spectrum of social concern. Existing legislative controls and vocabulary were closely tied to the old stereotypes, and society responded to this new drug-using behavior through separate legislative action (the Drug Abuse Control Amendments of 1965) and a new linguistic symbol. "Dangerous drugs" emerged as the statutory label for the nonnarcotic drugs, such as hallucinogens, amphetamines and barbiturates, whose non-medical use was socially disapproved.

The single-mindedness of American drug policy is illustrated clearly by the reorganization of the federal drug bureaucracy which took place in 1968. For technical reasons stemming from the revenue structure of the Harrison Act, narcotics enforcement had always been lodged in the Treasury Department. When the "dangerous drugs" were brought under regulatory control in 1965, enforcement responsibility was assigned to a new bureau in the Department of Health, Education, and Welfare. Then in 1968, the responsibilities of the two agencies were merged in a new agency established in the Department of Justice: the Bureau of Narcotics and Dangerous Drugs. Public policy had the appearance of coherence once again.

But this was not enough. Marihuana use continued to increase throughout the decade, and the public was caught up in a highly emotional debate. For the first time since the inception of the American "narcotics" policy, public opinion focused on some of the fundamental assumptions. Not surprisingly, debate on the marihuana issue was often couched in terms of the statutory vocabulary which has come to symbolize drug policy. For example, the scientifically indefensible classification of marihuana as a "narcotic" immediately provoked an erosion of the symbolic coherence which had previously characterized drug policy. Similarly, the inevitable comparison between alcohol and marihuana called into question the substantive separation between narcotics and dangerous drug policies on the one hand and alcohol policy on the other.2 After all, alcohol can legitimately be classified as a "narcotic" in a very specific sense of that term, and it is surely a "dangerous drug" as well.

Until the close of the 1960's, official defenses of marihuana policy continued to be premised on the implications of the statutory vocabulary. Although the narcotic ideology was quickly abandoned, many official pronouncements continued to link marihuana with the opiates because of their association in the law and to insist that marihuana was a "dangerous drug" even if it was not a "narcotic." An historical

'During most of the period of national alcohol prohibition, the Bureau of Prohibition was responsible for enforcement of the Harrison Act as well as the Volstead Act; but passage of these two laws had parallel rather than shared histories, a point clearly demonstrated by subsequent events.

understanding apprises us that these classifications are reflections of, rather than reasons for social disapproval.

It became clear by the end of the decade that "narcotics" and "dangerous drugs" were no longer adequate symbols of social policy; consequently "drug abuse" was adopted as a replacement symbol. However, the need to distinguish marihuana use from other forms of "drug abuse" resulted in yet another distinction: marihuana was classified as a "soft" drug as opposed to the "hard" drugs, suggesting the same kind of distinction drawn between "hard liquor" and other alcoholic beverages. But, as has been the case with all drug vocabulary, this distinction serves a social rather than a scientific purpose. This terminology generally indicates an attempt to distinguish marihuana from heroin and cocaine, the stereotypical "hard" drugs. However, there is no consensus whatsoever as to which other substances, if any, are considered to be "hard." If hard drugs is a narrow category, referring only to the opiates and cocaine, it is simply another way of saying "narcotics;" on the other hand, if it is taken to mean everything other than marihuana, it is simply an expedient way of disassociating marihuana from other disapproved drugs.

Like "drug abuse," the hard-soft terminology reflects a nascent effort to reestablish a sphere of "bad" drug use. Within the official community as well as the general public, attempts are being made to grade drugs according to their potential hazards, particularly their capacity for inducing physical dependence. To the extent that this is true, the new linguistic symbols suggest that public concern has in some ways returned full circle to where it began almost a century ago.

THE SOCIAL RESPONSE: FALSE PREMISES AND THE PERPETUATION OF A PROBLEM

As this brief historical summary illustrates, American drug policy is almost seven decades old, and not once during this period have the underlying assumptions been systematically evaluated and a broad, coherent foundation for policy making established. As a result, each new occurrence in drug development and each new use pattern have been viewed as unfamiliar, with the unfamiliarity breeding a sense of crisis, and the crisis precipitating ad hoc policy responses.

The Commission feels strongly that the present institutional response, despite sincere efforts to move it in the right direction, continues to be rooted in the mistakes of the past, and, indirectly, tends to perpetuate the "problem." Accordingly, it is useful to scrutinize the goals toward which the policy is directed and the premises which support it, as well as to describe briefly some of the present governmental responses which are guided by these assumptions. Finally, as a prelude to

will attempt to "wipe the slate clean" and to sketch a general frame. work for defining the problem and formulating a coherent social policy.

The Assumptions and Premises of Present Policy

Elimination of Non-Medical Drug Use

American drug policy has been predicated on one fundamental notion that the societal objective is to eliminate "non-medical" drug use. Inquiry has rarely been addressed to whether this goal is desirable or possible. Failure to address such questions is abetted by the exclusion of certain drugs and certain types of drug taking from the realm of social distress. For example, the non-medical use of alcohol and tobacco would be inconsistent with the declared goal; thus, statutory vocabulary and social folklore have established the fiction that they are not drugs at all. Although use of these substances may arouse concern, they are not viewed in the wider context of drug use.

