Regulating Vice: Chapter 3, "The Robustness Principle"
- posted by Jim Leitzel @ 10:38 PM

Enough time has elapsed since the, er, five-part summary of Chapter 2, for Vice Squad to move on to summarizing Chapter 3 in surprise bestseller Regulating Vice. Recall that we started by looking at John Stuart Mill's harm principle. Then we explored addiction, to see if there is any reason to alter the harm principle because of the addictiveness and self-control problems (or just plain shortfalls from rationality) associated with many vices. Chapter 3, "The Robustness Principle," argues that yes, Mill's approach -- which would rule out policies that have as their motivation the reduction of adult vice -- should be replaced by that pesky Robustness Principle, long foisted on the loyal Vice Squad reader. From Chapter 3:


Some adult vice-related consumption is harmful and (arguably) less than rational; further, we cannot easily distinguish rational from irrational choice with respect to vice. This leads us to the robustness principle.... Public policy towards potentially addictive activities should be robust with respect to departures from full rationality. Vice policy for adults should hold up pretty well if everyone is always well-informed and fully rational, and it should work well, too, even if some or many vice-related choices are irrational. We require this robustness precisely because we cannot ascertain how much vice is rational, nor distinguish the rational component from that which flows from a degradation of the reflecting faculties.

A robust vice policy will provide some support for those who are uninformed or struggling with self-control in their decision making. The provision of such support should not impose substantial costs upon those whose vice-related decisions are marked by rationality. One example of a policy that satisfies the robustness principle is a requirement for purchases of heroin, say, to be made with at least three days’ notice – where the notice would be revocable by the adult would-be purchaser at any time during the ensuing waiting period. Rational heroin consumers, and even rational addicts, can then assure themselves of a steady supply, but those struggling with self-control issues will not be able to immediately satisfy an unforeseen craving and can cancel an impulsive order when their decision-making faculties are controlled by their more considered selves.

I suspect some more Vice Squad discussion of the Robustness Principle in the days (weeks? decades?) ahead. [Update: Here's the brief follow-up post.]

For those keeping score at home, here's the Regulating Vice Posts Roundup:
(1) Announcement
(2) Introduction (part I)
(3) Introduction (part II)
(4) Introduction (part III)
(5) Erratum, Page 2!!
(6) Chapter 1, The Harm Principle (part I)
(7) Chapter 1, The Harm Principle (part II)
(8) GMU Talk (part I)
(9) GMU Talk (part II)
(10) Chapter 2, Addiction (part I)
(11) Chapter 2, Addiction (part II)
(12) Chapter 2, Addiction (part III)
(13) Chapter 2, Addiction (part IV)
(14) Chapter 2, Addiction (part V)

Labels: heroin, Mill, Regulating Vice, robustness

 
Don't Mess With Taxes
- posted by Jim Leitzel @ 6:10 PM

Remember Texas's "pole tax," the $5 per customer fee applied to strip clubs in January? Turns out that a state judge has ruled the tax to be a violation of the First Amendment. The Attorney General intends to devote more public funds to appealing the ruling, while other supporters of the tax are investigating reforms to the legislation that would help it pass constitutional muster. (Incidentally, I haven't read the court opinion, but I am surprised that a case decided on free speech grounds also seems to hinge (if the published reports are correct) on the earmarking of the revenues from the tax.)

In unrelated news, via Pete at Drug WarRant we learn of a wonderful series of videos concerning heroin. The presenter is Michael Jourdan, a leading Danish drug researcher. Heroin (like methamphetamine) is a word that for many people is so evocative of danger as to preclude marshaling facts or reasoning about policy. Jourdan provides the facts, and some fine reasoning along the way, too.

Labels: dancing, Drug WarRant, heroin, taxes, Texas

 
Vietnamese Cruelty
- posted by Jim Leitzel @ 10:19 PM

US drug laws are draconian by any rational standard, but in various Asian dragons, draco stalks the land even more ruthlessly. An Australian woman was convicted in Vietnam for trying to smuggle 1.5 kilos of heroin OUT of the country. She received life in prison.

