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Legalization of Drugs of Abuse and the Pediatrician

Legalization of Drugs of Abuse and the Pediatrician Abstract • Growing numbers of individuals are proposing that drugs be legalized in the United States, with claims that federal, state, and local efforts to prohibit the use of illicit drugs are irrational and unenforceable. "Drug reform" advocates include persons of all political persuasions. Ironically, the call for drug reform comes at a time when trends in drug abuse, as reflected in national and state surveys, show a promising decline. It also is contradictory to at least one recent public opinion poll, in which respondents opposed the legalization of marijuana by a five-to-one margin. While their position is by no means unanimous, proponents of drug reform generally base their arguments on several key premises, such as elimination of or reductions in drug trafficking, enforcement, and interdiction expenditures; increased tax revenues from the legal sale of drugs; and reductions in health-care expenses associated with drug treatment. Reform advocates further claim that legalization would not be followed by an increase in drug use. The validity of each of these arguments is highly questionable. Legalization is a simplistic, short-sighted solution to a complex issue with public health, economic, criminal justice, and societal ramifications. Legalization would, moreover, abrogate the position taken in 1961 by the United States and 114 other nations in ratifying the United Nations Single Convention on Narcotic Drugs. The impact of drug reform merits an unbiased study by an independent agency. Until that time, pediatricians should inform themselves of the arguments for and against drug reform and be prepared to educate patients and their families about the issue. (AJDC. 1991;145:1153-1158) References 1. The Drug Policy Foundation. Drug Prevention Newsletter. 1990. 2. Trebach AS. The Great Drug War . New York, NY: Macmillan Publishing Co; 1987. 3. Ostrowski J. Thinking about drug legalization . CATO Institute Policy Analysis . Washington, DC: CATO Institute; 1989;121. 4. Hay JW. The harm they do to others: a primer on the external costs of drug abuse. Presented at the Hoover Institution Conference on US Drug Policy; November 15, 1990; Stanford, Calif. 5. Rosenthal MS. The logic of legalization: a matter of perspective. Presented at the Hoover Institution Conference on US Drug Policy; November 15, 1990; Stanford, Calif. 6. Schwartz RH, Hayden GF, Getson PR, DiPaola A. Drinking patterns and social consequences: a study of middle-class adolescents in two private pediatric practices . Pediatrics . 1986;77:139-143. 7. Bohman M, Cloninger R, Sigvardsson S, Von Knorring A-L. The genetics of alcoholism and related disorders . J Psychiatry Res. 1987;21:447-452.Crossref 8. Cloninger CR, Bohman M, Sigvardsson S. Inheritance of alcohol abuse . Arch Gen Psychiatry . 1981;38:861-868.Crossref 9. Goodwin DW. Adoption studies of alcholism . Prog Clin Biol Res. 1981;69:71-76. 10. Friedman AS, Glickman N, Utada U. Does drug and alcohol use lead to failure to graduate from high school? J Drug Educ. 1985;15:353-364.Crossref 11. Zwerling C, Ryan J, Endel JO. The efficacy of preemployment drug screening for marijuana and cocaine in predicting employment outcome . JAMA . 1990;264:2639-2643.Crossref 12. Schwartz RH, Luxenberg MG, Hoffman NG. 'Crack' use by American middle-class adolescent polydrug abusers . J Pediatr. 1991;118:150-155.Crossref 13. Jenny L, Schwartz RH. Adolescent drug dependency and the family . Va Med. 1985;112:711-713. 14. Bell P. Arguments against legalizing drugs . Drug Abuse Update . 1988;26:18-19. 15. Van de Wijngaart GF. A social history of drug use in the Netherlands: policy outcomes and implications . J Drug Issues . 1988;18:481-495. 