting Us.

"A wide spectrum of plausible approaches to the prevention of substance use exist in both theory and practice. The effectiveness of most of these approaches for reducing substance use is unknown because the research evidence is nonexistent or inconclusive. Some of the approaches for which we have no evidence of effectiveness include many popular control strategies, such as zero-tolerance policies, the use of security measures such as locker searches, and the presence of police in schools, as well as more innovative approaches that draw on advances in toxicology, molecular biology, genetics, and clinical medicine (e.g., parents' attempts to protect their children via increased use of home test kits to detect drug use, or active immunization of high-risk children with vaccine analogues)."

I often feel our prevention establishment resembles amber, encoded with the dinosaur DNA of prohibition exaggeration. I need to work more on this challenge.

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