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We Can Change Our Wicked Problems!

Drug, Alcohol and Tobacco Problems

So much of the U.S. healthcare system is about selling drugs for medical treatments and symptom relief.  It would make sense if drug and other substance use and abuse were health issues?  Not in the U.S. of A.  Much of the drug use and abuse in the U.S. is considered the purview of the criminal justice system, and problems with drug use and abuse are probably larger for legal than for illegal substances.

Healthy Use and Relationship

 

Human beings have been getting altered by plants and alcohols for millennia, maybe millions of years.  That’s probably why our brains are now wired with so many receptors for chemicals that alter us.  Probably, all human societies use mind-altering substances.  90% of modern societies give drug-induced altered states of consciousness roles in our fundamental belief systems.  Until recently, we respected and used psychoactive substances for healing and spiritual purposes, administered by spiritual shamans.  Some academics think spirituality and religion arose in these experiences.  Others think they had roles in origins of symbolic thinking and major intellectual breakthroughs that set us apart from other apes.

Use of Peyote, a desert cactus hallucinogen, goes back 5,700+ years.  Chinese farmers grew hemp and used marijuana 7,000+ years ago.  Opium spread to most of Europe from Asia at least 8,000 years ago.  In the South American Andes, superfood plant medicine of choice coca has been in use for 8,000+ years.  In Peru, the oldest known use of the psychoactive San Pedro cactus goes back to at least 8,000 years.  Use of mescal bean hallucinogens goes back at least 9,000 years.  Hallucinogenic mushrooms were used in Central America between 500 B.C. and 900 A.D., and in the sub-arctics, since “time immemorial.”  Alcohol goes back millions of years to ape times.  Apes and monkeys eat wild fermented fruit now.[1] 

There’s nothing wrong with using plants and spirits to alter states, for good reasons, safely and healthily.  It’s another thing when we do too much, or do it wrong-headedly and kill or harm ourselves or others, including how we get them, or if we become addicted and lose control of when and how we use them.

The U.N. says there are 275 million illegal drug users globally; 89% are not classified as problematic.[2]  In other and older cultures, spirit plants/medicines are not viewed as problems, but great opportunities.  In our culture, relations with vilified illegal drugs, like methamphetamines and opioids, have problems.  But so do our relations with legal drugs, like alcohol, tobacco and many prescription medications.

The “War on (Illegal) Drugs”

Since it began in 1970, the U.S. has spent at least $1, [3] maybe $1.5 trillion,[4] on a “War on Drugs.”  Exactly what that war is for can be difficult to tease out, as with many wars, but ostensibly it’s to eliminate undesirable drug use and associated social behaviors and ills, as decided by our politicians?  Exactly what the War on Drugs costs is also difficult to learn, because that isn’t formally accounted for. 

The phrasing “War on Drugs” suggests drugs are the enemy.  We’re fighting a war to eliminate drugs.  Clearly, we don’t mean all drugs, because an enormous part of our healthcare system is based on drugs, and the pharmaceutical industry spends more money lobbying than any other.  We mean illegal drugs.  We try to eliminate illegal drugs, their use and associated undesirable social behaviors and ills, right?  Presumably, harms we’d want to reduce include:  loss of health, productivity and well-being in users, and harms associated with violence and criminal activities in trafficking and trading illegal drugs.  Activities in this “war” would then be things that would reduce those undesired outcomes, right? 

Tactic 1:  Reducing Supplies of Illegal Drugs

 

How do we do that?  Tactic 1:  attack and eliminate the supply of illegal drugs, instead of the behaviors.  Get rid of the illegal drugs, and the undesirable behaviors will just go away?  The U.S. spends about $40 billion (3.5% of FADS) a year trying to stop the supply of illegal drugs.[5]  How’s that going?  In the U.S., our illegal drugs are far more available than ever, and they are much stronger and cheaper than ever.[6]  The average purity of heroin increased 60%, cocaine 11% and marijuana 160%, between 1990 and 2007, while the prices of these drugs, adjusted for inflation and purity, fell about 80%.[7]  Those trends remain.

Addiction[8] and hard drug use rates[9] had been the same as in 1970 through the 48-year “war,” but have recently gone way up.  90% of high school seniors say marijuana is "very easy" to get (much easier than alcohol and tobacco, which are legal, regulated drugs). [10]  OK, so Tactic 1 efforts to stem the supply of illegal drugs is not working.  Supply is up, availability and quality are better.[11]  Yet, we keep doing it. 

Tactic 2:  Imprison Traffickers and Users as Deterrents

 

Tactic 2 is to attack and imprison illegal drug sellers and users, and punish them with loss of livelihood, inability to get jobs, loss of voting rights, harm to their families, inability to get student financial aid, and so forth, so we will be afraid of using drugs and having our lives ruined by the criminal justice system, and so we won’t.  How’s it going?  After 48 years, the U.S. is the #1 country in the world for drug use.[12] 

The U.S. imprisons more people for drug offenses than any other country.[13]  92,000 (52%) are in federal prisons for drug offenses, 49% of males and 59% of females.  200,000 (16%) are in state prisons for drugs, 46,000 (4%) for drug possession.[14]  153,000 sit in local jails for drug charges.[15]  Of 3.8 million on probation at end of 2015, 950,000 (25%) had a drug charge as their most serious offense.  Of 870,000 people on parole, 270,000 (31%) had a drug charge as their most serious offense.[16]  Altogether, that’s 1.7 million people in the criminal justice system in the U.S. for illegal drugs.  That’s a lot of people. 

1 in 5 people in prison are there for drugs.[17]  It costs $30,000+ a year for each.  We spend $15 billion (1.3% of FADS) to imprison them, about what it would cost to send them to a decent 4-year college.  Would we be better off helping them get the knowledge and skills to contribute productively to society, rather than sending them to criminal school in prison and rendering them almost unemployable?

U.S. law enforcement agencies made 1.6 million drug law violation arrests in 2017, up 4% over 2016.  Over 1.4 million (85%) of those were for simple drug possession, making it the #1 cause of U.S. arrests, followed by drunk driving, at a million.[18]  Every 25 seconds, the U.S. arrests somebody for drug use.[19] 

Marijuana’s an interesting subset of that.  Someone in the U.S. is arrested for possessing marijuana at least every minute, 1,700 people per day.  A marijuana arrest costs about $750 in administration fees.[20]  $750 times 620,000 arrests is $500 million a year just to process arrests for pot possession in 2014.[21]  Marijuana possession is one of the single largest U.S. arrest categories, over 5%, 1 in 20 of all arrests.[22]  We arrest more for weed possession than all of our violent crime:  murder, rape, robbery and assault.  Half the violent crimes go unsolved.[23]   There’s no victim in pot use?  It does little harm?[24]  It’s less harmful than alcohol or cigarettes.[25]  Would we be better off as a society if we used law enforcement resources and efforts for solving violent crime, rather than arresting people for victimless marijuana? 

60% of U.S. citizens favor legalizing pot.[26] [27]  As of the end of 2018, citizens have voted and legalized adult use of marijuana in the nation’s capital, Washington, DC, and 10 U.S. States.[28] 

Washington, DC and 33 States have legalized medical marijuana.[29]  Other States have marijuana legalization votes pending.  (Many seem motivated to legalize more by opportunities to make money, business and tax revenues, than for moral reasons, like lotteries becoming widely legal despite anti-gambling morality and laws.)   Only 17 States (34%) don’t have some form of legal marijuana.  2/3 do.  Nevertheless, federal law still considers marijuana a Schedule 1 illegal drug, with “no currently accepted medical use and a high potential for abuse,”[30] even though the U.S. government itself holds a medical patent on marijuana.[31]  Why does the Federal Government refuse to lighten up on marijuana laws?