16. Sherer MA, Kumor KM, Cone EJ, Jaffe JH. Suspiciousness induced by four-hour intravenous infusions of cocaine: preliminary findings . Arch Gen Psychiatry . 1988;45:673-677.Crossref 17. Gawin FH, Ellinwood EH Jr. Cocaine and other stimulants: actions, abuse, and treatment . N Engl J Med. 1988;318:1173-1182.Crossref 18. Deriet RW, Albertson TE. Emergency department presentation of cocaine intoxication . Ann Emerg Med. 1989;18:182-186. 19. Tardiff K, Gross E, Wu J, Stajie M, Millman R. Analysis of cocaine-positive fatalities . J Forensic Sci. 1989;34:53-63. 20. Budd RD. Cocaine abuse and violent death . Am J Drug Alcohol Abuse . 1989;15:375-382.Crossref 21. Schwartz RH, Hoffman NG, Smith D, Hayden GF, Riddile N. Use of phencyclidine among adolescents attending a suburban drug treatment facility . J Pediatr. 1987;110:322-324.Crossref 22. Regan DO, Ehrlich SM, Finnegan LP. Infants of drug addicts: at risk for child abuse, neglect, and placement in foster care . Neurotoxicol Teratol . 1987;9:315-317.Crossref 23. Bays J. Substance abuse and child abuse . Pediatr Clin North Am . 1990;37:881-904. 24. Summary of trend analysis from 1990 National Household Survey on Drug Abuse . NIDA Capsules . (December) 1990. 25. Facts about teenagers and drug abuse . NIDA Capsules . (January) 1991. 26. Office of Alcohol and Drug Abuse Programs. Oregon Public School Drug Use Survey: 1990 . Salem, Ore: Department of Human Resources, State of Oregon; 1990. 27. Wayne S. 1989 Virginia Youth Survey: Main Findings . Richmond, Va: Governor's Council on Alcohol and Drug Abuse Problems; 1990. 28. Maryland Department of Health and Mental Hygiene. 1989-1990 Survey of Substance Abuse Among Maryland Adolescents . Baltimore, Md: Alcohol and Drug Abuse Administration and the Juvenile Advisory Council of Maryland; 1989. 29. Drug and Alcohol Use Among New Jersey High School Students: 1990 . Trenton, NJ: New Jersey Department of Law and Public Safety; 1990. 30. Report to the Attorney General. Biennial Survey of Drug and Alcohol Use Among California Students in Grades 7, 9, and 11: Winter 1989-90 . Sacramento, Calif: Office of the Attorney General, Crime Prevention Center; 1991. 31. Lindenbaum GA, Carroll SF, Daskal I, Kapusnick R. Patterns of alcohol and drug abuse in an urban trauma center: the increasing role of cocaine abuse . J Trauma . 1989;29:1654-1658.Crossref 32. Soderstrom CA, Triffilis AL, Shankar BS, Clark WE, Cowley RA. Marijuana and alcohol abuse among 1023 trauma patients . Arch Surg. 1988;123:733-737.Crossref 33. Harruff RC, Francisco JT, Elkins SK, Phillips AM, Fernandez GS. Cocaine and homicide in Memphis and Shelby County: an epidemic of violence . J Forensic Sci. 1988;33:1231-1237. 34. Berman AL, Schwartz RH. Suicide attempts among adolescent drug users . AJDC . 1990;144:310-314. 35. Fullilove RE, Fullilove MT, Bowser BP, Gross SA. Risk of sexually transmitted disease among black adolescent crack users in Oakland and San Francisco, Calif . JAMA. 1990;263:851-855.Crossref 36. Jenny C. Adolescent risk-taking behavior and the occurrence of sexual assault . AJDC . 1988;142:770-772. 37. Hingson RW, Strunin L, Berlin BM, Heeren T. Beliefs about AIDS, use of alcohol and drugs, and unprotected sex among Massachusetts adolescents . Am J Public Health . 1990;80:295-299.Crossref 38. Chasnoff IJ. Drug use in pregnancy: parameters of risk . Pediatr Clin North Am . 1988;82:888-895. 39. Novick LF, Berns D, Stricof R, Stevens R, Pass K, Wethers J. HIV seroprevalence in newborns in New York State . JAMA. 1989;261:1745-1750.Crossref 40. Nicholas SW, Sondheimer DL, Willoughby AD, Yaffe SJ, Katz SL. Human immunodeficiency virus infection in childhood, adolescence, and pregnancy: a status report and national research agenda . Pediatrics . 1989;83:293-308. 