Freedom vs. Security

[Didymos Thomas]

Come on -- terrorize? The worst 99.999% of us will ever know of the Patriot Act and similar measures is inconvenience at the airport security points. That's not to defend the Patriot Act, which I feel is unconstitutional and an egregious potential abuse of power. But seriously, do you wake up every day feeling terrorized?

Would you take me seriously if I reply 'yes'?

I, personally, do not feel terrorized by the Patriot Act alone - it's one part of the puzzle, and a small part on my account. But none the less, the legislation, as you say, is unconstitutional and gives the government a mean stick to beat you with if it so choses.

I look at the airport secuirty mess as the government terrorizing the people - it's fear mongering. They are intentionally trying to scare us. If we're not affraid of the terrorists, we probably wont like spending billions of dollars every week fighting the terrorists.

Drugs are a major public health crisis in the United States and no one has figured out what to do about it.

Which drugs? Alcohol, tobacco, yeah, serious crisis. The death toll from illicit drugs does not even come near that of legal drugs.

I'm sure there will be a million opinions about how legalizing them will work, but that's frankly an opinion that's devoid of any supportive data so I can't take it seriously. US drug policy has been terrible, but it's multifactorial and it's difficult to deal with without intervening in the affairs of other countries -- which is why the DEA is reviled in all of South America.

The example of alcohol prohibition doesn't seem instructive?

American drug policy seems to have failed miserably - I cannot see any progress in the whole affair, just more and more money burned up (and not even a buzz for the burning).

Terrorism is a tactic, Thomas, it's not an aim. The US is not responsible for tactical decisions made by adversaries except in the few SPECIFIC instances where a terrorist group is directly supported by the US. Examples would be the Sandanistas. Otherwise, what's going on is we're playing global politics, and terrorism is a common tactic among the adversaries we have -- but just because we create adversaries doesn't mean we create terrorism.

Right, I'm saying the US uses the tactic of terrorism. Promotes the use of that tactic in puppet states. We didn't invent the tactic, there are Biblical accounts of terrorism, but we have had no problem using the tactic. Vietnam, Laos.

Our methods might be different - instead of suicide bombers, we have B-52s. Both are used to terrify populations.

Yes -- as I said perhaps the worst in the world since the Khmer Rouge, or maybe the current government in Sudan. They were never open and honest about their policies because they were basically inaccessible -- but even if they were, I hardly give that a pass in light of the giant human rights abomination that Afghanistan became under the Taliban.

I'm not trying to pat the Taliban on the back.

No he's not, I've been following their politics for years and he's never been honest about it. He jails opposition figures for manufactured crimes, he sends thugs into the street to intimidate voters, and he claims all the while that he's standing up for democracy.

I didn't mean him to be straightforward in a good way - I meant him being straightforwardly oppressive and brutal. But, apparently, I was wrong about that anyway - so point taken.

[Aedes]

Originally Posted by Didymos Thomas

Which drugs? Alcohol, tobacco, yeah, serious crisis. The death toll from illicit drugs does not even come near that of legal drugs.

It's not about comparison to legal drugs, it's about the public health burden that illegal drugs bear unto themselves. Your argument here is like saying that cancer isn't important because far more people die of heart attacks. It's irrelevant.

The hepatitis C outbreak in the United States is almost exclusively due to IV drug use (because it's not very transmissible sexually) -- and as a result there are 4 million people infected with hep C, as many as 200,000 new cases a year, and 10,000 to 20,000 deaths from cirrhosis and from hepatocellular carcinoma, and it's the leading cause of liver transplant. As many as 40% of the hep C patients in this country are coinfected with HIV.

Furthermore, about 40% of all HIV cases in the United States are due to IV drug use, and that figure is far higher in urban areas.

IV drug use and the associated bloodborne infections put a disproportionately huge burden of disease on impoverished people in inner cities, and this is borne out by the correspondingly far higher rates of HIV and chronic viral hepatitis (B and C) in these areas.

Furthermore, this is synergistic with alcohol use in that the combination of alcohol and hep C dramatically increases the risk of liver cancer and cirrhosis over either alone. And finally, we're talking about populations that already bear disproportionate rates of disease and have tragic health disparities.

As for tobacco, it's going to die out on its own. The rate of smokers is decreasing for the simple reason that 3000 people in the US die every single day from a smoking-related illness, and campaigns to limit teen smoking have substantially cut the recruitment of new smokers. Eventually it will not be profitable for farms to produce tobacco -- and that's already happening.