Anyway, back to how tactic 2 is doing, arresting and punishing people for selling and using drugs to deter people from doing that.  If that’s working, then, all else equal, States with higher imprisonment rates for drug use should have lower rates of drug use and related problems.  They don’t.  Tennessee imprisons drug offenders at 3X the rate of New Jersey, but drug use rates are the same in both States.  Indiana and Iowa have almost the same rates of drug imprisonment, but Indiana ranks 27th among States in self-reported drug use, 18th in overdose deaths, compared with 44th and 47th for Iowa.[32]

1 in 20 adults on Earth use illegal drugs, the same proportion as a decade ago.  "There is no correlation between the harshness of drug laws and incidence of drug-taking: citizens living under tough regimes (notably the U.S. but also Britain) take more drugs, not fewer."  Do cultural differences explain this?  Well, apparently, they do not.  "Even in fairly similar countries tough rules make little difference to the number of addicts: harsh Sweden and more liberal Norway have precisely the same addiction rates."[33]  OK, so tactic 2 is not working for drug use.  Arresting, imprisoning and punishing people doesn’t work.[34]

Let’s estimate conservatively that a fifth of the total $298 billion a year in U.S. federal, state and local “protection” budgets are used for drug law enforcement, the ratio of people who are in prison for drugs.  That’s $60 billion a year (5% of FADS) on drug law policing, enforcement and punishment in the U.S.

Penalties for drug crimes in the U.S. are more than prison.  They prevent people from getting financial aid for education,[35] strip voting rights,[36] and make employment hard because of criminal records.[37]  They seize “forfeited” property.[38]  Through repercussions like those, the War on Drugs has created an enduring underclass of people with few educational or job opportunities.[39]  Lost abilities to be productive and contribute have created massive negative impacts of the U.S.’ economy and society.

These add big social costs to this 2nd tactic.  1.7 million in the criminal justice system for drugs lose jobs, can’t work in jail, can’t get jobs later, can’t vote, can’t get home or apartment rentals, lose property, can’t get welfare and other social aid, and in many other ways are harmed by their legal records.  Pulling a round number from the air, let’s say they lose an average of $10,000 a year for that criminal record.  That’s $17 billion a year (1.5% of FADS) in social costs for these casualties of The War on Drugs.  Added to the $60 billion in “protection” budgets, that’s $77 billion in annual War on Drugs costs (7% of FADS).  (These numbers aren’t right, but nobody’s numbers are right.  All show this is extremely expensive.)

Those in “the system” for drugs aren’t the only ones impacted.  69% of male and 55% of female drug offenders in federal, and 59% of male and 63% of female drug offenders in state prisons have children.  Family is harmed, by at least lost relationships, financial support, emotional support, respect and love.  “Putting more drug-law violators behind bars for longer periods of time has generated enormous costs for taxpayers, but it has not yielded a convincing public safety return on those investments. Instead, more imprisonment for drug offenders has meant limited funds are siphoned away from programs, practices, and policies that have been proved to reduce drug use and crime."[40]  Those in tactic 3.

Tactic 3:  Counseling and Support

 

Tactic 3 is treating people for health, psychological and addiction problems leading them to drug abuse.  Our health and healthcare systems are broken.[41]  The U.S. Surgeon General found mental illnesses are the 2nd leading cause of disability in the U.S., affecting 1 in 5 people.[42]  Less than half of the mentally ill get ongoing, managed care.[43]  65% of non-metropolitan counties have no psychiatrists.[44]  Tons of those people are self-medicating for mental health problems with illegal drugs.  Way more than that are self-medicating with illegal drugs for stress, anxiety and worries that most would not call mental illness, but are genuinely causing pain and harm.  These health and life problems drive illegal drug use.

17% of people in state and 18% of people in federal prison for things other than just drug use committed their crimes to get money for drugs, many for self-medication.  Mental health treatment delivered in communities is one of the most cost-effective ways to prevent those crimes.  Per year, it costs $20,000 (2/3) less than putting a person in prison.[45]  Each $1 spent on treatment in community yields more than $18 in cost savings related to crime, versus $.37 in public safety benefit per $1 spent for prisons.  Treatment is far cheaper and more effective than prison. [46]  States already spend very big money on it, 10% to 20% of total state budgets.[47]  At least $147 billion a year (13% of FADS) is spent on mental health services in the U.S.[48]  Half those who need it aren’t being served.  So, many use alcohol or drugs.

That tells us something very big and important.  Really, a whole lot of people in the U.S. are feeling bad and are using street drugs and alcohol to feel better.  That seems to be the heart of the abuse problem.  Government estimates for every $1 spent on drug treatment, $7 are saved; it works; but treatment and prevention get 45% of the federal drug budget, while enforcement and interdiction, which don’t work, get 55%, not including the huge costs of incarcerating drug offenders.[49]  Does it make more sense to stop putting people in jail for self-medicating with street drugs and use that money for counseling, or, better, use it solving the wicked problems which are leading to the suffering people self-medicate for?

Failures of the War on Drugs

 

Polls show stuff like 82% of citizens think the U.S. is losing the War on Drugs; 7% say it’s winning.[50]   Prohibition doesn’t work.[51]  We know that from our alcohol prohibition era and its later repeal.  The War on Drugs is not eliminating illegal drug use or availability, reducing available illegal drug quality, or eliminating violence or harms from illegal activities for illegal drug trade, at least not cost-effectively. 

“Defenders of harsh penalties for drug possession say they are necessary to deter people from using drugs and to protect public health. But despite the tough-on-crime push that led to the surge in arrests in recent decades, illicit drug use today is more common among people in the U.S. age 12 and older than it was in the early 1980s. Federal figures show no correlation between drug-possession arrests and rates of drug use during that time."[52] 

Has the War on Drugs reduced drug use?  The U.S. is still the #1 nation in the world in illegal drug use.  During Prohibition, banning alcohol didn't stop people drinking; it stopped them from obeying the law; and it punished them for that.  Exactly the same thing is happening for illegal drug laws.[53] 

 

Incarcerating people for drug-related offenses has little impact on substance misuse rates.  However, incarceration is linked with increased mortality from overdose.  In the first 2 weeks after prison release, individuals are almost 13X more likely to die than the general population, mostly from overdosing.  During that period, they’re at a 129% greater risk of dying from an overdose than the general public.[54]

The War on Drugs delivers huge punishments, “cruel and unusual,” out of proportion for the infractions. 

“In Texas, for instance, 116 people are currently serving life sentences on charges of simple drug possession. Seven of those people earned their sentences for possessing quantities of drugs weighing between 1 gram and 4 grams, or less than a typical sugar packet. That's because Texas also has a habitual-offender law, allowing prosecutors to seek longer-than-normal sentences for people who have two prior felonies…  In 2015, more than 78 percent of people sentenced to incarceration for felony drug possession in Texas possessed under a gram."[55]

The War on Drugs fails also because its results are racist, and the U.S. is established on equality values. 

  • Blacks are 6X more likely to go to jail for drug offenses than whites, despite equal infractions.

  • Blacks are 4X more likely to be arrested for marijuana charges than whites.