41. National Institute of Justice. Drug Use Forecasting: January to March 1990, October 1990 . Washington, DC: National Institute of Justice (Research and Action), US Department of Justice; 1990. 42. Nadelmann EA. Drug prohibition in the United States: costs, consequences, and alternatives . Science . 1989;245:939-947.Crossref 43. Tamura M. Japan: stimulant epidemics, past and present . Bull Narcotics . 1989;41:83-93. 44. Bejerot N. Drug abuse and drug policy . Acta Psychiatr Scand. 1975;256( (suppl) ):27-42. 45. Dobbs WH. Methadone treatment of heroin addicts . JAMA . 1971;218:1536-1541.Crossref 46. Zeese KB. Marijuana: time to end the misunderstanding . The Drug Policy Letter . 1990;2:1-3. 47. Van Mastrigt H. Review of literature . Newsletter of the European Movement for the Normalization of Drug Policy . 1989;6: (March 19) , 1989:17-19. 48. Van Capelle MAA. Het Nederlandse Drugs befeid in hoofdlijnen (In Dutch) . Algemeen Politieblad . 1988;13:291-296. 49. Wikesjo R. Recruiting drug addicts In the name of the law . Parents Resource Institute on Drug Education (PRIDE) . (April) 1990. 50. Schwartz RH, Decriminalization of drugs of abuse: the Dutch experience . Hosp Pract. 1991;26:93-100. 51. Shannon M. Clinical toxicity of cocaine adulterants . Ann Emerg Med. 1988;17:1243-1247.Crossref 52. Levine SR, Brust JCM, Futrell N, et al. Cerebrovascular complications of the use of the 'crack' form of alkaloidal cocaine . N Engl J Med. 1990;323:699-704.Crossref 53. Spivey WH, Everle B. Neurologic complications of cocaine abuse . Ann Emerg Med. 1990;19:1422-1428.Crossref 54. Dressler FA, Malekzadeh S, Roberts WC. Quantitative analysis of amounts of coronary arterial narrowing In cocaine addicts . Am J Cardiol. 1990;65:303-308.Crossref 55. Virmani R, Roblnowltz M, Smlalek JE, Smyth DF. Cardiovascular effects of cocaine: an autopsy study of 40 patients . Am Heart J. 1988;115:1068-1076.Crossref 56. Stimson GV. British drug policies In the 1980s: a preliminary analysis and suggestions for research . Br J Addict . 1987;82:477-488.Crossref 57. Segal B. Drug-Taking Behavior Among Alaskan Youth-1988: A Follow-Up Study . Anchorage, Alaska: The Center for Alcohol and Addiction Studies, University of Alaska; 1988, 58. Johnston LD, O'Malley PM, Bachman JG. Drug Use, Drinking, and Smoking: National Survey Results from High School, College, and Young Adult Populations: 1975-1989 . Rockvllle, Md: National Institute on Drug Abuse; 1990. 59. Segal B. Prevalence of drug-taking behavior among Alaskan youth: comparisons with national findings . Alaska Med. 1987;29:9-14. 60. Ministry of Health, Province of British Columbia . British Columbia Alcohol and Drug Programs Adolescent Survey: 1987 . Victoria, British Columbia: Ministry of Health; 1988. 61. Billings JA. A Statewide Report on Substance Use among Public School Students In Washington . Portland, Ore: Northwest Regional Educational Laboratory; 1989. 62. Ellickson PL, Bell RB. Prospects for Preventing Drug Use Among Young Adolescents . Santa Monica, Calif: Rand Corp; 1990: V111. 63. Sandwijk JP, Westerterp I, Musterd S. Het Gebruik Van Legale en Illegale Drugs In Amsterdam (In Dutch) . Amsterdam, the Netherlands: Universitelt van Amsterdam, Instltuut Sociale Geografie; 1988:110-113. 64. The Drug Policy Foundation . The American People Talk About Drugs: A Nationwide Survey . Washington, DC: The Drug Policy Foundation; 1990, 65. Frances RJ. Should drugs be legalized?: Implications of the debate for the mental health field . Hosp Community Psychiatry . 1991;42:119-120, 125. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png American Journal of Diseases of Children American Medical Association

Legalization of Drugs of Abuse and the Pediatrician

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Publisher
American Medical Association
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Copyright © 1991 American Medical Association. All Rights Reserved.