The example of alcohol prohibition doesn't seem instructive?

That's an example of an illegalization policy where it had been legal before. It's the opposite of a new legalization policy for which we do not have precedent. Furthermore, rates of alcoholism and alcohol use decreased during prohibition. The main reason for its repeal was that it was too expensive for US law enforcement to enforce, not because it was a failed policy. While one can argue that that's already the case for heroin and cocaine, one can also easily point to the disability-adjusted life years, lost work productivity, and health care expenditures of the predictable increase in addicts to these drugs which would almost certainly outweigh the cost of enforcement.

[Didymos Thomas]

It's not about comparison to legal drugs, it's about the public health burden that illegal drugs bear unto themselves. Your argument here is like saying that cancer isn't important because far more people die of heart attacks. It's irrelevant.

And the health issue is irrelevant to the topic at hand - the war on drugs is a socially oppressive policy, Not to mention being entirely ineffective as a response to the health issues.

That's an example of an illegalization policy where it had been legal before. It's the opposite of a new legalization policy for which we do not have precedent.

And there was a time in our nation's history when these drugs were legal. And even with legislation in place, the laws basically went uninforced. The drugs went from legal/ignored to illegal. Some drugs, like LSD, were entirely legal until the War on Drugs - Merry Pranksters, remember?

Furthermore, rates of alcoholism and alcohol use decreased during prohibition. The main reason for its repeal was that it was too expensive for US law enforcement to enforce, not because it was a failed policy.

From what I can find, use dropped initially and then increased - but I'm not so sure about these sources. Is your position just common knowledge, or is there something you can direct me to for reading?

In any case, though, didn't the alcohol in use during prohibition become more dangerous to consume? And wasn't crime bolstered by the introduction of a new and popular black market product? If these two items are true, I can't imagine how prohibition was a success - even if use of alcohol decreased.

While one can argue that that's already the case for heroin and cocaine, one can also easily point to the disability-adjusted life years, lost work productivity, and health care expenditures of the predictable increase in addicts to these drugs which would almost certainly outweigh the cost of enforcement.

I'm not so sure the costs would be more than the War on Drugs. I don't know what the costs you mention would amount to, but I can look up the annual cost of the War on Drugs and the figures are staggering - and if we then include money spent waging small scale wars all over the globe, the figure balloons further.

And don't we already have to accept that the War on Drugs is a failed policy as drug use has increased across the board? It's hard for me to buy the idea that 'disability-adjusted life years, lost work productivity, and health care expenditures of the predictable increase in addicts to these drugs' would be a significant problem when drug use becomes increasingly popular despite government policy.

[Aedes]

Originally Posted by Didymos Thomas

And the health issue is irrelevant to the topic at hand

I made the point that it's a major public health issue, which you're apparently not contesting -- and that's why the country NEEDS to have a policy to cut down use. The war on drugs, irrespective of its efficacy or lack thereof, is SPECIFICALLY a response to the public health problem, which is a lot more real than the ubiquitous terrorist threat we keep hearing about.

And don't we already have to accept that the War on Drugs is a failed policy as drug use has increased across the board?

I don't believe it's "failed" -- I believe it's irrelevant. Drug use, at least hard drugs like coke and heroin, seems to rise and fall along with other economic factors. This argues to me that the federal drug policy is neither making it better nor worse. Although cocaine use seems to be down considerably since the early 1980s.

It's hard for me to buy the idea that 'disability-adjusted life years, lost work productivity, and health care expenditures of the predictable increase in addicts to these drugs' would be a significant problem when drug use becomes increasingly popular despite government policy.

Why is that so hard to buy? Health care expenditures for adults over 65 are increasing too despite government policy. On the other hand work productivity and DALYs are improving among AIDS patients thanks to government policies that provide free antiretrovirals. Government drug policy would not exist were it not for objective justification -- and if you limit your understanding of the issue simply to overdose deaths and not other measures of morbidity and mortality, then you're going to lose the actual measurable impact of drug use.

[Didymos Thomas]

I made the point that it's a major public health issue, which you're apparently not contesting -- and that's why the country NEEDS to have a policy to cut down use. The war on drugs, irrespective of its efficacy or lack thereof, is SPECIFICALLY a response to the public health problem, which is a lot more real than the ubiquitous terrorist threat we keep hearing about.