  • Blacks make up 30% of all drug-related arrests, despite being only 12.5% of all substance users.

  • 80% of people serving time for a federal drug offense are black or Latino.

  • In state prisons, people of color make up 60% of those serving time for drug charges.

  • In the federal system, an average black defendant convicted of a drug offense will serve nearly the same time (58.7 months) as a white defendant would for a violent crime (61.7 months).

  • 70% of people convicted of charges with mandatory minimum sentences are people of color.  Prosecutors are twice as likely to pursue a mandatory minimum sentence for blacks than whites charged with the same offense.  Blacks are less likely to get any relief from mandatory minimums.  On average, defendants subject to mandatory minimums spend five times longer in prison.[56]

 

Sending people to prison or otherwise engaging them in the criminal justice system has done great harm to many offenders, and their families and loved ones, particularly in communities of color, creating stress, loss of livelihood, reduced incomes, inability to get work, inability to get social services or financial aid, loss of rights to vote, and therefore social disenfranchisement.  Those harms are greater than those drug laws were supposedly intended to reduce in the first place.  That’s a failure.

Successes in the War on Drugs

  • Fatalities are being reduced by making naloxone available, an opioid overdose reversal drug.

  • Syringe programs provide people with clean injection equipment to prevent syringe sharing, with big reductions in blood-borne diseases.  After implementing syringe services, Washington State had an 80% drop in new diagnoses of hepatitis B and C.  In DC, syringe programs produced a 70% decrease in new HIV infections over 2 years, saving $44 million in lifetime healthcare costs.  Nationally, syringe access programs yield a return on investment of $8 for every $1 spent.

  • 60 international cities now operate supervised injection facilities (SIFs), safe, hygienic places where people inject drugs with medical supervision and connect to treatment and social services.  These reduce overdose fatalities and blood-borne illnesses.  Over 2 years, a safe injection site in Vancouver, BC saw a 35% reduction in overdose fatalities in its vicinity and a 30% increase in users entering treatment.  U.S. cities, including Philadelphia, Seattle, and New York, are employing SIFs.  

  • More than 3,100 U.S. “drug courts” reduce recidivism by sentencing defendants to treatment, support services, supervision and monitoring, instead of prison.  Participants have lower rates of reoffending, including lower drug-related and property crimes.  They’re also less likely to report unmet educational, employment and financial service needs.

  • Law Enforcement Assisted Diversion (LEAD) programs allow officers to divert individuals to treatment and/or social services, rather than making low-level drug arrests.  Pioneered in Seattle, it’s had good results.  Those diverted in the LEAD program were 58% less likely to be rearrested, compared to similar people processed through the criminal justice system.[57]

The Real Reason for War on Drugs?

 

The War on Drugs began in 1970 during the Nixon administration.  Nixon was a criminal impeached and essentially removed from office as President of the United States of America. 

“The Nixon campaign in 1968, and the Nixon White House after that, had two enemies: the antiwar left and black people. You understand what I’m saying? We knew we couldn’t make it illegal to be either against the war or black, but by getting the public to associate the hippies with marijuana and blacks with heroin, and then criminalizing both heavily, we could disrupt those communities. We could arrest their leaders, raid their homes, break up their meetings, and vilify them night after night on the evening news. Did we know we were lying about the drugs? Of course we did.”

– John D. Ehrlichman, Richard M. Nixon’s Counsel & Domestic Policy Chief[58]

Wow!  That may explain a lot about politicians’ refusal to reduce the War on Drugs or drug laws.  Hiding under the pretense of eliminating harms from drug use and trafficking is the political strategy to make and keep illegal the drugs that political opponents or racial enemies mostly likely use, and prosecute those who break those laws aggressively, because that eliminates them as voters who’d likely vote against and activists who would act against these politicians in power or their desires. 

It attacks those opponents’ lives directly and very hard, taking their attentions and efforts away from resisting politicians.  In Nevada, a person convicted of a misdemeanor may face over 200 federal and state consequences of a drug law conviction, many which bar employment and professional licensing.  There are over 45,000 state and federal consequences for convictions.  It affects housing rights, access to loans, family rights and many things.  It’s called “the secret sentence,” or “the silent punishment.”  Even a minor conviction can get a permanent, legal resident deported.[59]  Enforce it on undesirables?!

1 in 150 U.S. adults is in the criminal justice system in these attacks.  That is enough voter alienation to swing many U.S. elections.  That’s playing hardball for political power.  It’s a vicious attack on the very foundations of democracy in the U.S., a treason and corruption of representative democracy?  Our freedoms include freedoms to use substances?  It’s for voter disenfranchisement and racism?

“The back-story to this problem is the patchwork of state disfranchisement laws that prevent over 5.3 million Americans with criminal records from voting. In 48 states (all but Maine and Vermont) and the District of Columbia, citizens lose the right to vote upon conviction of a felony; in at least a handful of states, the right is also lost upon conviction of a misdemeanor. All 48 states (and the District of Columbia) also provide mechanisms by which these citizens may seek to regain their voting rights, though some processes are much more viable than others. These mechanisms range from automatic restoration (upon completion of incarceration or sentence) to restoration only after satisfaction of an extensive, onerous and sometimes costly individual application process.

The variety and complexity of these disfranchisement policies has led to considerable confusion and misapplication of the laws, effectively barring countless eligible Americans from the ballot box. Research has shown that many people with past criminal records mistakenly believe they are ineligible to vote, a problem compounded by the prevalence of similar confusion among elections officials, who often dispense incorrect eligibility information to… 47 million Americans with criminal records…  Twenty-two states' and the District of Columbia's registration forms provide inaccurate, incomplete or misleading explanations of who is ineligible to vote and for how long…  Eleven states' registration forms contain incorrect or misleading references to how voting rights are restored…  Four states' registration forms use confusing or misleading formats to present state disfranchisement policy…  Four states' registration forms contain no guidance on registering to vote with a criminal record, despite the existence of state disfranchisement policies…"[60]

 

This strategy isn’t new, either.  More than 100 years ago, politicians decided to divide drug markets and laws into two types:  medical and nonmedical.  These distinctions are still used.  Many don’t realize that “the people building these categories were the same people who were building Jim Crow racial segregation, campaigning for immigration restriction and implementing eugenic policies.”  Drugs called “medicines” were used by the “kinds of people” politicians liked:  “white people of respectable means.”  Drugs used by immigrants or African-Americans were made illegal and used as means of discrimination.  “Medicines” get less scrutiny, are legal and regulated, because they’re used by “trustworthy” people.”[61]  The legal system is abused for racial and political discriminatory purposes.

That leads to prejudiced results, like white collar criminals being punished less for larger crimes than blue collar criminals, or people going to prison for life for using marijuana, but abusing alcohol, being addicted to tobacco and blasting others with second-hand smoke, or abusing and being addicted to prescription drugs is perfectly legal.  It leads to results like racist and malicious politicians in power.

Problems with Legal Drugs

Opioid Epidemic

 

The biggest drug problem in the U.S. is our epidemic prescription and street opioid drug addiction,[62] which cost us $500 billion a year (43% of FADS), in 2017,[63] the deadliest drug crisis in our U.S. history.  Drug overdoses are now lead causes of death for people under 50, with deaths rising faster than ever.  In 2016, overdoses killed more than guns or autos, increasing faster than the H.I.V. epidemic at its peak.  

