Chasing the Scream: The First and Last Days of the War on Drugs (45 page)

This argument won. In 1997, some 70 percent of Swiss electors voted to keep the reforms. In 2008, the conservative forces regrouped and called another referendum. The campaign supported by Ruth ran posters of a young mother with her baby, saying: “I want to keep our public parks free of syringes.” Another poster showed a couple in their fifties saying: “Thanks to treatment, our son could quit drugs.” This time, 68 percent
⁷⁸
backed the policy. These campaigns showed,
⁷⁹
in embryo, the case that, I believe, could end prohibition around the world.
⁸⁰

They did it to protect and defend not the addicts, but themselves. This is, it occurs to me, a crucial lesson for drug reformers. Those of us who believe in ending the drug war already pretty much have the liberals and leftists on our side. It’s the moderates and the conservatives we need to win over—and the way to do it may be heard in a distant yodel from the mountaintops of Switzerland.

One day, Ruth went as president to a heroin clinic in Bern to talk to the addicts there, and among them was one young man—well-dressed and handsome—whom she tried to strike up a conversation with, but he seemed shy, and would barely say a word to her. To her surprise, as she was leaving, he handed her a note, and said she should wait until she was back in her office before reading it.

“Six months ago
⁸¹
I was in the streets,” he said. “I hated myself, I had lost all respect for myself. I was dirty, I slept outside in the streets and the parks, and [then] I was accepted in the clinic . . . and now I am coming three times a day to receive my heroin. I regained respect.” And then he explained that he had been reluctant to talk to her because now he worked for her, in the department she runs.

“When you read such a letter,” she says, “you can continue for many years on that.”

It’s hard, I say to Ruth in her apartment in Geneva one afternoon, to imagine an American president or British prime minister doing what she has done: sitting with addicts, learning their stories, and urging people to help them. “They should,” she says. “You have to learn and to see with their own eyes.” If she was stuck in an elevator with Barack Obama and David Cameron, she would tell them: “You are responsible for all of your citizens, and being responsible means protecting them and giving them the means to protect themselves. There is no group that you can abandon.”

Yet the same forces that had pressured Britain into locking down John Marks tried to intimidate the Swiss. The International Narcotics Control Board declared: “Anyone who plays
⁸²
with fire loses control over it,” and said Switzerland was “send[ing] a disastrous signal to countries in which the drugs were produced.” But Ruth Dreifuss was not going to be intimidated by anyone. When the U.S. drug czar, General Barry McCaffrey, visited Europe, he went to the Netherlands and held a press conference at which—like a colonial governor addressing the natives—he berated the Dutch government for their wickedness. He was scheduled to come to Switzerland shortly after. “It was terrible what he said in the Netherlands [about] the cannabis shops,” Ruth says.

So she called him and explained: “There will be no
⁸³
press conference in Switzerland. We do not accept [for] you to interfere in our political debate.”

Once she left office, Ruth came together with other former heads of state—including President Fernando Henrique Cardoso of Brazil—to set up an organization called the Global Commission on Drug Policy, demanding an end to the global drug war. When I spoke to her, she had recently been to Mexico, Ghana, Budapest, Vilnius, and Italy. Everywhere she goes, she says, she can see that “doubts are rising,” and people are eager to hear about the rational alternatives.

It’s even harder to imagine, I tell her, a former U.S. president or British prime minister living a minute’s walk from a heroin clinic.

“As far as possible, we always wanted to have these places in the center of the city,” she says, smoking a cigarette and flicking the ash. “For many reasons. I mean, these people have to come regularly. We can’t send them I-don’t-know-where. When they have a job it’s important they can come during the lunch break or so. It’s practical.”

And she looks out the window, in the direction of the heroin clinic.

After I returned from Switzerland, I enthusiastically jabbered to several Americans about these results and said they should be tried back in the Land of the Free—and they often came back with a response that threw me.

But we already prescribe powerful opiates, they said. We prescribe Oxycontin and Vicodin and other painkillers—and, far from having the effect you are describing, it has caused a disaster. Look, they said, at the headlines any day of the week. More people are becoming addicted every year to prescription drugs that they were given at first for pain relief. More people are overdosing. More people are becoming criminals. More people are transferring to even harder drugs, like heroin. You want more of that?

This narrative was everywhere—including in liberal outlets normally receptive to drug policy reform, like
Rolling Stone
. The conclusion seemed obvious: for some reason, in this country, prescription doesn’t reduce problems—it metastasizes them.