Sure, drug use is a health issue. Health issue or not, the response to drugs as a health issue, the War on Drugs, seems to be an oppressive policy. A policy that terrorizes the public.

I don't believe it's "failed" -- I believe it's irrelevant. Drug use, at least hard drugs like coke and heroin, seems to rise and fall along with other economic factors. This argues to me that the federal drug policy is neither making it better nor worse. Although cocaine use seems to be down considerably since the early 1980s.

Well, the war in Nicaragua is over, so the government no longer supports cocaine imports.

Policy A is designed to address problem Y. Policy A, once implemented, is irrelevant, does not significantly address problem Y. Therefore, Policy A is a failed policy because Policy A did not help address problem Y. Where's my mistake?

As for making the problem worse or not - if drug use has not been altered by the War on Drugs, and if the War on Drugs has lead to the drugs becoming more dangerous (ex, spraying marijuana fields with poison, then users smoking poisoned marijuana), it would seem to me that the War on Drugs increases the health risk involved with drug use.

Why is that so hard to buy? Health care expenditures for adults over 65 are increasing too despite government policy. On the other hand work productivity and DALYs are improving among AIDS patients thanks to government policies that provide free antiretrovirals. Government drug policy would not exist were it not for objective justification -- and if you limit your understanding of the issue simply to overdose deaths and not other measures of morbidity and mortality, then you're going to lose the actual measurable impact of drug use.

The idea is that legalization will increase 'disability-adjusted life years, lost work productivity, and health care expenditures of the predictable increase in addicts to these drugs', right?

I have a hard time buying this because, despite criminalization, drug use goes up, which would mean those problems increase. If drug use increases, and these problems increase in the face of government policy, why would the repeal of this policy further the problems associated with drug use? Consider the example in Holland . Decriminalization and treatment have allowed them to reduce drug use.

[Aedes]

Originally Posted by Didymos Thomas

the War on Drugs, seems to be an oppressive policy. A policy that terrorizes the public.

This is something else that I fail to feel terrorized by, and I bet 99.999% of the country agrees with this too.

I vehemently disagree with many government policies. But feeling terrorized by them is a different story. I work in a refugee clinic at the department of public health -- THOSE are people who have felt terrorized. I know it's semantic, but I'd use that word more gingerly.

The idea is that legalization will increase 'disability-adjusted life years, lost work productivity, and health care expenditures of the predictable increase in addicts to these drugs', right?

The idea isn't about legalization, no. The idea is that a policy that successfully reduces use of IV drugs will decrease the measurable economic and medical costs of these drugs. And I brought them up because these drugs cause a huge public health burden that extends far beyond just the number of people who outright die from them -- and this burden is borne most strongly in disadvantaged communities. So before trivializing their importance with statements about how alcohol and tobacco kill more people (true or not), you need to understand the very large quantifiable impact of them AND how these quantifiable endpoints depend solely on usage rates.

I have a hard time buying this because, despite criminalization, drug use goes up, which would mean those problems increase.

I'm not making a case about criminalization. I think decreasing supply is a major component. Subsidizing farmers to pick crops other than opium is pretty cheap in a place like Afghanistan where the per capita income is crap. Problem is, a lot of opium comes from Myanmar, northern Thailand, and southern China, and it's a lot harder to influence these areas. Cutting the supply will increase price and make it less affordable. This is a lot more meaningful than running after street criminals.

[Didymos Thomas]

This is something else that I fail to feel terrorized by, and I bet 99.999% of the country agrees with this too.

I vehemently disagree with many government policies. But feeling terrorized by them is a different story. I work in a refugee clinic at the department of public health -- THOSE are people who have felt terrorized. I know it's semantic, but I'd use that word more gingerly.

Then I think you underestimate the scope of this policy. The number of non-violent drug offenders in prison is staggering. Use of mandatory minimums often condemn non-violent drug users to sentences longer than rapists and child molesters.

I'm not going to compare the police and government intimidation and persecution of drug users to the plight of the world's political refugees. However, the government is terrorizing the population when the government institutes draconian punishments for crimes that a large portion of the population commits, especially when that crime is non-violent.