1 in 50 U.S. deaths are drug-related, but overdoses are just the most visible and easy to count symptom.  Over 2 million (1 in 125) adults are estimated to have opioid problems.  97 million took prescription painkillers in 2015, 12 million without a doctor’s supervision.[64]  Doctors are a huge part of the problem.  With 5% of the global population, the U.S. consumes 80% of the world’s opiates.[65] 

Opioids act on nervous system opioid receptors:  opium, morphine, heroin, prescription painkillers like Vicodin, Percocet and OxyContin, and synthetic drugs like methadone and fentanyl.  Opioid receptors drive pain and reward systems in the body, making them powerful painkillers, but very addictive. 

 

These problems often start with legal drugs, prescribed for pain, which is hard for doctors to verify.  People get prescribed, and then get hooked on them, in part because they provide relief from emotional and psychological pain, not just physical pain.  When they can’t get or can’t afford the pills anymore, they turn to heroin and other cheaper street drugs.  Then came fentanyl, a newish synthetic opioid that is 50 times more potent than heroin, and it is causing many overdoses, because it is so hard to dose.[66]  Of 50,000 people in the U.S. who died of drug overdoses in 2015, 63% involved opioids.[67]  In 2017, 72,000 U.S. people died from drug overdose deaths.[68] 

These are largely legal drugs that are abused, and pharmaceutical companies and their owners have been delighted in the profits they’ve made from them.  For example, the 16th richest family in the U.S., worth $14 billion (1.2% of FADS), made its money from OxyContin, one of these abused opioids,[69] which they pushed aggressively.[70]  They’ve now been given a patent to help clean up the opioid epidemic.[71]  They’re considered pillars of the community.  Make problems; sell their solutions; get rich or richer.  Legal “pushers” like these are a big part of the problem? 

 

The opioid epidemic:

  • In 2016, 11.8 million U.S. people misused prescription opioids or heroin.  3.6% of adolescents (ages 12 to 17) and 7.3% of young adults (ages 18 to 25) reported opioid misuse in 2015.

  • Every 16 minutes, a person in the U.S. dies from an opioid overdose.  In 2016, 42,249 people in the U.S. died from opioid overdoses, more than were killed in motor vehicle accidents.

  • Between 2014 and 2016, opioid overdose deaths increased by approximately 48% nationwide. Whites have highest rates of fatal opioid overdoses, but community of color fatalities are rising. During that period, opioid deaths rose by nearly 53% among Latinos and 84% among blacks.

  • Roughly 1 of every 100 U.S. adults, 2.4 million people, have an opioid-use disorder.

  • The opioid epidemic costs the U.S. an estimated $504 billion per year (44% of FADS), including costs to healthcare and justice systems and the economic impact of premature fatalities.

  • Doctors wrote 259 million opiate prescriptions in 2012, enough for one for every U.S. adult, with 19 million extras.  Prescription painkiller overdose deaths jumped 400% in women, 1999 - 2010.

  • Opioid fatality rates jumped 28% from 2015 to 2016, in large part due to fentanyl overdoses.  Synthetic opioids were the leading cause of drug-related deaths, claiming 20,000 lives in 2016.[72]

 

This opioid epidemic and linked deaths are related to epidemic suicides in the U.S., parts of a social phenomenon lowering life expectancy rates, especially for white adult males in their earning years who haven’t been to college.  Suicide became the 2nd leading cause of death for 10- to 34-year-olds in 2016. 1.4 million tried suicide in 2017.[73]  This supports the observation that many in the U.S. are suffering mentally and emotionally and self-medicating with alcohol, cigarettes and legal and illegal drugs.  “Deaths of Despair” are now reducing U.S. life expectancy.[74]  Those come from our wicked problems.

Alcohol Problems

 

There are much bigger alcohol abuse problems in the U.S.  “Excessive alcohol use led to approximately 88,000 deaths and 2.5 million years of potential life lost each year in the U.S. from 2006 to 2010, shortening the lives of those who died by an average of 30 years.  Excessive drinking was responsible for 1 in 10 deaths among working-age adults 20-64 years old.  The economic costs of excessive alcohol consumption in 2010 were estimated at $249 billion, or $2.05 a drink.  (22% of FADS). 

This problem has long been killing more people than the opioid epidemic, and it causes far more harm to far more people in the U.S., but it receives almost no press or government attention, and it is perfectly legal, for anyone over the age of 21, perhaps because alcohol and tobacco have long been the drugs of choice for the white, privileged and empowered class in the U.S.

According to the U.S. Centers for Disease Control (CDC):

Short-Term Health Risks:  Excessive alcohol use has immediate effects that increase the risk of many harmful health conditions.  These are most often the result of binge drinking and include:

  • Injuries, such as motor vehicle crashes, falls, drownings and burns.

  • Violence, including homicide, suicide, sexual assault and intimate partner violence.

  • Alcohol poisoning, a medical emergency from high blood alcohol levels.

  • Risky sexual behaviors, including unprotected sex or sex with multiple partners, that can result in unintended pregnancy or sexually transmitted diseases, including HIV.

  • Miscarriage and stillbirth or fetal alcohol spectrum disorders (FASDs) among pregnant women.

 

Long-Term Health Risks:  Excessive alcohol use can lead to diseases and other problems, including:

  • High blood pressure, heart disease, stroke, liver disease and digestive problems.

  • Cancer of the breast, mouth, throat, esophagus, liver and colon.

  • Learning and memory problems, including dementia and poor school performance.

  • Mental health problems, including depression and anxiety.

  • Social problems, including lost productivity, family problems and unemployment.

  • Alcohol dependence or addiction, or alcoholism.[75]

 

According to the World Health Organization (WHO):

  • Worldwide, 3 million deaths a year come from harmful use of alcohol, 5.3% of all deaths.

  • Ages 20-39 years, about 14% of worldwide deaths are alcohol-attributable.

  • Harmful use of alcohol is a causal factor in more than 200 disease and injury conditions.

  • 5% of global disease/injury burden is from alcohol, measured in disability-adjusted life years.

  • There is a causal relationship between harmful alcohol use and mental and behavioral disorders, and other harms, including infectious diseases like tuberculosis and the course of HIV/AIDS.

  • Beyond health consequences, harmful alcohol use brings significant social and economic losses to individuals and society in general.[76]

 

According to the National Institutes of Health, about the U.S.:

  • 86% of us 18 or older have drunk alcohol; 70% in the last year; 56% in the past month.

  • In 2015, 27% of people 18 or older reported they engaged in binge drinking in the past month, (typically 4 drinks for women and 5 drinks for men in about 2 hours) 7% reported they engaged in heavy alcohol use in the past month (binge drinking on 5 or more days in the past month).

  • In 2015, 15 million (6% of) adults 18 and older, 10 million (8% of) men and 5 million (4% of) women, had Alcohol Use Disorder (AUD - a chronic relapsing brain disease characterized by impaired abilities to stop or control alcohol use, despite adverse social, occupational or health consequences, with 2 disorders:  alcohol abuse and alcohol dependence).  

  • 7% of adults with AUD in the past year received treatment, 7% of men and 5% of women.

  • 623,000 (2.5% of) adolescents ages 12–17, 2% of males and 3% of females, have AUD.

  • 5% of youth with AUD in the past year got treatment, 5% of males and 5% of females.

  • 88,000 people (62,000 men; 26,000 women) die from alcohol-related causes annually, making alcohol the #3 preventable U.S. cause of death. #1 is tobacco, #2 poor diet & physical inactivity.

  • 2014, there were 9,967 alcohol-impaired driving fatalities in the U.S. (31% of all driving deaths).