That is, at first she received a life sentence, but the sentence was changed on appeal. Not an appeal by the defense -- no, an appeal by the prosecution. And the appeals court could not abide by the trial court's leniency -- after all, mercy in this case might lead to more heroin leaving the country. So now the 34-year old woman is slated to be executed by firing squad.

This is the (il)logical end of the criminalization of victimless crimes. The usual story is that we calibrate punishment with the harm caused by criminal behavior. Without actual harm, who knows what constitutes an appropriate penalty? A small fine? Execution? There were times when those who traded heroin internationally were respected, upstanding businesspeople -- their punishment was thanks. How have we -- and the Vietnamese -- convinced ourselves that heroin trading must be harshly, cruelly punished?

Labels: Asia, heroin, sentencing

 
Indonesian Insanity
- posted by Jim Leitzel @ 12:53 PM

Indonesia's cruelty in the name of the drug war is persistent but, alas, not unique. Here's an article concerning a 21-year old Australian whom the Indonesians hope soon to kill for carrying around an officially disapproved substance when he was 18 -- surely his impending death will be undertaken for the children. Another Indonesian court is showing dangerous leniency in the case of a repeat possessor (not trafficker), an American who has been sentenced to a mere three and a half years in prison. (More than ten years ago his failure to obey rules on what not to possess cost him a year in an Indonesian jail.) I am certain his (surely too merciful) punishment is for the children, because the judge said so: 'The defendant repeated his acts, which could cause the moral damage of Balinese youth.' Throwing people's lives away for a pin's fee, however, apparently is not morally damaging, to children or adults.

Indonesian idiocy is longstanding; it is also widely shared. What did Bertrand Russell say? “The fact that an opinion has been widely held is no evidence whatever that it is not utterly absurd; indeed in view of the silliness of the majority of mankind, a widespread belief is more likely to be foolish than sensible."

Labels: Asia, drugs, heroin, sentencing

 
China's Drug War Cruelty
- posted by Jim Leitzel @ 10:48 AM

The absurd punishments for the consensual drug-related 'crimes' in the US are disheartening, but some countries are even worse -- I suppose the States can take some comfort there? China is one of the most egregious offenders. Right now, seven Ugandans have been sentenced to death for heroin trafficking in China. They were convicted of trafficking in more than 50 grams -- that's nearly two ounces, folks, and might be enough to keep a single addict supplied with heroin for a whole month. (If they were convicted of trafficking of less than 50 grams, they would have been eligible "only" for 15 years in prison.) The Ugandan government is pleading for clemency from the Chinese, but at the same time, doesn't want anyone to think that Uganda isn't committed to the well-designed global drug war policy. The story can be found here.

Labels: China, heroin, sentencing

 
Bupe in B-more
- posted by Jim Leitzel @ 12:10 AM

In 2002, new FDA rules made it possible for doctors to meet in their offices with addicts, and to prescribe the opiate agonist buprenorphine. In the form prescribed, the buprenorphine is combined with the antagonist naloxone, thereby rendering the compound ineffective in taking by injection for a high. Unlike methadone clinics, which generally require daily visits by patients, addicts treated with the bupe/naloxone mix could receive a month's supply at a time.

Vice Squad hometown of Baltimore, Maryland, is racked by a terrible heroin problem. In October, 2006 Baltimore announced that it was going to promote buprenorphine treatment for heroin addicts; the state of Maryland has earmarked $3 million for bupe treatment in the coming fiscal year. Unfortunately, Maryland doctors do not seem all that eager to climb aboard the bupe train, and those that do board find the journey to be arduous, according to an article this week in the Baltimore Sun:

"One of the biggest barriers to prescribing buprenorphine is dealing with the insurance companies," said Dr. Christopher Welsh, a psychiatrist and assistant professor at the University of Maryland School of Medicine in Baltimore. Welsh uses the drug to treat patients at the university's hospital. Some come from hundreds of miles away to get a prescription, only to have their treatment thwarted by red tape.

