Drug Trial

Jacob Sullum from the March 1998 issue

(Page 3 of 6)

In November 1996, Californians voted to allow possession and use of marijuana for medical purposes with a physician's recommendation. Arizonans went further. They permitted patients to possess and use any illicit drug, provided they receive a written prescription from a physician, who, in turn, obtains a concurring second opinion. In addition, the Arizona ballot measure gave drug users probation and rehabilitation rather than prison time for the first two convictions. It prohibited incarceration of nonviolent drug offenders until the third conviction. Finally, the measure made eligible for release all inmates serving time for simple drug possession with no other offenses.

Vice President Al Gore, Attorney General Janet Reno, drug czar Barry McCaffrey, and former Presidents Bush, Carter, and Ford participated in media events warning voters of the dangers posed by these initiatives. Despite those efforts, the ballot measures passed easily, with 56 percent support in California and 65 percent in Arizona.

From the perspective of some libertarians, most notably Thomas Szasz, the public health model embodied in these initiatives can be seen only as a pernicious extension of the meddlesome Therapeutic State. But when applied to drug policy, medicalization actually represents a radical rupture with the federal government's oppressive drug war.

I served as medical spokesman for the group that developed and promoted the Arizona initiative. Our mission was to seek alternatives to current drug policy. Accordingly, we commissioned focus group research to explore how citizens felt about the drug issue.

Two dispositions were immediately apparent: 1) People overwhelmingly felt the drug war was a failure, and 2) people strongly opposed the alternatives of decriminalization and legalization. But this did not mean they opposed significant reform. For example, focus group participants firmly rejected the policy of "do drugs, do time." They believed treatment was much more appropriate than imprisonment for drug users. This belief was so strong that they were willing to parole offenders already in prison. Furthermore, they believed that when it came to prescribing drugs--even marijuana, heroin, and LSD--the patient/doctor relationship should supersede government control. Arizona voters probably did not realize how widely such beliefs were shared: Tracking polls showed that 60 percent supported the initiative but only 25 percent thought it would pass.

The focus group and tracking poll results illustrate what postmodern philosopher Michel Foucault calls "subjugated knowledge"--an implicit belief that people cannot communicate unless given the language to do so. The Arizona focus group research revealed a radical resistance to the drug war that lacked a narrative with which to express itself. The common "metaphors" of resistance--legalization and decriminalization--were unsatisfactory. A new vocabulary took shape as a result of the focus group experience. Group members repeatedly said drug abuse is really a "medical" issue. They said drug treatment, even if it doesn't work, is a more just form of punishment. Thus, a new discourse on drugs emerged, representing a halfway position between prohibition and repeal. Years of prohibitionist propaganda made it impossible to generate popular support for anything more ambitious.

This new discourse of medicalization is not a top-down narrative of control written by the government. Instead, the people have generated a language of resistance to oppressive and ineffective policies. This discourse is percolating up from citizens who believe medical authorities can address the drug issue more effectively than government bureaucrats.

Libertarian critics mistakenly take the term medicalization to mean the transfer of power from a political dictator to a medical dictator. To be sure, the postmodernist would agree that medicalization is a metaphor of control. But as Foucault argues, there is no way "outside of" power; all human interactions involve power relations. Therefore, the only way of conceiving issues of autonomy is through empowerment. In the context of drug policy, "medicalization" is a metaphor of empowerment.

In practical terms, the Arizona and California ballot measures have eased statist drug controls. The federal government responded by threatening to punish doctors who prescribe illicit drugs to their patients. This policy prompted federal lawsuits (including one in which I am a plaintiff) that fundamentally challenge the way drugs and medical practice are regulated. A recent national poll found that 69 percent of Americans oppose the federal response to the medicalization initiatives.

During the Arizona campaign, I had many arguments with libertarian friends who shared Dr. Szasz's suspicions of medicalization. But the reaction of the federal government and the law enforcement community to the measure's approval, coupled with strong public opposition to that reaction, has led many of them to re-examine their positions. Any drug policy reform that engenders so much outrage from the political establishment and incites such widespread dissent can't be all bad.

Jeffrey Singer is a Phoenix surgeon who served as medical spokesman for Arizonans for Drug Policy Reform, which ran the Proposition 200 campaign.

The Medical Marijuana Menace
By Dave Fratello

California and Arizona voters changed the politics of the drug war when they approved "medicalization" ballot initiatives in 1996. Both reformers and prohibitionists have had to deal with the consequences.

On the reform side, as the movement begins to mature and achieve a tangible success here and there, we are seeing internal debate and factionalization. For years the movement has functioned amorphously, with a "big tent" mentality and a lot of preaching to one another. Nowadays, those of us working on medical marijuana initiatives for the 1998 ballot seem to catch flak from every angle. Repeal advocates tell us that medical marijuana does not go far enough. We are also criticized for how we would permit medical marijuana--with regulation rather than declarations of complete freedom for doctors and patients--and for limiting it to certain medical conditions.

At the same time, the 1996 votes have helped remind reformers of our common enemies. When an issue like allowing some patients to use marijuana, seemingly so peripheral to the broader drug policy debate, causes a panic among the drug war's partisans, it is worth asking why. One way of addressing that question is to speculate what might happen if voters approve every state initiative on medical marijuana (a total of four to six) this November. Could we expect anything like the over-the-top, multi-agency roar federal officials let out in 1996? If so, perhaps the drug warriors will further erode their credibility by fighting public wishes and denying patients a useful medicine.