  • In 2010, alcohol misuse cost the U.S. $249 billion (21.5% of FADS), ¾ related to binge drinking.

  • More than 10% of U.S. children live with a parent with alcohol problems.

  • Ages 12–20 (for whom alcohol is illegal):

    • 8 million (20%) say they drank alcohol in last month, 20% of males; 21% of females.

    • 5 million (13%) say they binge drank in last month, 13% of males; 13% of females.

    • 1.3 million (3%) report heavy alcohol use in the last month, 4% of males; 3% of females

  • Research says teenage alcohol use may interfere with normal adolescent brain development and increase risk of developing AUD.  In addition, underage drinking contributes to a range of acute consequences, like injuries, sexual assaults and deaths, including those from car crashes.

  • Between 2 and 7 births per 1,000 in the U.S. have Fetal Alcohol Syndrome (FAS), and 20 to 50 per 1,000 births have Fetal Alcohol Spectrum Disorders (FASD).

  • In 2015, of 78,529 liver disease deaths in individuals ages 12 and older, 47% involved alcohol.

  • In 2009, alcohol-related liver disease was the main cause of almost 1 in 3 U.S. liver transplants.

  • Drinking alcohol increases risk of mouth, esophagus, pharynx, larynx, liver and breast cancers.

  • For full-time college students ages 18–22:

    • 58% drank alcohol in the past month, versus 48% of others the same age.

    • 38% reported binge drinking in past month, versus 33% of others the same age.

    • 13% reported heavy alcohol use in past month, versus 9% of others the same age.

 

Each year for U.S. college students between 18 and 24:

  • 1,825 die from alcohol-related unintentional injuries

  • 696,000 are assaulted by another student who’s been drinking.

  • 97,000 report experiencing alcohol-related sexual assault or date rape.

  • Roughly 20% of college students meet the criteria for AUD.

  • About 1 in 4 report academic consequences from drinking, including missing class, falling behind in class, doing poorly on exams or papers, and receiving lower grades overall.[77]

 

Alcohol use, a big a part of all abuse and addiction problems, is legal and loosely regulated in the U.S.  Marijuana isn’t?  As with other substances, most people are able to have healthy or non-problematic relationships with alcohol, but many have big problems with abuse, addiction and things that leads to. 

 

In 2017, the U.S. Federal Government collected $10 billion in alcohol taxes.[78]  In 2015, U.S. state and local governments collected $7 billion in alcohol taxes.[79]  Together, that’s $17 billion (1.5% of FADS), versus $249 billion in social costs, a net social cost of alcohol to society of $147 billion (13% of FADS).

Tobacco Problems

 

Tobacco is a natural plant with a long history of use by humans.  It is legal for adult use in the U.S., regulated and taxed by governments.  It can be physically addictive.  Cigarettes, cigars, pipe tobacco, chewing tobacco and snuffs are made from tobacco leaves.  E-cigarettes have recently become popular.

Tobacco products suffer problems other food and drink in the U.S. suffer from, through unhealthy agriculture and processing, like big uses of toxic chemical fertilizers, herbicides and insecticides in farming practices, and various chemical preservatives, additives and plastics used in processing and packaging, to add flavor, make it smoke better or affect aesthetics.  These make people sick.

Tobacco smoke has thousands of chemicals, including at least 70 known to cause cancer, carcinogens. Some of the chemicals found in tobacco smoke are:  Nicotine (the addictive drug that has the effects people are looking for), Hydrogen cyanide, Formaldehyde, Lead, Arsenic, Ammonia, Radioactive elements, Benzene, Carbon monoxide, Nitrosamines and Polycyclic aromatic hydrocarbons (PAHs).[80]

According to the Centers for Disease Control (CDC):

  • Smoking tobacco leads to disease and disability and harms almost every organ of the body.

  • Smoking causes cancer, heart disease, stroke, lung diseases, diabetes, and chronic obstructive pulmonary disease (COPD), which includes emphysema and chronic bronchitis.

  • Smoking increases risk for tuberculosis, certain eye diseases, and immune system problems, including rheumatoid arthritis.

  • Smoking is a known cause of erectile dysfunction in males.

  • Smoking is the leading cause of preventable death.

  • Worldwide, tobacco use causes nearly 6 million deaths per year.

  • Current trends show tobacco use will cause more than 8 million global deaths annually by 2030.

  • Cigarette smoking kills 480,000 per year in the U.S., including more than 41,000 from secondhand smoke exposure.  That’s one in five deaths annually, 1,300 deaths every day.

  • On average, smokers die 10 years earlier than nonsmokers.

  • 6 million (1 in 13) less than 18 years old, will die prematurely from a smoking-related illness, if they keep smoking at current rates.

  • More than 16 million people in the U.S. are living with a disease caused by smoking.

  • In 2016, the tobacco industry spent $10 billion on cigarette and smokeless tobacco advertising and promotion, about $26 million per day, more than $1 million per hour.

  • Total economic costs of smoking are more than $300 billion a year (26% of FADS), including:

    • Nearly $170 billion in direct medical care for adults

    • > $156 billion in premature death and lost productivity from exposure to secondhand smoke

  • State spending on tobacco prevention and control doesn’t meet CDC-recommended levels.  In 2018, states collected a record $28 billion from tobacco taxes and legal settlements, but only spent $722 million (less than 3%) on tobacco prevention and cessation programs. 

 

Cigarette Smokers in the U.S. in 2016 (who reported smoking every day or some days at survey time):

  • 16% of all adults (38 million people): 18% of males, 14% of females

  • 32% of American Indians/Alaska Natives

  • 25% of multiple race individuals

  • 17% of Blacks, and 17% of Whites

  • 11% of Hispanics, and 9% of Asians

  • Each day, more than 3,200 people younger than 18 years of age smoke their first cigarette.

  • Each day, 2,100 youth and young adults who were occasional become daily cigarette smokers.

  • 68% of adult cigarette smokers want to stop smoking.

  • 55% of adult cigarette smokers tried to quit in the past year.

 

Tobacco use is well-recognized as a far larger problem than illegal drugs.  Yet, it is perfectly legal, and marijuana, which is less harmful, is not.  Tobacco is a drug of choice of the white and privileged.

Make Drugs Legal?

 

“In business, if one of our companies is failing, we take steps to identify and solve the problem. What we don't do is continue failing strategies that cost huge sums of money and exacerbate the problem.”  - Sir Richard Branson on the U.S. War on Drugs Failure[81]

In the U.S., if all illegal drugs were taxed at rates comparable to those on alcohol and tobacco, they would yield $100 billion in tax revenue (9% of FADS).[82]  Legalizing drugs would save the U.S. $77 billion a year in enforcing the drug laws, as calculated above.  Together, that’s $177 billion (15% of FADS).  Many think we should make all drugs legal, regulate, manage and tax them, and use revenues to pay for counseling and social services needed to make it all safe and healthy, like Portugal.  What do you think?

Need for Change in our Relationships with Substances

 

People have been using alcohol, tobacco and a very wide range of plant medicines and teachers for a very long time, millennia, productively and healthily.  There are great benefits to using substances carefully, in the right settings, with the right guidance, for the right reasons, and with good intentions.  Insights and revelations can be extraordinarily therapeutic and valuable, including deeply profound and personal spiritual awakenings and advancements.  We can still do that.  We don’t have to.  It’s a choice.