"A few hours later, you'll get a call, and the patient will tell you that the pharmacy said the prescription wasn't authorized," said Welsh, who participated in the survey.

He added that a physician who intervenes to help the patient is often "passed from voice mail to voice mail" by the health care provider, and the experience "can be very time- and labor-intensive."

Two years ago, Vice Squad noted a prescient Wired article detailing barriers to the spread of bupe treatment for heroin addicts.

Labels: addiction, buprenorphine, heroin, treatment

 
Informal Heroin Maintenance
- posted by Jim Leitzel @ 6:40 AM

The Guardian today reprints (from Black Poppy magazine) a moving story about a family that is being devastated by a son's ten-years-and-counting heroin addiction. The author of the story is the addict's mom, who also serves as his drug dealer. (She's a college teacher, too.) That is, she decided that the best way to minimize the harms of her son's addiction -- and they have tried many, many alternatives -- is to buy heroin herself and to dole it out to him. But this measure has not made the situation bearable, in part because the purity of the black-market heroin is variable and the cost of street heroin, as her son's tolerance grows, is close to prohibitive.

The son tried various treatment regimens, including methadone maintenance -- all have failed. The article does not mention heroin maintenance, but it seems like it offers the best (short-term, perhaps) hope for improvement. After all, the son already is on a heroin maintenance scheme, but one that is partly undermined by variable purity and high cost. An official heroin maintenance scheme, one that would eliminate these two problems, could hardly be worse.

There are many small insights in the article. I'll only mention one here, the notion that an addict's knowledge of his own failure to handle his addiction can spur more drug use, as a way of blotting out a painful self-awareness.

Labels: addiction, Britain, heroin, treatment

 
Singapore's Anti-Drug Cruelty
- posted by Jim Leitzel @ 11:06 AM

For most of human history sellers of opiates have engaged in a legal and even respected trade. Of course, in our more enlightened times we know that such sellers must be punished. And no country is more eager to punish, and to take the punishment to absurd extremes, than Singapore (though China and Malaysia are among the progressive nations competing for the honor). Today Singapore hanged a 21-year old man who had been convicted of heroin trafficking.

Update: Moscow's mayor endorses the cruelty.

Labels: Asia, heroin, Russia

 
Vietnam v. Singapore...
- posted by Jim Leitzel @ 6:41 PM

..and Vietnam wins.

Life in prison for possession of a few pounds of heroin is a travesty of justice. But the bar for justice has been set so low, especially in Asia, that even such a cruel sentence looks compassionate. Let's hope that this signals the start of a Dutch auction in drug possession sentencing.

Labels: Asia, heroin

 
The Heroin Equivalent of the Red-Headed League
- posted by Jim Leitzel @ 1:22 AM

Chris Rock once said "Drug dealers don't sell drugs. Drugs sell themselves." So it should be no problem to distribute free heroin, right? Well, those who are organizing the Canadian experiment with heroin maintenance are finding out that if you impose enough conditions, it's hard even to give the stuff away:

Addicts must have been on heroin for at least five years, must have tried methadone twice without success -- and must be older than 25.

Also, the addict cannot currently be on methodone [sic]-- and cannot have a criminal record.

The researchers aim for 157 participants, but so far, have come up with only 21 eligibles.

Here's the original Red-Headed League.

Labels: Canada, heroin, treatment

 
British Heroin Maintenance
- posted by Jim Leitzel @ 3:10 PM

Until the early 1970s, doctors in Britain could prescribe heroin to addicts. With increased addiction being tied to leakages from the prescription system, distribution of heroin for addiction maintenance was tightened. Today there are about 450 British addicts who receive heroin from some 100 specially-licensed physicians. But now, following the perceived successes of previous heroin maintenance experiments in Switzerland and the Netherlands, the British intend to initiate pilot programs that will expand prescription access by addicts to heroin.

Thanks to John Band at Shot By Both Sides for the pointer.

An alternative treatment for opioid addicts is the oral administration of buprenorphine. We noted a while ago some of the barriers to the spread of this treatment in the US; a detailed explanation of how buprenorphine treatment works, based partly on personal experience, is provided by Nephalim's Drug War Revealed.

