Dimensions: 6'' x 9'' AEI Press  (Washington) Publication Date: February 2005 Paperback ISBN: 0844741914 Price: $ 20.00 Add to Cart   Examination Copies

April 2005
An Analytic Assessment of U.S. Drug Policy
By David Boyum and Peter Reuter

 This book summary is also available here as an Adobe Acrobat PDF.

The United States currently spends approximately $40 billion every year to control drug use, but is drug use, in fact, decreasing? In An Analytic Assessment of U.S. Drug Policy, David Boyum and Peter Reuter evaluate the effectiveness of government efforts in the war on drugs and recommend that American drug policy should be reoriented toward reducing drug-related problems and expanding treatment services for heavy users.

David Boyum is an independent consultant in New York City, and Peter Reuter is a professor at the University of Maryland and a senior economist in the Drug Policy Research Center at RAND.

The use of illegal drugs is an enduring social problem in the United States, especially in urban minority communities. Government policy has attempted to limit the use and abuse of drugs through a vigorously enforced prohibition, coupled with modest provisions of drug treatment and prevention programs. Notwithstanding large expenditures over many years—about $40 billion a year now—and the incarceration of nearly half a million people for drug offenses, America continues to experience the Western world’s worst drug problems. There are many possible changes in drug policy—ranging from modest reforms to sweeping ones—that might be more successful.

An Analytic Assessment of U.S. Drug Policy is a comprehensive survey and analysis of drug use and drug policy in the United States. The book presents a brief history of America’s drug control efforts, examines current patterns of drug use and abuse, evaluates drug control policies, and discusses opportunities for improvement. Two-thirds of America’s drug control funding goes to enforcement programs; only 25 percent goes to treatment and 12 percent to prevention. Are these the correct ratios of funding? The authors of this study believe the evidence suggests it is not. While America has pursued an “enforcement first” approach to drug control for decades, there has been little progress made in the war on drugs. A careful evaluation of these programs suggests that more support for treatment and prevention might be a better use of our resources.

Historical Development

Until the late 1960s, illegal drugs were a modest problem in the United States. By 1970 an epidemic of heroin use and the normalization of occasional marijuana use led Richard Nixon to become the first president to declare a “war on drugs.” The Nixon administration pressured Turkey to ban opium production, thought to be the source of most of the heroin consumed in the United States, and established a federally subsidized drug treatment system. After a lull in the later 1970s, the cocaine and crack epidemics of the 1980s prompted a massive intensification in drug enforcement. Laws were toughened at every level of government, an approach that has remained unchanged over the last two decades.

The development of policy goals has been a particularly important part of this story. At least since 1989, when the first National Drug Control Strategy was submitted to Congress by the administration of George H. W. Bush, the principal goal of federal drug policy has been to reduce the percentage of Americans who use drugs—that is, the prevalence of drug use. The emphasis on prevalence is problematic, since it is based on a misunderstanding of the true nature of America’s drug problem: most of the damage associated with drugs involves a small minority of drug users who engage in compulsive use, and it is unlikely that rates of heavy use are affected much by general prevalence, except perhaps in the long run.

America’s Drug Problems

About one in fifteen Americans ages twelve and over currently uses drugs. By a wide margin, prevalence is highest among older teenagers and those in their early twenties. Most Americans who try drugs use them only a few times.

Marijuana is by far the most commonly used illicit drug. In broad population surveys, three-quarters of Americans who say they currently use drugs report marijuana use, while fewer than half report use of any other illicit drug. Since most marijuana users are not dependent, trends in the overall prevalence of drug use largely reflect trends in casual marijuana use.

While most drug users are occasional marijuana smokers, a substantial (and, on average, older) minority are chronic abusers of heroin, cocaine, and crack. These long-term users, who account for most of the estimated $60 billion spent annually on drugs, are largely the product of the three drug epidemics the nation has experienced since the late 1960s, which focused on each of the above drugs in turn. Those epidemics are long past and there have been very few new users of cocaine, crack, or heroin since the late 1980s, so the number of people addicted to these drugs has been falling for some time. Methamphetamine has become a major problem in many parts of the country, but the number of users still remains much smaller than for cocaine or heroin.

These heavy users also account for most of the harmful effects of drug abuse, including illness, death, homelessness, poverty, neglectful parenting, lost productivity, crime, and violence. For example, intravenous drug use accounts for a large share of U.S. AIDS cases, and most people who are arrested for crimes test positive for recent drug use. The total social costs of drug use (including health effects, crime, and lost productivity) were estimated to be $160 billion in 2000.

Drug use in the general population appears to be driven largely by cultural and epidemiological factors rather than by policy. New drugs acquire glamour, and new users recruit friends. When the adverse effects of a drug become apparent, recruitment drops sharply. If the drug is addictive, like heroin, however, there may still be a large population of addicts.