This seemed to blast a hole in the case for providing legal access to the most potent drugs in the United States, and I was sent into a spiral of confusion. I looked over the evidence, and these critics seemed to be right. Oxycontin and Vicodin addictions are indeed spreading in the United States, and they are causing more criminality and overdose. The cause, everyone seems to agree, is that doctors have prescribed the drugs too freely.

How could it be, I asked myself, that opiate prescription worked so well in Switzerland but was proving to be a disaster in the United States? Is this just a deep cultural difference? Or is there a flaw in the Swiss model that I’m not seeing?

It was only when I discussed this with Meghan Ralston, an expert on prescription drugs with the Drug Policy Alliance, with Professor Bruce Alexander back in Vancouver, and with Dr. Hal Vorse, a medical doctor who treats prescription drug addicts in Oklahoma City, that I began to understand what was really happening. Between them, these three experts raised three different questions that forced me to see the prescription drug crisis in a radically different light.

The first question that made me think again is: When do the worst problems associated with Oxycontin and Vicodin, the ones you see on the news, start? When do the addicts start to hold up pharmacies to get their next batch, or prostitute themselves, or start overdosing on a massive scale? Meghan Ralston, one of the leading experts on this crisis, explained to me: They don’t begin when the drugs are prescribed. They begin when the prescriptions are
cut off
.

The United States, she explained, doesn’t have a Swiss-style policy of prescribing Oxycontin or Vicodin or other opiates to addicts. In fact, it has the precisely opposite policy. If I am an American who has developed an Oxycontin addiction, as soon as my doctor realizes I’m an addict, she has to cut me off. She is allowed to prescribe to treat only my physical pain—not my addiction. Indeed, if she prescribes just to meet my addiction, she will face being stripped of her license and up to twenty-five years in jail
⁸⁴
as a common drug dealer—just like Henry Smith Williams’s brother at the birth of the drug war.

That’s when, in desperation, I might hold up a pharmacy
⁸⁵
with a gun, or go and buy unlabeled pills from street dealers. Most of the problems attributed to prescription drugs in the United States, Meghan Ralston says, begin here, when the legal, regulated route to the drug is terminated. Nobody, she explained to me, swallows 80 mg of Oxycontin prescribed by their doctor and goes out to commit a crime, or dies of an overdose. No: it’s when the doctor realizes the patient is an addict and cuts them off that all the trouble begins.

This is so different from how the prescription drug crisis has been almost universally reported that it took some time for me to absorb it. It was only when I began to think about it in relation to the last time drugs were sold freely in the United States—before 1914—that I started to understand.

Remember the transformation Henry Smith Williams lived through. Before the ban, almost all opiate users would buy a mild form of the drug at their corner store for a small price. A few did become addicts, and that meant their lives were depleted, in the same way that an alcoholic’s life is depleted today. Nobody should dismiss this effect: it is real human suffering. But virtually none of them committed crimes to get their drug, or became wildly out of control, or lost their jobs. Then the legal routes to the drug were cut off—and all the problems we associate with drug addiction began: criminality, prostitution, violence.

The same pattern is playing out today with prescription drugs. If I am a young man with a legal Oxycontin prescription that I am using compulsively to deal with my psychological pain, my life will be depleted, and sluggish, and incomplete. If I am cut off from that prescription—if my own personal 1914 hits me—my life will become disastrous, and I will start acting in all the chaotic ways associated with the prescription drug crisis today. It is when the legal routes are cut off that the worst begins. So, Meghan says, the prescription drug crisis doesn’t discredit legalization—it shows the need for it.

But what does “legalization” mean when it comes to prescription drugs? Some people would argue that they should be openly sold, like alcohol—but I think Switzerland’s heroin experiment shows a better path forward: you could expand the criteria for prescription. If you can prescribe opiates for back pain, why can’t you prescribe them for psychological pain? Imagine if a woman addicted to Oxy in Oklahoma City wasn’t abruptly told to stop using, with directions to the nearest Narcotics Anonymous group and a brisk “Good luck.” Imagine if, instead, she was told exactly what the patients in Geneva are told: you will be given a safe, legal dose for as long as you need it, and while you receive it, we will give you support and care to help you to rebuild your life, get secure housing, and keep your job.

It seems reasonable to expect that the results would be the same in Vermont or Alabama as they were in Switzerland—that most people would, over time, choose to reduce their dose and eventually give up their drugs as their pain abated.

But that’s only the first step: it’s the bandage that stops the hemorrhaging. Then you need to have a deeper strategy—one that stops these wounds from forming in the first place. To do that, you need to change the culture so people find life less unbearable. We have to build a society that looks more like Rat Park and less like a rat race. If that sounds like pie in the sky, remember the alternative: addiction outbreaks that only swell, like an Oxy slick forming across the sky.