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0002-922X
DOI
10.1001/archpedi.1991.02160100085028
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Abstract

Abstract • Growing numbers of individuals are proposing that drugs be legalized in the United States, with claims that federal, state, and local efforts to prohibit the use of illicit drugs are irrational and unenforceable. "Drug reform" advocates include persons of all political persuasions. Ironically, the call for drug reform comes at a time when trends in drug abuse, as reflected in national and state surveys, show a promising decline. It also is contradictory to at least one recent public opinion poll, in which respondents opposed the legalization of marijuana by a five-to-one margin. While their position is by no means unanimous, proponents of drug reform generally base their arguments on several key premises, such as elimination of or reductions in drug trafficking, enforcement, and interdiction expenditures; increased tax revenues from the legal sale of drugs; and reductions in health-care expenses associated with drug treatment. Reform advocates further claim that legalization would not be followed by an increase in drug use. The validity of each of these arguments is highly questionable. Legalization is a simplistic, short-sighted solution to a complex issue with public health, economic, criminal justice, and societal ramifications. Legalization would, moreover, abrogate the position taken in 1961 by the United States and 114 other nations in ratifying the United Nations Single Convention on Narcotic Drugs. The impact of drug reform merits an unbiased study by an independent agency. Until that time, pediatricians should inform themselves of the arguments for and against drug reform and be prepared to educate patients and their families about the issue. (AJDC. 1991;145:1153-1158) References 1. The Drug Policy Foundation. Drug Prevention Newsletter. 1990. 2. Trebach AS. The Great Drug War . New York, NY: Macmillan Publishing Co; 1987. 3. Ostrowski J. Thinking about drug legalization . CATO Institute Policy Analysis . Washington, DC: CATO Institute; 1989;121. 4. Hay JW. The harm they do to others: a primer on the external costs of drug abuse. Presented at the Hoover Institution Conference on US Drug Policy; November 15, 1990; Stanford, Calif. 5. Rosenthal MS. The logic of legalization: a matter of perspective. Presented at the Hoover Institution Conference on US Drug Policy; November 15, 1990; Stanford, Calif. 6. Schwartz RH, Hayden GF, Getson PR, DiPaola A. Drinking patterns and social consequences: a study of middle-class adolescents in two private pediatric practices . Pediatrics . 1986;77:139-143. 7. Bohman M, Cloninger R, Sigvardsson S, Von Knorring A-L. The genetics of alcoholism and related disorders . J Psychiatry Res. 1987;21:447-452.Crossref 8. Cloninger CR, Bohman M, Sigvardsson S. Inheritance of alcohol abuse . Arch Gen Psychiatry . 1981;38:861-868.Crossref 9. Goodwin DW. Adoption studies of alcholism . Prog Clin Biol Res. 1981;69:71-76. 10. Friedman AS, Glickman N, Utada U. Does drug and alcohol use lead to failure to graduate from high school? J Drug Educ. 1985;15:353-364.Crossref 11. Zwerling C, Ryan J, Endel JO. The efficacy of preemployment drug screening for marijuana and cocaine in predicting employment outcome . JAMA . 1990;264:2639-2643.Crossref 12. Schwartz RH, Luxenberg MG, Hoffman NG. 'Crack' use by American middle-class adolescent polydrug abusers . J Pediatr. 1991;118:150-155.Crossref 13. Jenny L, Schwartz RH. Adolescent drug dependency and the family . Va Med. 1985;112:711-713. 14. Bell P. Arguments against legalizing drugs . Drug Abuse Update . 1988;26:18-19. 