Since I have worked in three U.S. Administrations on drug policy issues, I am often asked where I stand on drug policy and why.

Because I have argued stridently against legalization, people often assume that my preferred approach to drug policy is incarceration. So it is refreshing to be able to set the record straight. Here are a handful of principles that reflect what I really think.

          1. Mend it, don’t end it. Current drug policy leaves something to be desired – unintentional drug overdoses are the second leading cause of death, millions of people are saddled arrests that can hamper their future prospects and render them unemployable, and we only give treatment to 10 percent of those who need it. But illegal drugs are still used by far fewer people than legal drugs, and we’ve learned over the past few decades that targeted enforcement (like this) against violent dealers community organizing (like this), and treatment connected to swift and certain sanctions (like this and this) are both effective and cost-effective. Ending our current effort against drugs would put us at great public health risk. So why not just make it better?

          2. Legalization is a simplistic solution to a complicated problem. Dispassionate research tells us that legalization would slash current drug prices and thereby increase their use. Use of our already legal substances, alcohol and tobacco, far outpaces that of our illegal drugs Furthermore, our experience with even tightly regulated prescription drugs, such as Oxycontin, shows that legalization widens drug availability and misuse, even when well-meaning controls are in place. And don’t even think about tax revenues. Federal excise taxes collected on alcohol in 2007 totaled around $9 billion; states collected around $5.5 billion – a pittance compared to the $185 billion in alcohol-related costs to health care, the criminal justice system, and productivity in the workplace. Tobacco does not fare much better. Each year, Americans lose more than $200 billion in the social costs of smoking, but only about $25 billion are collected in tobacco taxes. Want to reduce arrest rates? Legalization likely won’t help – alcohol, a legal drug, is responsible for more than 2.6 million arrests a year. That’s almost a million more arrests than for all illegal drugs combined.

          3. Drug policy is dynamic. Good policy today may be bad policy tomorrow. Just ask the Congressional Black Caucus. Their activism secured the passage of strict mandatory minimums for crack cocaine – sentences that were severely more punitive than those for powder cocaine. Now, they argue that the time has come to end such laws. And they’re right. But perhaps the biggest lesson here is that laws and policies need to be constantly adapted to current drug trends. Fifteen years ago, we probably didn’t need a Prescription Drug Monitoring Program to monitor pill use. Now we clearly do. Jon Caulkins says it best.

          4. Is marijuana medicine? Smoked marijuana isn’t, but in pill or other forms, isolated components of the drug can be. Today we have two medications based on these components – Marinol and Cesamet – and in the future we might have more. Studying the marijuana plant is an exciting area of science, especially as we’ve recently learned that our own brains and bodies produce natural compounds similar to those in marijuana, and that they have a role in regulating numerous physiological processes including appetite, memory, and pain. One of the more promising marijuana-based medications is Sativex – a drug that combines two of marijuana’s components while creating no dependence-inducing “high.” The makers of Sativex are doing it right – working within the established Food and Drug Administration (FDA) process rather than through the shady political process of “medical marijuana” initiatives in various states. Voters aren’t qualified to determine what medicine is, but scientists sure are: the medical profession does not tell us to chew on willow bark; it tells us to take a particular dosage of aspirin. Similarly, we wouldn’t ask someone to smoke opium in order to reap the benefits of morphine. So it makes little sense to smoke marijuana to get any medical benefits that the plant might offer.

          5. Treatment [insert Prevention or Enforcement] works, but it isn’t enough. If I had a dollars for everyone who told me that our drug problem would go away if we only invested more in treatment, I’d be rich. The truth is that most people with a drug problem don’t think they have one, and therefore, don’t seek treatment. That isn’t to say that we shouldn’t invest more in treatment; doing so would substantially reduce crime, reduce health care costs, and increase productivity. And treatment availability certainly varies depending on which neighborhood you come from. But while treatment is vital to reducing our drug problem, it is only part of the solution.

          6. The criminal justice system is vital to the public health of Americans, but we must use that system wisely. I often hear the argument, “Since the criminal justice system ruins otherwise innocent people’s lives, we should legalize drugs.” This, of course, would be appealing if we lived in a world where our only two options were long-term incarceration and legalization. You’ve probably figured out by now that I reject that dichotomy. In fact, the criminal justice system – by using both incentives and coercion wisely – has great potential to enhance public health. But we are still learning how to use the justice system wisely. Mean-spirited laws that bar ex-drug offenders from getting jobs, housing, or education once they have moved on from drug use rarely have a deterrent effect. However, I’m a fan of judicial training, drug courts, and probation programs like HOPE. These approaches recognize that swiftness and certainty of punishment – not simply severity – are keys to changing behavior. Now if only most of the criminal justice system would catch up, we’d all be much better off.