Consider this - in the 1980's Ricky Ross makes a fortune selling crack cocaine. Ross' supply of cocaine comes from the Contras in Nicaragua. The CIA gives the Contras free reign to import cocaine into the US so that the Contras can use the cocaine profits to fund their revolution which Congress has refused to pay for. In the meantime, as LA is flooded with cheap crack cocaine, from Ross and ultimately from the Contras, the government fills prisons with crack cocaine users picked up off those same streets.

The government allows this stuff to come into the country, and then locks users away for 20+ years for using the substance. If I buy a t-shirt at the Congressional gift shop, then police arrest me for wearing the shirt on the steps of Congress, I'm going to feel terrorized. Oppressed. Abused.

The Contra situation is extreme - the most extreme case I'm familiar with in the War on Drugs. But hardly the only example. Google Sheriff Joe Arpaio - he's pretty popular.

The idea isn't about legalization, no. The idea is that a policy that successfully reduces use of IV drugs will decrease the measurable economic and medical costs of these drugs. And I brought them up because these drugs cause a huge public health burden that extends far beyond just the number of people who outright die from them -- and this burden is borne most strongly in disadvantaged communities. So before trivializing their importance with statements about how alcohol and tobacco kill more people (true or not), you need to understand the very large quantifiable impact of them AND how these quantifiable endpoints depend solely on usage rates.

I'm not trying to downplay the medical impact of drug use. I'm confused, now:

You say "one can also easily point to the disability-adjusted life years, lost work productivity, and health care expenditures of the predictable increase in addicts to these drugs which would almost certainly outweigh the cost of enforcement."

Has the War on Drugs reduced the use of IV drugs? Or of any other sort of drug? Not from what I've read, instead, the policy seems to have been entirely ineffective.

So, we have a policy that costs us huge sums of money to enforce, which does not seem to be of help with respect to reducing drug use. Tons of money spent, drug use increases anyway. Health crisis grows.

I'm not making a case about criminalization. I think decreasing supply is a major component. Subsidizing farmers to pick crops other than opium is pretty cheap in a place like Afghanistan where the per capita income is crap. Problem is, a lot of opium comes from Myanmar, northern Thailand, and southern China, and it's a lot harder to influence these areas. Cutting the supply will increase price and make it less affordable. This is a lot more meaningful than running after street criminals.

Absolutely - the demand exists. But if we can end production, at least large scale production, we will have done some good. Meanwhile, Afghanistan went from producing almost no opium under the Taliban to producing nearly 80% of the world's supply under US occupation. This, if I recall, has lead to a large increase in the availability of heroin, and all at cheaper prices.

[Aedes]

Originally Posted by Didymos Thomas

Then I think you underestimate the scope of this policy.

For the four years of my residency one of the medical floors in my hospital was a maximum security prison floor, and I worked regularly on this floor with the prisoners. Believe me, I don't underestimate it.

However, the government is terrorizing the population when the government institutes draconian punishments for crimes that a large portion of the population commits, especially when that crime is non-violent.

I've heard this argument many times and I'm not impressed by it. While I think the efforts are misdirected, I don't agree that it falls within the scope of the words draconian or terrorize. The law is the law, for all its flaws, and if some dumb college kid goes to jail for selling pot, he doesn't get to hysterically claim draconian punishment as if he didn't know it was illegal. I agree wholeheartedly that it's a waste of effort and money, but this isn't the Spanish Inquisition here. Live by the law, change the law, or move.

The government allows this stuff to come into the country

Amazing the presence of DEA officers I encountered in the Peruvian Amazon, and amazing the stories with them burning farms and conducting raids. Again, it's barbarically-conducted policy but you're kidding yourself if you think it's some open door policy.

You say "one can also easily point to the disability-adjusted life years, lost work productivity, and health care expenditures of the predictable increase in addicts to these drugs which would almost certainly outweigh the cost of enforcement."

Cost-benefit analyses are an important part of medical policymaking. A huge amount of money is lost to the economy because of the medical implications of drug use. This is one of many elements of the societal cost that one would hope to recoup by having effective and efficient drug-control policies.

My argument is not in favor or against any specific policy -- although I think outright legalization of heroin, cocaine, meth, and XTC would be frankly criminal.

So, we have a policy that costs us huge sums of money to enforce, which does not seem to be of help with respect to reducing drug use. Tons of money spent, drug use increases anyway. Health crisis grows.

YOU are the one who started this conversation out by dismissing the importance of cocaine and heroin use. That's my point. They have huge societal costs.