Current Policies

The federal government spends about $20 billion annually on drug control. State and local governments probably spend about the same. Enforcement programs dominate the federal drug control budget, accounting for about two-thirds of expenditures; the ratio is even more pronounced for state and local expenditures. Most enforcement is domestic. International enforcement programs, though widely publicized, typically receive less than 5 percent of the federal drug budget. Interdiction (attempts to seize drugs or couriers on their way into the United States) absorbs another 10 percent of the budget. In terms of demand reduction programs, treatment expenditures usually receive 25 percent of federal drug spending and prevention about 12 percent.

The intensity of drug enforcement since 1980 has risen massively. There has been more than a tenfold rise in the population of imprisoned drug offenders; in 2002 approximately 300,000 drug offenders were in state and federal prisons, and 150,000 inmates were held in local jails on drug charges. The growth in drug incarcerations rose during the 1990s even as the size of the drug markets was decreasing.

Drug treatment funding has grown substantially in recent years, but most people dependent on cocaine, heroin, or methamphetamines are still not in treatment. For example, of the estimated 1 million chronic heroin users, fewer than 200,000 are receiving methadone.

There are two main components of drug prevention policies: school-based programs—the largest of which is Drug Abuse Resistance Education (DARE)—and mass-media campaigns. DARE, by far the most popular of school prevention programs, is not effective and is currently undergoing major changes. Almost no attention is given to stopping drug use after it has begun but before it has produced identifiable symptoms or problems; similarly, prevention programs do not try to minimize the health consequences of drug abuse.

Policy Effectiveness

Enforcement efforts against established drug markets (such as cocaine or heroin) are unlikely to reduce drug supplies significantly. Enforcement does impose costs on traffickers and dealers, however, which makes drugs more expensive for users and reduces consumption.

In contrast, it is doubtful that international programs do much to raise prices, since the cost of drugs in source countries is a tiny fraction of the prices paid by American users, or to reduce supplies. There have been a few occasions when crop eradication efforts have created meaningful shortages, but these are very rare events (none has occurred in over twenty-five years), and the outlook for such opportunities is not promising.

Interdiction aimed at smugglers adds more to retail drug prices than does overseas enforcement, but the contribution still appears modest. Import prices typically account for about 10 percent of retail prices, suggesting that even a substantial increase in the cost of importing drugs would not have a major effect on retail prices. And experience indicates that traffickers rapidly adapt routes and conveyance methods in response to enforcement pressure.

Domestic enforcement is likely responsible for most of the impact of enforcement on retail prices. However, enforcement faces diminishing marginal returns, and it is hard to find evidence that the massive increase in dealer incarceration beginning in the 1980s has done much to boost drug prices or reduce availability. Adjusted for inflation, cocaine prices have fallen by more than half since 1980, despite much greater enforcement efforts.

In contrast, there is significant evidence that drug treatment can be effective. Most studies have found that participation in treatment programs is associated with declines in drug use, criminal activity, and HIV risk behaviors, both during and after treatment. Importantly, the best cost-benefit analysis to date found that an additional dollar spent on treating heavy users was several times more beneficial than an additional dollar spent on any kind of enforcement.

While drug treatment is effective, prevention has not been. Prevention programs have not shown that they can consistently reduce the percentage of their subjects who use drugs. Some school-based programs have shown promise but have not been able to demonstrate effectiveness when implemented without researcher supervision. Evaluations of anti-drug media campaigns have found no positive changes in attitudes or drug use among those exposed to campaign messages. There is evidence that some mass-media campaigns have been effective in reducing youth cigarette smoking; whether those successes are potentially applicable to drugs is an open question.

Policy Reforms

There is considerable uncertainty about the effectiveness of U.S drug policy. The evidence, though imperfect, points strongly to the conclusion that America’s drug policy is overly harsh.
Domestic enforcement should be directed more toward reducing drug-related problems, such as violence around drug markets, rather than on locking up large numbers of low-level dealers. Crop eradication should not be a routine aspect of international programs, especially where it may conflict with other foreign policy objectives. Criminal punishment of marijuana use does not appear justified; the criminal justice system should be focused on dealing with abusive users of cocaine, crack, and heroin, not casual users of marijuana.

Treatment services should be expanded. Perhaps more important, treatment needs to be concentrated on heavy, criminally active users. A good starting point would be to increase funding and reduce burdensome regulation of methadone and other opiate maintenance therapies. Programs that coerce convicted drug addicts to enter treatment and maintain abstinence as a condition of continued freedom should be augmented.

Tough enforcement, the centerpiece of American drug policy in terms of rhetoric, budget, and substance, has little to show by way of success. If, instead of putting 450,000 drug sellers and users into local jails and state and federal prisons, the nation were to lock up only 225,000, a great many people (both inmates and their families) would suffer less. It is surely reasonable to ask that those who would maintain the status quo offer some basis for believing this additional expense and suffering is justified.

 This book summary is also available here as an Adobe Acrobat PDF.