 

Our society has a messy relationship with this stuff.  We’ve segregated them into acceptable medicines, administered by the healthcare system, or legal to use; and “illegal drugs,” demonized and punished, partially based on racist and political biases, and in strategic attacks to gain and control political power.  We’ve made those preferred by the white and empowered legal, though they do the greatest harms, and we’ve made those preferred by other races and those most likely to oppose that power illegal. 

We’ve enforced drug laws 48 years, spent more than $1 trillion on it, and put 1 in 50 of us in the criminal justice system over it, punishing us directly in prisons and indirectly with thousands of rules alienating us from normal rights and living, without eliminating use, availability or problems.  In doing that, we’ve produced incredible harms, not just for those selected users, but for their networks of loved ones.  We’ve also allowed it to undermine our representative democracy, disenfranchising huge numbers, enough to corruptly secure and retain political power for many, at every level of government.

 

Our healthcare system is a wicked problem itself, and its legal opioid pain drugs have led to a huge and epidemic crisis of death, addiction and loss.  Alcohol and tobacco are legal, but they have created many far bigger problems than illegal drugs.  Massive numbers of people in the U.S. are suffering physically, mentally and emotionally, and self-medicating because we cannot deal with our many wicked problems in healthier ways, or get help through our healthcare, government and social systems. 

Throughout this mess, there is the underlying motivation of misuse of substances to alleviate suffering.  That suffering comes from our wicked problems?  Together, our War on Drugs, mental health services, opioid epidemic, alcohol and smoking problems cost us at least $1.277 trillion (110% of FADS) a year.[83]  Waaaay broken.  Using common sense, this is dumb, right?  We can do better.  Let’s change! 

Get knowledgeable about our legal and illegal substances!  Understand what they are, how they work, what their benefits, costs and risks are, their proper doses and settings, how they can create problems, and what to do if those problems come up, even if you do not use them, so you can help others! 

If you engage with substances, do that knowledgeably, in ways that are optimal for those substances, with guidance and clear positive reasons and intentions!  Or don’t!  Nobody has to do any of them.

Don’t use these substances to treat emotional, psychological and life problems, rather than address the sources of those problems!  The way to stop feeling bad is to address what makes you feel bad, and do something about it, not avoid that effort by escaping into substances that numb or distract you from it.  Identify the real reasons for physical, emotional, spiritual and psychological pain and deal with those!  Don’t mask symptoms with substances!  Get professional, spiritual, family, friend and community help! 

Work to change to fair and effective drug laws and policies and get people out of the justice system for illegal drug use!  Use substances healthily if and when you choose, not because of outside pressures!  Share this information with others!  Be healthy!  Write to government and news organizations about it!

 
 
 
 
 
 
 
 

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Endnotes

 

[1] “Our Ancestors Got High, Too”, Cody Cottier, April 9, 2018, Discover, http://blogs.discovermagazine.com/crux/2018/04/09/ancestors-high-drugs/?utm_campaign=Feed%3A+AllDiscovermagazinecomContent+%28All+DISCOVERmagazine.com+stories%29&utm_medium=feed&utm_source=feedburner#.W7-5V2hKg2w

[2] “Global Overview of Drug Demand and Supply: Latest trends, cross-cutting issues”, World Drug Report 2018, Volume 2, United Nations Office on Drugs and Crime, https://www.unodc.org/wdr2018/prelaunch/WDR18_Booklet_2_GLOBAL.pdf

[3] “War on drugs a trillion-dollar failure”, Richard Branson, CNN, December 7, 2012, http://www.cnn.com/2012/12/06/opinion/branson-end-war-on-drugs/index.html

[4] “A Chart That Says the War on Drugs Isn't Working”, Serena Dai, October 12, 2012, The Atlantic, https://www.theatlantic.com/national/archive/2012/10/chart-says-war-drugs-isnt-working/322592/

[5] "A reality check on drug use", George F. Will, October 29, 2009, Washington Post, pp. A19, http://www.washingtonpost.com/wp-dyn/content/article/2009/10/28/AR2009102803801.html

[6] “Interactive: Explore how illegal drugs have become cheaper and more potent over time”, Talia Brohnshtein, Stat News, November 16, 2016, https://www.statnews.com/2016/11/16/illegal-drugs-price-potency/

[7] “Illegal Drugs Are Cheaper, Stronger than Ever”, Bahar Gholipour, October 3, 2013, Live Science, https://www.livescience.com/40169-illegal-drugs-cheaper-stronger.html

[8] “A Chart That Says the War on Drugs Isn't Working”, Serena Dai, October 12, 2012, The Atlantic, https://www.theatlantic.com/national/archive/2012/10/chart-says-war-drugs-isnt-working/322592/

[9] “Drug War Poll Shows Americans Believe U.S. Is Losing”, Lucia Graves, November 14, 2012, The Huffington Post, http://www.huffingtonpost.com/2012/11/13/drug-war-poll-losing_n_2125464.html

[10] “America's Longest War Has Shown Once Again Prohibition Doesn't Work”, Aaron Houston, July 6, 2012, U.S. News and World Report, https://www.usnews.com/debate-club/is-it-time-to-scale-back-the-war-on-drugs/americas-longest-war-has-once-again-shown-that-prohibition-doesnt-work

[11] “World Drug Report 2018:  Executive Summary Conclusions and Policy Implications”, United Nations Office on Drugs and Crime, https://www.unodc.org/wdr2018/prelaunch/WDR18_Booklet_1_EXSUM.pdf

[12 “War on drugs a trillion-dollar failure”, Richard Branson, CNN, December 7, 2012, http://www.cnn.com/2012/12/06/opinion/branson-end-war-on-drugs/index.html

[13] “Substance Abuse Treatment and Public Safety”, Justice Policy Institute, January 2008, http://www.justicepolicy.org/images/upload/08_01_REP_DrugTx_AC-PS.pdf

[14] “Drug War Facts”, http://www.drugwarfacts.org/chapter/drug_prison

[15] “Mass Incarceration: The Whole Pie 2018”, Peter Wagner and Wendy Sawyer, Prison Policy Initiative, March 14, 2018, https://www.prisonpolicy.org/reports/pie2018.html

[16] "Probation and Parole in the United States, 2015", (Washington, DC: US Dept of Justice Bureau of Justice Statistics, Dec. 2016), NCJ250230, Table 1, p. 3, and Table 4, p. 5., https://www.bjs.gov/content/pub/pdf/ppus15.pdf

[17] “Mass Incarceration: The Whole Pie 2017”, Peter Wagner, Bernadette Rabuy, March 14, 2017, Prison Policy Initiative, https://www.prisonpolicy.org/reports/pie2017.html

[18] “The U.S. Needs to Decriminalize Drug Possession Now”, Ethan Nadelmann, Rolling Stone, November 26, 2018, https://www.rollingstone.com/politics/politics-features/united-states-decriminalize-drug-possession-nadelmann-760001/

[19] “Police arrest more people for marijuana use than for all violent crimes — combined”, Christopher Ingraham, October 12, 2016, The Washington Post, https://www.washingtonpost.com/news/wonk/wp/2016/10/12/police-arrest-more-people-for-marijuana-use-than-for-all-violent-crimes-combined/?utm_term=.2d38eb43417f

[20] “Every minute, someone gets arrested for marijuana possession in the U.S.”, Christopher Ingraham, September 28, 2015, The Washington Post, https://www.washingtonpost.com/news/wonk/wp/2015/09/28/every-minute-someone-gets-arrested-for-marijuana-possession-in-the-u-s/?utm_term=.682f7eb59057