Labels: Britain, buprenorphine, heroin, treatment

 
The Uphill Trek Facing Buprenorphine
- posted by Jim Leitzel @ 4:58 PM

Yesterday we looked at the use of naltrexone in the treatment of alcohol addiction; today's link is to a Wired story on the use of buprenorphine to combat opiate addiction. The article details the many barriers to making buprenorphine available to addicts, including the reluctance of doctors to welcome addicts into their waiting rooms and difficulties in first allowing and then easing the dispensing of buprenorphine from methadone clinics.

Relative to methadone, buprenorphine offers advantages to some patients, including the fact that a stock of bupe (its nickname) can be kept by the addict, with a pill taken daily to reduce opiate craving and withdrawal. Patient-managed inventories are possible because one form of bupe comes mixed with the opioid antagonist naloxone, thereby making it unattractive as a recreational drug. (The Wired article might even be a little too laudatory of bupe; opioids tend to have widely varying effects upon different users, so no doubt methadone or heroin maintenance would be preferable to bupe for some patients.)

Thanks to Ken Lammers at Crim Law for the pointer.

Labels: addiction, buprenorphine, heroin, treatment

 
The New Containment
- posted by Jim Leitzel @ 1:52 PM

Eminence grise George Kennan has passed away, and his policy of containment has seen quite a decline, too. Congress is upset that the US hasn't done more to combat opium growing in Afghanistan; here's Congressman Henry Hyde going over the top: "The U.S. government has been AWOL too long in the fight against illicit drugs in Afghanistan which is part of the same war against the same enemy that is global terrorism." (He then went on to say, "Of course, it is our public policies, and not the chemical properties of illicit drugs, that establish any connection between drugs and terrorism." Oh, no, he didn't say that.)

Anyway, some DEA folks had to testify to Congressman Hyde and others at a Congressional hearing to signal how seriously we take the crop-growing habits of dirt-poor, early-perishing Afghan peasants. How serious are we? Cold War serious, that's how serious: Operation Containment. From the Voice of America:

Michael Braun, of the U.S. Drug Enforcement Administration (DEA), says special DEA foreign-deployed agents may begin work at the end of March, supplementing an existing regional effort.

"Operation Containment is a DEA-led multinational cooperative program initiated in 2002 in an effort to place a security belt around Afghanistan that would prevent processing chemicals from entering the country and opium and heroin from leaving," he explained.

Meanwhile, other folks are hoping to get Afghanistan in on that portion of opium cultivation that receives official imprimatur.

Labels: Afghanistan, heroin, opium

 
Is Ongoing Drug Use Equivalent to Addiction?
- posted by Jim Leitzel @ 8:14 PM

We still don't have a good handle on the precise nature of addiction. But we do seem to be learning more, and one of the best places to keep abreast of what is being learned is the journal named, er, Addiction. In the December 2004 issue of Addiction appears the short article "ADDICTION, DISINHIBITION, IMPULSIVITY, COMPULSIVITY: WHAT'S THE DIFFERENCE, WHY DOES IT MATTER AND WHAT IS THE ROLE OF CONTEXT?," by MURAT YÜCEL, DAN I. LUBMAN, and CHRISTOS PANTELIS. Here's an excerpt:

We know that some drugs appear to be more addictive in certain societies/environments, in certain individuals, at certain times. This is another way of saying that addiction is a complex and multifaceted condition involving factors internal to the individual (neurobiological; such as genetics, neurochemistry, cognitive-affective regulation, personality) and factors external to the individual (contextual; such as environmental, cultural, spiritual, situational). As such, we strongly support the suggestion that context has an important role in the addictive process. We would argue that neurobiological vulnerabilities set the stage for psychopathology, but they by no means determine its onset, nature and course. In support of this, we know that neurobiological vulnerabilities expressed in different contexts often lead to vastly different outcomes. An example of this might be that only 6% of American soldiers who had used heroin in Vietnam became re-addicted three years after returning to the United States of America, despite 75% feeling that they had been addicted in Vietnam (Robins 1993). However, heroin was certainly more available and acceptable in Vietnam, and the relative consequences of ongoing use (in the face of a constant external threat) were likely to be much less severe than on return to the USA. This suggests that ongoing drug use in certain contexts does not necessarily equate to intractable addiction, but rather addiction should include the notion of continued use in the face of severe adverse consequences that far outweigh the benefits of using.