Absolutely - the demand exists. But if we can end production, at least large scale production, we will have done some good. Meanwhile, Afghanistan went from producing almost no opium under the Taliban to producing nearly 80% of the world's supply under US occupation. This, if I recall, has lead to a large increase in the availability of heroin, and all at cheaper prices.

The use of heroin in the United States dramatically increased in the early and mid 1990s, following the peak in the crack epidemic in ~1993, and in the late 1990s began to approach levels not seen since the 1970s. So the current increase is only partly due to the increase in production in Afghanistan. On the other hand, the higher quality heroin from South America and Mexico has decreased quantity over that time, and even Burma is producing less, so the increase in Afghanistan has been somewhat offset. I don't know the reasons for the decrease elsewhere.

[Didymos Thomas]

For the four years of my residency one of the medical floors in my hospital was a maximum security prison floor, and I worked regularly on this floor with the prisoners. Believe me, I don't underestimate it.

Then you know that more than 99.999% of the population is affected by the current drug policy. And you know that more than 99.999% of the population risks regularly incarceration for their recreational drug use.

I've heard this argument many times and I'm not impressed by it. While I think the efforts are misdirected, I don't agree that it falls within the scope of the words draconian or terrorize. The law is the law, for all its flaws, and if some dumb college kid goes to jail for selling pot, he doesn't get to hysterically claim draconian punishment as if he didn't know it was illegal. I agree wholeheartedly that it's a waste of effort and money, but this isn't the Spanish Inquisition here. Live by the law, change the law, or move.

The Japanese Internment during the second world war wasn't the Inquisition, either, but those citizens were certainly oppressed by their government.

To say 'it's the law' doesn't justify the law. Much less make the law any less oppressive.

Amazing the presence of DEA officers I encountered in the Peruvian Amazon, and amazing the stories with them burning farms and conducting raids. Again, it's barbarically-conducted policy but you're kidding yourself if you think it's some open door policy.

I do not suggest it's an open door policy - again, the war in Nicaragua is over, the Contras are no longer shipping cocaine to support their rebellion. Doesn't change the history.

Cost-benefit analyses are an important part of medical policymaking. A huge amount of money is lost to the economy because of the medical implications of drug use. This is one of many elements of the societal cost that one would hope to recoup by having effective and efficient drug-control policies.

And I'm all for effective and efficient drug-control policies. Holland's system is not without flaws, but their model seems much more effective than ours, which is why I brought up the example.

My argument is not in favor or against any specific policy -- although I think outright legalization of heroin, cocaine, meth, and XTC would be frankly criminal.

And I would agree with you.

YOU are the one who started this conversation out by dismissing the importance of cocaine and heroin use. That's my point. They have huge societal costs.

I don't think I ever tried to suggest that the dangers of cocaine and heroin use are unimportant. Sure, the costs are great. The health costs of tobacco and alcohol to our society seem much greater, but either way, what got us on this was whether or not the War on Drugs is oppressive.

[Aedes]

Originally Posted by Didymos Thomas

Then you know that more than 99.999% of the population is affected by the current drug policy. And you know that more than 99.999% of the population risks regularly incarceration for their recreational drug use.

Well, there is always a risk of false arrest -- but honestly that risk does not fall evenly on the shoulders of the entire population. It's grossly weighted towards the people who actually DO use drugs. And not having used illegal drugs before, I don't feel like I'm at particular risk from US drug policy.

The Japanese Internment during the second world war wasn't the Inquisition, either, but those citizens were certainly oppressed by their government.

Yup. And I'd argue that the marginalization of the educational system and social programs is, as we might say in medicine, an ex vacuo type of severe oppression on the part of the government.

To say 'it's the law' doesn't justify the law. Much less make the law any less oppressive.

So change the law -- or accept it if you fail. It's a democracy -- you have the opportunity to try and change the law. If it doesn't work, and you're outnumbered, then you can leave, you can change your behavior, or you can accept the risk. I'd love handguns to be illegal, but that's not going to happen either.

I'm not overly concerned by the stresses faced by recreational drug users who can choose to behave otherwise, so I don't have much sympathy for a claim of oppression. I AM concerned that they get help when they screw up their life, and I AM concerned that social programs be in place to help prevent drug use, help provide treatment including dual diagnosis management, and help provide programs to maintain sobriety.