15. Van de Wijngaart GF. A social history of drug use in the Netherlands: policy outcomes and implications . J Drug Issues . 1988;18:481-495. 16. Sherer MA, Kumor KM, Cone EJ, Jaffe JH. Suspiciousness induced by four-hour intravenous infusions of cocaine: preliminary findings . Arch Gen Psychiatry . 1988;45:673-677.Crossref 17. Gawin FH, Ellinwood EH Jr. Cocaine and other stimulants: actions, abuse, and treatment . N Engl J Med. 1988;318:1173-1182.Crossref 18. Deriet RW, Albertson TE. Emergency department presentation of cocaine intoxication . Ann Emerg Med. 1989;18:182-186. 19. Tardiff K, Gross E, Wu J, Stajie M, Millman R. Analysis of cocaine-positive fatalities . J Forensic Sci. 1989;34:53-63. 20. Budd RD. Cocaine abuse and violent death . Am J Drug Alcohol Abuse . 1989;15:375-382.Crossref 21. Schwartz RH, Hoffman NG, Smith D, Hayden GF, Riddile N. Use of phencyclidine among adolescents attending a suburban drug treatment facility . J Pediatr. 1987;110:322-324.Crossref 22. Regan DO, Ehrlich SM, Finnegan LP. Infants of drug addicts: at risk for child abuse, neglect, and placement in foster care . Neurotoxicol Teratol . 1987;9:315-317.Crossref 23. Bays J. Substance abuse and child abuse . Pediatr Clin North Am . 1990;37:881-904. 24. Summary of trend analysis from 1990 National Household Survey on Drug Abuse . NIDA Capsules . (December) 1990. 25. Facts about teenagers and drug abuse . NIDA Capsules . (January) 1991. 26. Office of Alcohol and Drug Abuse Programs. Oregon Public School Drug Use Survey: 1990 . Salem, Ore: Department of Human Resources, State of Oregon; 1990. 27. Wayne S. 1989 Virginia Youth Survey: Main Findings . Richmond, Va: Governor's Council on Alcohol and Drug Abuse Problems; 1990. 28. Maryland Department of Health and Mental Hygiene. 1989-1990 Survey of Substance Abuse Among Maryland Adolescents . Baltimore, Md: Alcohol and Drug Abuse Administration and the Juvenile Advisory Council of Maryland; 1989. 29. Drug and Alcohol Use Among New Jersey High School Students: 1990 . Trenton, NJ: New Jersey Department of Law and Public Safety; 1990. 30. Report to the Attorney General. Biennial Survey of Drug and Alcohol Use Among California Students in Grades 7, 9, and 11: Winter 1989-90 . Sacramento, Calif: Office of the Attorney General, Crime Prevention Center; 1991. 31. Lindenbaum GA, Carroll SF, Daskal I, Kapusnick R. Patterns of alcohol and drug abuse in an urban trauma center: the increasing role of cocaine abuse . J Trauma . 1989;29:1654-1658.Crossref 32. Soderstrom CA, Triffilis AL, Shankar BS, Clark WE, Cowley RA. Marijuana and alcohol abuse among 1023 trauma patients . Arch Surg. 1988;123:733-737.Crossref 33. Harruff RC, Francisco JT, Elkins SK, Phillips AM, Fernandez GS. Cocaine and homicide in Memphis and Shelby County: an epidemic of violence . J Forensic Sci. 1988;33:1231-1237. 34. Berman AL, Schwartz RH. Suicide attempts among adolescent drug users . AJDC . 1990;144:310-314. 35. Fullilove RE, Fullilove MT, Bowser BP, Gross SA. Risk of sexually transmitted disease among black adolescent crack users in Oakland and San Francisco, Calif . JAMA. 1990;263:851-855.Crossref 36. Jenny C. Adolescent risk-taking behavior and the occurrence of sexual assault . AJDC . 1988;142:770-772. 37. Hingson RW, Strunin L, Berlin BM, Heeren T. Beliefs about AIDS, use of alcohol and drugs, and unprotected sex among Massachusetts adolescents . Am J Public Health . 1990;80:295-299.Crossref 38. Chasnoff IJ. Drug use in pregnancy: parameters of risk . Pediatr Clin North Am . 1988;82:888-895. 39. Novick LF, Berns D, Stricof R, Stevens R, Pass K, Wethers J. HIV seroprevalence in newborns in New York State . JAMA. 1989;261:1745-1750.Crossref 40. Nicholas SW, Sondheimer DL, Willoughby AD, Yaffe SJ, Katz SL. Human immunodeficiency virus infection in childhood, adolescence, and pregnancy: a status report and national research agenda . Pediatrics . 