Labels: addiction, drugs, heroin

 
Indonesian Justice
- posted by Jim Leitzel @ 8:12 AM

From today's Chicago Tribune (registration required):

An appeals court overturned the convictions of four Indonesian security officers implicated in 1999 violence in East Timor, a major blow to efforts to punish top brass over the bloodshed that killed as many as 1,500 people...

The verdicts mean that 16 of the 18 suspects tried in the violence have now been acquitted. The only two who have been found guilty--Guterres ["notorious militia leader Eurico Guterres," whose own ten-year jail term was cut in half] and the tiny country's ex-governor--were ethnic East Timorese civilians.

On the other hand, a man convicted of attempting to smuggle 13 kilograms of heroin into Indonesia was executed by a firing squad on Thursday. (He did not have the heroin on him -- he was implicated by two other men who were caught with the heroin.) His execution might be the start of a cascade, as there are twenty or more other prisoners placed on Indonesia's death row for drug charges. The point of anti-drug laws, of course, is humanitarian, to offer people healthier lives. Vietnam is not shirking its role in the humanitarian effort, by upholding four death sentences handed out for smuggling less than 8 kilos of heroin.

Heroin used to be sold over-the-counter in the United States and in many other parts of the world; possession of heroin in the US was not made illegal until 1924. Fortunately, we have become more enlightened since then, and have given fuller rein to our humanitarian impulses.

Labels: Asia, heroin

 
Buprenorphine Treatment for Opioid Addicts
- posted by Jim Leitzel @ 6:28 PM

Methadone treatment for heroin addicts is pretty effective, as these things go. For many addicts, once-a-day methadone stabilizes them, prevents withdrawal, and allows them to maintain a more-or-less normal life. But it looks as if a drug called "buprenorphine" is even better, at least for many opioid addicts. You take it less frequently, and in the form in which it is provided in treatment, it is not easily subject to abuse. As a result, doctors can prescribe a month's supply at a time to an addict, reducing the need for clinic visits. It has only been available for treatment in the US for a short time. This fine story, in yesterday's New York Times, has more.

Labels: addiction, buprenorphine, heroin, treatment

 
Russia’s victories in the war on drugs
- posted by Michael @ 9:21 PM

Russia’s federal agency for fighting the war on drugs, Gosnarkokontrol, has just announced (this source is in Russian) that during the first year of its existence it has confiscated 44 tons of illegal drugs. The agency claims that it has been working only on really big cases and not bothering with small fry. The deputy head of the agency, Mr. Alexander Mikhailov, stated that the agency managed to stop more than 1,000 of large shipments, including 400 kilos of heroin from Afghanistan discovered in the Moscow region. It seems, however, that Mr. Mikhailov’s information about not bothering with small fry might have been somewhat misleading. (Perhaps he was getting bad intelligence.) For example, in the end of last year, Gosnarkokontrol went after the sellers of consumer items that promoted drug culture. In particular, the agency tried to impose fines on the sellers of t-shirts and cigarette lighters with pictures of cannabis on them. The rather predictable result has been that these items can still be bought but only under the table. Last April, the federal narkokontrollers tried to ban all the fiction that mentioned the ways of making or using illegal drugs. However, Russia is apparently not quite ready yet for this and the ban has not taken place. Perhaps Russia will mature for such a ban by the end of the second year of the glorious agency’s work.

