Why we should legalize drugs by Benson B. Roe, MD Benson Roe is Professor Emeritus and former Chair of Cardiothoracic Surgery at the University of California at San Francisco. And "poison" is also a misleading shibboleth. The widespread propaganda that illegal drugs are "deadly poisons" is a hoax. There is little or no medical evidence of long term ill effects from sustained, moderate consumption of uncontaminated marijuana, cocaine or heroin. If these substances - most of them have been consumed in large quantities for centuries - were responsible for any chronic, progressive or disabling diseases, they certainly would have shown up in clinical practice and/or on the autopsy table. But they simply have not! More than 20 years ago when I was removing destroyed heart valves from infected intravenous drug abusers I assumed that these seriously ill patients represented just the tip of the iceberg of narcotic abuse. In an effort to ascertain what proportion of serious or fatal drug-related disease this group represented, I sought information from the San Francisco Coroner. To my surprise he reported that infections from contaminated intravenous injections were the only cause of drug-related deaths he saw except for occasional deaths from overdoses. He confirmed the inference that clean, reasonable dosages of heroin, cocaine and marijuana are pathologically harmless. He asserted he had never seen a heroin user over the age of 50. My obvious conclusion was that they had died from their. habit but he was confident that they had simply tired of the drug and just quit. When asked if the same were basically true of marijuana and cocaine, he responded affirmatively. That caused me to wonder why these substances had been made illegal. It is frequently stated that illicit drugs are "bad, dangerous, destructive" or "addictive," and that society has an obligation to keep them from the public. But nowhere can be found reliable, objective scientific evidence that they are any more harmful than other substances and activities that are legal. In view of the enormous expense, the carnage and the obvious futility of the "drug war," resulting in massive criminalization of society, it is high time to examine the supposed justification for keeping certain substances illegal. Those who initiated those prohibitions and those who now so vigorously seek to enforce them have not made their objectives clear. Are they to protect us from evil, from addiction, or from poison? The concept of evil is derived from subjective values and is difficult to define. just why certain (illegal) substances are singularly more evil than legal substances like alcohol has not been explained. This complex subject of "right" and "wrong" has never been successfully addressed by legislation and is best left to the pulpit. Addiction is also a relative and ubiquitous phenomenon. It certainly cannot be applied only to a short arbitrary list of addictive substances while ignoring. a plethora of human cravings - from chocolate to coffee, from gum to gambling, from tea, to tobacco, from snuggling to sex. Compulsive urges to fulfill a perceived need are ubiquitous. Some people are more susceptible to addiction than others and some "needs" are more addictive than others. Probably the most addictive substance in our civilization is tobacco - yet no one has suggested making it illegal. As for prohibition, it has been clearly demonstrated that when an addictive desire becomes inaccessible it provokes irresponsible behavior to fulfill that desire. Education and support at least have a chance of controlling addiction. Deprivation only sharpens the craving and never works. Even in prison addicts are able to get their `fix.' And "poison" is also a misleading shibboleth. The widespread propaganda that illegal drugs are "deadly poisons" is a hoax. There is little or no medical evidence of long term ill effects from sustained, moderate consumption of uncontaminated marijuana, cocaine or heroin. If these substances - most of them have been consumed in large quantities for centuries - were responsible for any chronic, progressive or disabling diseases, they certainly would have shown up in clinical practice and/or on the autopsy table. But they simply have not! Media focus on the "junkie" has generated a mistaken impression that all uses of illegal drugs are devastated by their habit. Simple arithmetic demonstrates that the small population of visible addicts must constitute only a fraction of the $150 billion per year illegal drug market. This industry is so huge that it necessarily encompasses a very large portion of the ordinary population who are typically employed, productive, responsible and not significantly impaired from leading conventional lives. These drug users are not "addicts" just as the vast majority of alcohol users are not "alcoholics." Is it not a ridiculous paradox to have laws to protect us from relatively harmless substances and not from the devastating effects of other substances that happen to be legal? It is well known that tobacco causes nearly a million deaths annually (in the US alone) from cancer, cardiovascular disease and emphysema; more than 350,000 die from alcohol-related cirrhosis and its complications and caffeine is the cause of cardiac and nervous system disturbances. These facts suggest that the public is being fraudulently misled into fearing the wrong substances and into complacency about hazardous substances by allowing their sale and even subsidization. Our environment contains a plethora of hazards, of which recreational substances are much less important than many others. Recognizing the reality of consumer demand and the perspective of relative harm should make a strong case for alternatives to prohibition. Should we not have teamed from the failure of the Volstead Act of the 1920s and the current ubiquitous availability of illegal drugs that prohibition is the height of futility? Is it not time to recognize that the " problem" is not the drugs but the enormous amounts of untaxed money diverted from the economy to criminals? The economic incentive for drug dealers to merchandise their product aggressively is a multi-billion dollar return which has a far more powerful effect to increase substance abuse than any enforcement program can possibly do to, constrain that usage. The hopeless challenge of drug crime is compounded by the parallel expansion of theft, crime, which is the principal economic resource to finance the drug industry. How can this be anything but a lose-lose situation for society? We should look at the fact that a relatively low budget public education campaign has resulted in a significant decline in US consumption of both alcohol and tobacco during a period when a costly and intensive campaign to curtail illegal drugs only resulted in their increased usage. Is there a lesson to be heeded? Of course there is. Scrap the nonsense of trying to obliterate drugs and acknowledge their presence in our society as we have with alcohol and tobacco. Legalization would result in: purity assurance under Food and Drug Administration regulation; labeled concentration of the product (to avoid overdose); obliteration of vigorous marketing ("pushers"); obliteration of drug crime and reduction of theft crime savings in expensive enforcement and significant tax revenues. Effort and funds can then be directed to educating the public about the hazards of all drugs. Can such a change of attitude happen? Probably not, because the huge illegal drug industry has mountains of money for a media blitz and for buying politicians to sing the songs of "evil" and "danger" which is certain to kill any legislative attempt at legalization. Perhaps it will take some time before reality can prevail, but meanwhile we should at least do more to expose deception and to disseminate the truth.