Another area excluded from public discussion is drug use sanctioned by medical judgment. While most medically-approved consumption of psychoactive drugs is substantially different from the situation where the individual chooses to use the drug himself, this is not always true. The absence of the intervening judgment of a third party does not mean that the individual's motivation is "non-medical," or hedonistic. Nor does the intervention of medical judgment assure that the drug will be used for medically-intended purposes.3

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Drug policy makers cannot truthfully assert that this society aims to eliminate non-medical drug use. No semantic fiction will alter the fundamental composition of alcohol and tobacco. Further, even if the objective is amended to exclude these drugs, human history discounts the notion that drug-using behavior can be so tightly confined as a medical system implies. The substantial increase in self-medication in recent years illustrates this truth. The backyard pharmacy, where neighbors diagnose their friends' ailments and share their prescription drugs with them, the proliferation of over-the-counter preparations, the advertising of mood-altering drugs, and the popularity of minor tranquilizers are all manifestations of an important contemporary trend.

The medical/non-medical distinction has become increasingly blurred as emotional ailments increase. Many individuals tend today to assess their own needs and define the purposes for which they use a drug. For this reason, generalized societal proclamations regarding the

The third party judgment may intervene directly, as is the case with prescription drugs, or indirectly, as is the case with over-the-counter preparations previously approved for this purpose by the Food and Drug Administration.

need to eliminate non-medical drug use raise an important question. that must be honestly answered: how does the daily use of a prescribed barbiturate to bring a person "down" from the day differ from the similar use of a self-prescribed minor tranquilizer or, for that matter, a martini?

Deferring for the moment our own view as to what society's objective in this area ought to be, we do know that it is not as clear cut as official pronouncements imply. In determining the appropriate objective, a task that we will undertake in Chapter Four, policy makers must recognize the scope and complexity of drug-using behavior and develop rational distinctions between that which should be disapproved and that which should be tolerated, or even approved. Within the area of disapproval, policy makers should not consider all disapproved drug use to be of equal importance; priorities must be assigned on the basis of actual and potential social consequence, and not just on the basis of numbers of users.

Risk-Taking and Health

Often cited in support of societal disapproval of non-medical drug use is the proposition that individuals should not risk their health by using drugs. Without regard to the philosophical propriety of this premise as a guide for social policy, this view appears to be somewhat at odds with the facts about drug use and with prevailing social attitudes toward risk-taking in other areas.

Much emphasis has been placed on whether or not a drug is a dangerous drug; and analogies have been drawn between "street" drugs and such substances as cyclamates. These examples illustrate how closely public discussion of drug abuse has become tied to matters of individual health. In supporting present social policy, spokesmen often list those drug effects which are potentially harmful to individual health rather than focusing on the social consequences of drug-using behavior.

The Commission believes that persons who take this approach have misconstrued the nature of the drug issue. The assumption that all psychoactive drug use is a high-risk behavior presumes a progression from irregular use of low doses to continuous use of high doses, thereby ignoring pharmacological variations among drugs and the importance of frequency of use, method of administration, dose, and non-drug factors as determinants of risk. In fact, injury to health is associated primarily with chronic heavy use and at times with the acute effects of high doses.

Further, there is no correlation whatsoever between the capacity of psychoactive drugs to induce behavioral disorders and their capacity to induce organic or somatic toxicity or pathology. Of the drugs which

havior, alcohol produces the most clearly established and reproducible brain pathology. Cocaine, amphetamines and other stimulants, heroin and morphine-like drugs, and cannabis do not appear to have this effect. On the other hand, very heavy use of phenacitin, which has no significant behavioral impact at all, may produce renal damage, and heavy tobacco smoking is associated with greatly increased risk of lung cancer. If the standard for social policy were potential injury to individual health, barbiturates, alcohol, and tobacco would present the clearest cases for prohibition. Yet, the latter two are available for self-defined purposes, and the former is widely used in the practice of medicine.

Nonetheless, the approach often applied to "drugs of abuse" is the same as that applied to non-psychoactive substances: risks to individual health will be tolerated only if the medical needs for the substance justify the risks. But individuals would not choose to use psychoactive drugs if they did not perceive some advantage to themselves. So the fundamental question arises: Who is to weigh the perceived advantages of drug use against the risk, the individual or the society?

To deal with this question, we must examine the pattern of social response to risk-taking behavior in general. For example, we urge our youth to be curious and to explore. Until recent years, Americans tended to place a premium on high-powered automobiles. We tolerate the private ownership of firearms. We tend to applaud the courageous mountain climber or other adventurer who ignores the risks in the effort to establish human dominion over nature. In short, risk-taking behavior is permitted and often encouraged by many of our social institutions, which defer to individual judgment the weighing of often intangible benefits against the quite tangible risks.

Society has long been aware of the individual and social risks of alcohol use. Even with the effort now being made to inform the public of the risks of tobacco use, society still permits this drug to be widely available. In both cases, society clearly subordinates the risks inherent in such behavior, deferring instead to individual judgment.

The Commission is not suggesting that health risks are irrelevant to the formulation of drug policy. However, whatever appropriate weight is given to health considerations, it is a peripheral, rather than focal, concern. Drug policy must be based on the social consequences of drug use, and on the social impact of drug-induced behavior.

Motivation for Mood Alteration

Subsumed within the societal goal of eliminating non-medical drug use is the value judgment that use of drugs for the explicit purpose of mood alteration is per se undesirable. To harmonize this judgment