[21] “Every minute, someone gets arrested for marijuana possession in the U.S.”, Christopher Ingraham, September 28, 2015, The Washington Post, https://www.washingtonpost.com/news/wonk/wp/2015/09/28/every-minute-someone-gets-arrested-for-marijuana-possession-in-the-u-s/?utm_term=.682f7eb59057

[22] “More people were arrested last year over pot than for murder, rape, aggravated assault and robbery — combined”, Christopher Ingraham, September 26, 2017, The Washington Post, https://www.washingtonpost.com/news/wonk/wp/2017/09/26/more-people-were-arrested-last-year-over-pot-than-for-murder-rape-aggravated-assault-and-robbery-combined/?utm_term=.761a1a76f920

[23] “Every minute, someone gets arrested for marijuana possession in the U.S.”, Christopher Ingraham, September 28, 2015, The Washington Post, https://www.washingtonpost.com/news/wonk/wp/2015/09/28/every-minute-someone-gets-arrested-for-marijuana-possession-in-the-u-s/?utm_term=.682f7eb59057

[24] “Long-Term Pot Smoking Doesn’t Seem to Harm Health: Study”, Mandy Oaklander, June 7, 2016, Time, http://time.com/4359757/pot-smoking-marijuana-cannabis-health/

[25] “New study finds Marijuana less harmful than Alcohol or Cigarettes”, IFL Science, Accessed May 17, 2019, https://www.iflscience.com/health-and-medicine/new-study-suggests-risks-marijuana-use-have-been-overestimated/

[26] “Sixty percent of Americans favor legalizing pot, poll finds”, Chloe Aiello, 19 Jan 2018, CNBC.com, https://www.cnbc.com/2018/01/19/legalize-pot-say-majority-of-americans-in-nbcwsj-poll.html

[27] “More people were arrested last year over pot than for murder, rape, aggravated assault and robbery — combined”, Christopher Ingraham, September 26, 2017, The Washington Post, https://www.washingtonpost.com/news/wonk/wp/2017/09/26/more-people-were-arrested-last-year-over-pot-than-for-murder-rape-aggravated-assault-and-robbery-combined/?utm_term=.761a1a76f920

[28] “Here's where you can legally consume marijuana in the US in 2018”, Jeremy Berke, Business Insider, November 7, 2018, https://www.businessinsider.com/where-can-you-can-legally-smoke-weed-2018-1

[29] “What U.S. states have legalized medical marijuana?”, WebMD, https://www.webmd.com/a-to-z-guides/qa/what-us-states-have-legalized-medical-marijuana

[30] “Drug Schedules”, United States Drug Enforcement Administration, https://www.dea.gov/drug-scheduling

[31] “The Big Secret Surrounding Patent No. 6,630,507 [REVEALED]”, Staff, Marijuana Break, Updated on January 19, 2018, https://www.marijuanabreak.com/the-big-secret-surrounding-patent-no-6630507

[32] “Drug War Facts”, http://www.drugwarfacts.org/chapter/drug_prison

[33] "A reality check on drug use", George F. Will, October 29, 2009, Washington Post, pp. A19, http://www.washingtonpost.com/wp-dyn/content/article/2009/10/28/AR2009102803801.html

[34] “Imprisoning Drug Offenders Doesn’t Impact Drug Use, New Study Says: Pew researchers find no direct link between penalties and drug use”, Joyce Chen, Rolling Stone, June 20, 2017, https://www.rollingstone.com/culture/culture-news/imprisoning-drug-offenders-doesnt-impact-drug-use-new-study-says-206187/

[35] “Drug Convictions Can Send Financial Aid Up In Smoke:  Dude, where's my federal financial aid?”, Betsy Mayotte, April 15, 2015, U.S. News and World Report, https://www.usnews.com/education/blogs/student-loan-ranger/2015/04/15/drug-convictions-can-send-financial-aid-up-in-smoke

[36] “Voting With A Criminal Record - Executive Summary”, ACLU, https://www.aclu.org/other/voting-criminal-record-executive-summary

[37] “A Misdemeanor Conviction Is Not a Big Deal, Right? Think Again”, Maya Rhodan, April 24, 2014, Time, http://time.com/76356/a-misdemeanor-conviction-is-not-a-big-deal-right-think-again/

[38] “U.S. Department of Justice, Asset Forfeiture Program, FY 2018 PERFORMANCE BUDGET, Congressional Justification, https://www.justice.gov/file/968796/download

[39] Malign Neglect – Race Crime and Punishment in America, Michael Tonry, London: Oxford University Press, 1995, p 82,

[40] “Drug War Facts”, http://www.drugwarfacts.org/chapter/drug_prison

[41] See the chapter on Health and Healthcare

[42] “The Carter Center Mental Health Program: Combating the Stigma of Mental Illness", The Carter Center, https://www.cartercenter.org/health/mental_health/index.html

[43] “Study: U.S. Leads In Mental Illness, Lags in Treatment”, Rick Weiss, June 7, 2005, The Washington Post, http://www.washingtonpost.com/wp-dyn/content/article/2005/06/06/AR2005060601651.html

[44] “All-American Despair: For the past two decades, a suicide epidemic fueled by guns, poverty and isolation has swept across the West, with middle-aged men dying in record numbers”, Stephen Rodrick, Rolling Stone, May 30, 2019, https://www.rollingstone.com/culture/culture-features/suicide-rate-america-white-men-841576/

[45] "How to safely reduce prison populations and support people returning to their communities," June, 2010, p. 8, Justice Policy Institute, http://www.justicepolicy.org/images/upload/10-06_FAC_ForImmediateRelease_PS-AC.pdf

[46i] “Drug War Facts”, http://www.drugwarfacts.org/chapter/drug_prison

[47] “STATE SPENDING ON ADDICTION AND SUBSTANCE USE”, Center on Addiction, https://www.centeronaddiction.org/addiction/state-spending-addiction-risk-use

[48] “Mental Health and the Role of the States”, The PEW Charitable Trusts and the MacArthur Foundation, June 2015, https://www.pewtrusts.org/~/media/assets/2015/06/mentalhealthandroleofstatesreport.pdf

[49] “Legalize It All”, Dan Baum, April 2016, Harper’s Magazine, https://harpers.org/archive/2016/04/legalize-it-all/

[50] “Drug War Poll Shows Americans Believe U.S. Is Losing”, Lucia Graves, November 14, 2012, The Huffington Post, http://www.huffingtonpost.com/2012/11/13/drug-war-poll-losing_n_2125464.html

[51] “America's Longest War Has Shown Once Again Prohibition Doesn't Work”, Aaron Houston, July 6, 2012, U.S. News and World Report, https://www.usnews.com/debate-club/is-it-time-to-scale-back-the-war-on-drugs/americas-longest-war-has-once-again-shown-that-prohibition-doesnt-work

[52] “Police arrest more people for marijuana use than for all violent crimes — combined”, Christopher Ingraham, October 12, 2016, The Washington Post, https://www.washingtonpost.com/news/wonk/wp/2016/10/12/police-arrest-more-people-for-marijuana-use-than-for-all-violent-crimes-combined/?utm_term=.2d38eb43417f

[53] “War on drugs a trillion-dollar failure”, Richard Branson, CNN, December 7, 2012, http://www.cnn.com/2012/12/06/opinion/branson-end-war-on-drugs/index.html