1989;83:293-308. 41. National Institute of Justice. Drug Use Forecasting: January to March 1990, October 1990 . Washington, DC: National Institute of Justice (Research and Action), US Department of Justice; 1990. 42. Nadelmann EA. Drug prohibition in the United States: costs, consequences, and alternatives . Science . 1989;245:939-947.Crossref 43. Tamura M. Japan: stimulant epidemics, past and present . Bull Narcotics . 1989;41:83-93. 44. Bejerot N. Drug abuse and drug policy . Acta Psychiatr Scand. 1975;256( (suppl) ):27-42. 45. Dobbs WH. Methadone treatment of heroin addicts . JAMA . 1971;218:1536-1541.Crossref 46. Zeese KB. Marijuana: time to end the misunderstanding . The Drug Policy Letter . 1990;2:1-3. 47. Van Mastrigt H. Review of literature . Newsletter of the European Movement for the Normalization of Drug Policy . 1989;6: (March 19) , 1989:17-19. 48. Van Capelle MAA. Het Nederlandse Drugs befeid in hoofdlijnen (In Dutch) . Algemeen Politieblad . 1988;13:291-296. 49. Wikesjo R. Recruiting drug addicts In the name of the law . Parents Resource Institute on Drug Education (PRIDE) . (April) 1990. 50. Schwartz RH, Decriminalization of drugs of abuse: the Dutch experience . Hosp Pract. 1991;26:93-100. 51. Shannon M. Clinical toxicity of cocaine adulterants . Ann Emerg Med. 1988;17:1243-1247.Crossref 52. Levine SR, Brust JCM, Futrell N, et al. Cerebrovascular complications of the use of the 'crack' form of alkaloidal cocaine . N Engl J Med. 1990;323:699-704.Crossref 53. Spivey WH, Everle B. Neurologic complications of cocaine abuse . Ann Emerg Med. 1990;19:1422-1428.Crossref 54. Dressler FA, Malekzadeh S, Roberts WC. Quantitative analysis of amounts of coronary arterial narrowing In cocaine addicts . Am J Cardiol. 1990;65:303-308.Crossref 55. Virmani R, Roblnowltz M, Smlalek JE, Smyth DF. Cardiovascular effects of cocaine: an autopsy study of 40 patients . Am Heart J. 1988;115:1068-1076.Crossref 56. Stimson GV. British drug policies In the 1980s: a preliminary analysis and suggestions for research . Br J Addict . 1987;82:477-488.Crossref 57. Segal B. Drug-Taking Behavior Among Alaskan Youth-1988: A Follow-Up Study . Anchorage, Alaska: The Center for Alcohol and Addiction Studies, University of Alaska; 1988, 58. Johnston LD, O'Malley PM, Bachman JG. Drug Use, Drinking, and Smoking: National Survey Results from High School, College, and Young Adult Populations: 1975-1989 . Rockvllle, Md: National Institute on Drug Abuse; 1990. 59. Segal B. Prevalence of drug-taking behavior among Alaskan youth: comparisons with national findings . Alaska Med. 1987;29:9-14. 60. Ministry of Health, Province of British Columbia . British Columbia Alcohol and Drug Programs Adolescent Survey: 1987 . Victoria, British Columbia: Ministry of Health; 1988. 61. Billings JA. A Statewide Report on Substance Use among Public School Students In Washington . Portland, Ore: Northwest Regional Educational Laboratory; 1989. 62. Ellickson PL, Bell RB. Prospects for Preventing Drug Use Among Young Adolescents . Santa Monica, Calif: Rand Corp; 1990: V111. 63. Sandwijk JP, Westerterp I, Musterd S. Het Gebruik Van Legale en Illegale Drugs In Amsterdam (In Dutch) . Amsterdam, the Netherlands: Universitelt van Amsterdam, Instltuut Sociale Geografie; 1988:110-113. 64. The Drug Policy Foundation . The American People Talk About Drugs: A Nationwide Survey . Washington, DC: The Drug Policy Foundation; 1990, 65. Frances RJ. Should drugs be legalized?: Implications of the debate for the mental health field . Hosp Community Psychiatry . 1991;42:119-120, 125.

Journal

American Journal of Diseases of ChildrenAmerican Medical Association

Published: Oct 1, 1991

References