05/15/2013 11:40 am ET Updated Jul 15, 2013

Still Drug Crazed After All These Years

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Mike Graydied recently, at 77 years of age, with prominent obituaries in some publications due to his status as a successful movie screenwriter -- his most famous screenplay being for The China Syndrome, which was released in 1979 and garnered him an Oscar nomination. The film had considerable star power with Michael Douglas, Jack Lemmon, and Jane Fonda, and portrayed a near-disaster at a nuclear power plant, with resulting cover-up attempt. Just after the film premiered, Three Mile Island's nuclear meltdown occurred, and Gray looked like some sort of soothsayer.

As the New York Times aptly put it in his obituary, Gray "tackled thorny contemporary issues in his work." Beyond nuclear energy's risks, another such issue was drug policy, which he examined in his 1999 book Drug Crazy: How We Got Into This Mess and How We Can Get Out, which remains -- sadly -- an insightful and dismaying look at what even the AMA has called our nation's worst public health malady.

Gray's book effectively utilizes "street stories" featuring cops, addicts, drug treatment workers and more to illustrate the real-life impact of drug policies -- which are his primary focus. And according to Gray, the "drug war" has been a failure on many fronts. More than one-third of Americans over 11 have consumed illegal drugs and use of such drugs has fluctuated regardless of government efforts. Our prisons are overflowing from drug-related convictions, while drug-related crime has risen; AIDS has spread among drug users; drug treatment is often not available to those who want it; doctors are afraid to prescribe even needed medications; and countless lives are being ruined by the drug war's policies.

Gray held that the best measure of failure comes from the law of supply and demand: "After blowing hundreds of billions of dollars and tens of thousands of lives, the drugs on the street today are stronger, cheaper, more pure and more widely available than at any time in history." Further, the drug war has poisoned much else in American society, "blanketing the nation in a smog of delusion so pervasive nobody can see it, even as it warps foreign policy, corrodes the Bill of Rights and successfully reverses years of progress in race relations."

And much of the "warfare" is targeted at the wrong people, Gary wrote. "The medical literature is filled with thoroughly documented records of addicts who functioned normally throughout their lives"; in other words, the majority of people who experiment socially with illegal drugs suffer little harm and do not progress to addiction. Gray noted that the actual dangers posed by illegal drugs are dwarfed by the hazards of legal ones: "When compared to the annual number of premature deaths from tobacco (400,000) and from alcohol (100,000), drug deaths lag far behind." It's also true that the vast majority of casual users of drugs such as marijuana do not go on to try "harder" drugs. Even for those who do, "fewer than one percent of those who try cocaine become daily users."

Such facts have been known for a long time, but, as Gray pointed out, ideological opposition to any kind of drug use or to any hint of its approval have "overwhelmed the handful of scientists who tried to put the brakes on this juggernaut." For example, one medical expert, San Francisco's Dr. David Smith, founder of the Haight-Ashbury Free Medical Clinics and a pioneer in addiction medicine, was labeled as "pro-drug" in the '80s by anti-drug parent activists; "Having (Smith) on programs to fight drug use is like having Adolf Hitler teaching the American Generals how to fight the German Army," wrote one such parent who was "disgusted" by Smith's factual, nonjudgmental approach to drug education.

And with the rise of the "Just Say No" movement, "the most remembered phrase of the Reagan presidency... and the most ridiculed," all discussion of such innovative strategies as methadone maintenance or needle exchange "were just out... You had to just say no to all of it." By the end of the '80s, "Just Say No" was a largely discredited and commercialized slogan, but the effect of its "zero tolerance" imperative has been more lasting and pernicious. To implement that policy, the government turned to the military and the police.

The failures of alcohol prohibition earlier in the century are well-known, but the situation now is even worse. Addicts have no constituency, Gray notes, and since Prohibition, "whenever senators or congressmen found themselves outflanked on the right, they could come down on addicts like avenging angels to prove how tough they were on crime." In the process, the courts have been swamped with futile "revolving door" arrests on the one extreme and handing out inhumane mandatory sentences on the other.

It is undeniable that addiction has been a nightmare for millions of Americans, and drug-related crime has destroyed many communities. But while they differ somewhat in the details, but Gray argued that we need a radically different approach to these problems. What then should be done? The consensus still grows that a public health-oriented approach is needed, focusing on prevention and treatment rather than crime and punishment. Prevention relies on reality-based education, argued Gray, for "apparently the one sure-fire way to cut down on drug use is to give people the facts and let them use their own judgment." For those who "fail" drug education, guaranteed treatment for addicts, both free and imprisoned, is also necessary, without the long waiting lists that has those who want to quit drugs being "sucked back into the street." Contrary to popular perception, drug treatment, while admittedly far from foolproof, is preferable to the law enforcement approach, even for preventing crime and saving money.

In order to implement these and other policy improvements, such as the decriminalization of marijuana (which was favored in California and four other states in recent elections), drug laws would need to be changed, entailing a lot of activism and education. Beyond ideology and fear, the lure of money on all sides -- drug profits for dealers, and enforcement and incarceration funds for those who fight them -- may be the biggest obstacle to change. Many Americans profit from the status quo, even as they might publicly deplore it. But there is an ever-growing list of observers of all political and professional stripes who are questioning the path the United States is on. Gray's Drug Crazy remains a crucial and eloquent call for reform.

I met Gray just one, at a drug policy forum I co-hosted and where he was a speaker, and I asked him if he thought his pleas would be heeded anytime soon. "Probably not in my lifetime," he ruefully answered. And alas, with few exceptions, it seems he was right again.