[54] “Ending the War on Drugs: By the Numbers”, Betsy Pearl, Center for American Progress, June 27, 2018, https://www.americanprogress.org/issues/criminal-justice/reports/2018/06/27/452819/ending-war-drugs-numbers/

[55] “Police arrest more people for marijuana use than for all violent crimes — combined”, Christopher Ingraham, October 12, 2016, The Washington Post, https://www.washingtonpost.com/news/wonk/wp/2016/10/12/police-arrest-more-people-for-marijuana-use-than-for-all-violent-crimes-combined/?utm_term=.2d38eb43417f

[56] “Ending the War on Drugs: By the Numbers”, Betsy Pearl, Center for American Progress, June 27, 2018, https://www.americanprogress.org/issues/criminal-justice/reports/2018/06/27/452819/ending-war-drugs-numbers/

[57] “Ending the War on Drugs: By the Numbers”, Betsy Pearl, Center for American Progress, June 27, 2018, https://www.americanprogress.org/issues/criminal-justice/reports/2018/06/27/452819/ending-war-drugs-numbers/

[58] “Legalize It All”, Dan Baum, April 2016, Harper’s Magazine, https://harpers.org/archive/2016/04/legalize-it-all/

[59] “A Misdemeanor Conviction Is Not a Big Deal, Right? Think Again”, Maya Rhodan, April 24, 2014, Time, http://time.com/76356/a-misdemeanor-conviction-is-not-a-big-deal-right-think-again/

[60] “Voting With A Criminal Record - Executive Summary”, ACLU, https://www.aclu.org/other/voting-criminal-record-executive-summary

[61] “'It didn't happen overnight': How the U.S. opioid crisis got so bad”, Adriana Belmonte, Yahoo Finance, December 9, 2018, https://finance.yahoo.com/news/didnt-happen-overnight-u-s-opioid-crisis-got-bad-185552218.html

[62] “Short Answers to Hard Questions About the Opioid Crisis”, Josh Katz, August 10, 2017, The New York Times, https://www.nytimes.com/interactive/2017/08/03/upshot/opioid-drug-overdose-epidemic.html

[63] “The opioid epidemic is costing the U.S. more than $500 billion per year”, Maria LaMagna, November 26, 2017, MarketWatch, https://www.marketwatch.com/story/how-much-the-opioid-epidemic-costs-the-us-2017-10-27

[64] “Short Answers to Hard Questions About the Opioid Crisis”, Josh Katz, August 10, 2017, The New York Times, https://www.nytimes.com/interactive/2017/08/03/upshot/opioid-drug-overdose-epidemic.html

[65] “Why are Americans in so much pain?”, Mikaela Conley, Yahoo News, January 30, 2019, https://news.yahoo.com/americans-much-pain-141918964.html

[66] “Short Answers to Hard Questions About the Opioid Crisis”, Josh Katz, August 10, 2017, The New York Times, https://www.nytimes.com/interactive/2017/08/03/upshot/opioid-drug-overdose-epidemic.html

[67] “The opioid epidemic is costing the U.S. more than $500 billion per year”, Maria LaMagna, November 26, 2017, MarketWatch, https://www.marketwatch.com/story/how-much-the-opioid-epidemic-costs-the-us-2017-10-27

[68] “'It didn't happen overnight': How the U.S. opioid crisis got so bad”, Adriana Belmonte, Yahoo Finance, December 9, 2018, https://finance.yahoo.com/news/didnt-happen-overnight-u-s-opioid-crisis-got-bad-185552218.html

[69] “The OxyContin Clan: The $14 Billion Newcomer to Forbes 2015 List of Richest U.S. Families”, Alex Morrell, Forbes, July 1, 2015, https://www.forbes.com/sites/alexmorrell/2015/07/01/the-oxycontin-clan-the-14-billion-newcomer-to-forbes-2015-list-of-richest-u-s-families/#5e92709975e0

[70] “Damning court docs show just how far Sacklers went to push OxyContin:  Secretive, wealthy Sackler family is at the heart of the opioid crisis, lawsuit alleges.”, Beth Mole, Ars Technica, January 19 2019, https://arstechnica.com/science/2019/01/family-behind-oxycontin-called-addicts-criminals-while-pushing-pills/

[71] “OxyContin Maker Granted Patent for Opioid-Addiction Treatment”, Lilly Dancyger, September 11, 2018, Rolling Stone, https://www.rollingstone.com/culture/culture-news/oxycontin-purdue-pharma-patent-opioid-addiction-treatment-722646/

[72] “Ending the War on Drugs: By the Numbers”, Betsy Pearl, Center for American Progress, June 27, 2018, https://www.americanprogress.org/issues/criminal-justice/reports/2018/06/27/452819/ending-war-drugs-numbers/

[73] “All-American Despair: For the past two decades, a suicide epidemic fueled by guns, poverty and isolation has swept across the West, with middle-aged men dying in record numbers”, Stephen Rodrick, Rolling Stone, May 30, 2019, https://www.rollingstone.com/culture/culture-features/suicide-rate-america-white-men-841576/

[74] “Why life expectancy in America is down again”, C.K., The Economist, December 6, 2018, https://www.economist.com/democracy-in-america/2018/12/06/why-life-expectancy-in-america-is-down-again

[75] “Fact Sheets - Alcohol Use and Your Health”, U.S. Centers for Disease Control, Accessed December 20, 2018, https://www.cdc.gov/alcohol/fact-sheets/alcohol-use.htm

[76] “Alcohol”, World Health Organization (WHO), September 21, 2018, https://www.who.int/news-room/fact-sheets/detail/alcohol

[77] “Alcohol Facts and Statistics”, National Institute on Alcohol Abuse and Alcoholism, accessed December 20, 2018, https://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/alcohol-facts-and-statistics

[78] “Tax Policy Center Briefing Book:  Key Elements of the U.S. Tax System:  What are the major federal excise taxes, and how much money do they raise?”, Urban Institute and Brooking Institution Tax Policy Center, Accessed December 20, 2018, https://www.taxpolicycenter.org/briefing-book/what-are-major-federal-excise-taxes-and-how-much-money-do-they-raise

[79] “Alcohol Tax Revenue, 1977 to 2015”, Urban Institute and Brooking Institution Tax Policy Center, Accessed December 20, 2018, https://www.taxpolicycenter.org/statistics/alcohol-tax-revenue

[80] “Harmful Chemicals in Tobacco Products”, American Cancer Society, Accessed December 20, 2018, https://www.cancer.org/cancer/cancer-causes/tobacco-and-cancer/carcinogens-found-in-tobacco-products.html

[81] “War on drugs a trillion-dollar failure”, Richard Branson, CNN, December 7, 2012, http://www.cnn.com/2012/12/06/opinion/branson-end-war-on-drugs/index.html

[82] “Legalizing All Drugs Would Raise $100 Billion for U.S., Says Harvard Economist”, Zach Harris, Merry Jane, July 24, 2018, https://merryjane.com/news/legalizing-all-drugs-would-raise-100-billion-for-u-s-says-harvard-economist

[83] $60 billion a year on drug law policing, enforcement and punishment, plus $17 billion a year in War on Drugs social costs, plus $147 billion a year spent on mental health services, plus $504 billion for opioid epidemic costs, plus $249 billion economic costs of excessive alcohol consumption, plus $300 billion total economic costs of smoking.  Don’t worry if this is exactly right.  It isn’t.  It’s an estimate.  The point is that this is a huge problem.

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