While waiting for that day, the agency has managed to accomplish some other uniquely Russian (or are they?) spectacular achievements. Even prior to the end of its “major military operations” of eliminating all Afghani heroin shipments, Gosnarkokontrol has been mopping up the last remnants of enemy resistance. First, the agency tried to prosecute the veterinarians who used ketamine to anesthetize pets for surgery. In one such apparently typical case (the source is in Russian) in October 2003, a veterinarian was caught red-handed trying to administer the drug to a… cat. He was charged with unlawful transactions with drugs in large quantities. The vet, who was a victim of a sting operation, had a vial with 0.24 grams of ketamine. One of the witness accounts stated that the veterinarian was caught attempting to “supply the drug to a cat via an injection” (the Russian word used was “sbyt” which actually is closer to a “sale” than simple “supply”). At the time of the sting, the drug was prohibited for the use by veterinarians, but prior to the trial, the Ministry of Agriculture had legalized it although the appropriate accompanying regulations had not been implemented. Nonetheless, it appears that the defendant was acquitted mainly because of the legal change reported by Vice Squad earlier that increased the criminal quantities of illegal drugs, including ketamine, making the vet only civilly liable for a rather small fine. Most other “veterinarian cases” were discarded by the prosecutors by late June 2004.

However, Gosnarkokontrol soon shifted its attention (this is in Russian) to even more potentially drug abusive professions such as dentists and gynecologists. Several searches and audits revealed that the same ketamine and other drugs are sometimes used by these professionals without the appropriate licenses. For example, after a receipt for the purchase of ketamine was found during a search at the gynecological clinic “Blagovest,” the clinic’s director was charged with the sale of illegal drugs. The clinic had a license for the storage and use of these drugs valid through 2007. A new regulation required the clinic to obtain a license of a new type although the old licenses were never revoked. The clinic applied for a new license and was in the process of obtaining it, but ever-vigilant Gosnarkokontrol caught up with it before the new license has been issued. Similar cases were brought against some dentists and psychiatrists.

Even though Gosnarkokontrol may focus on large dealers (as well as veterinarians and gynecologists) it always remembers, of course, that the main goal of drug wars all over the world is to save the young people. Therefore, the agency announced (again, in Russian) that every Moscow night club would be required to obtain a special certificate stating that no drugs are sold on the premises. The certification is supposed to be conducted by a special Gosnarkokontrol commission. The certificate would then be posted at the entrance to the club. The clubs without the appropriate certificates will be subject to particularly close scrutiny of the police and could be closed. I’ll let the reader decide who the main beneficiaries of the certification requirement are going to be.

Labels: drugs, heroin, Russia

 
New South Wales Parliament Member Speaks Truthfully...
- posted by Jim Leitzel @ 6:14 PM

...and hence had to back off from her statement. She was speaking about how the drug trade, particularly heroin, is troubling a neighborhood in a suburb of Sydney: "Clearly if there's not so much money in drugs and they're not illegal then you wouldn't have a problem." But the MP didn't have to back off too far, as the Sydney Lord Mayor "called for the decriminalisation of heroin and a safe injecting room in the suburb." Memo to Drug Tsar John Walters: they're in danger of slipping off the plantation Down Under.

Labels: Australia, harm reduction, heroin

 
Harry Levine on Harm Reduction
- posted by Jim Leitzel @ 2:38 PM

Yesterday I promised a few more nuggets from Harry Levine's "The Secret of Worldwide Drug Prohibition," a 2002 article in The Independent Review. Harm reduction is the term applied to policies that generally don't aim at eliminating drug use, but rather, try to limit the harms that are imposed by drug use. Standard heroin harm-reduction strategies include methadone maintenance and needle exchanges. But most harm reduction strategies are designed to work within the currently existing drug prohibition regime. Levine notes the symmetry:

"Harm-reduction advocates' stance toward drug prohibition is exactly the same as their stance toward drug use. Harm reduction seeks to reduce the harmful effects of drug use without requiring users to be drug free. It also seeks to reduce the harmful effects of drug prohibition without requiring governments to be prohibition free."

Labels: drugs, harm reduction, heroin, Prohibition

 
Admitted Heroin Users Reticent About Cocaine Use
- posted by Jim Leitzel @ 5:09 PM

When people show up at an emergency room or for other medical care, knowledge of the drugs that they use can be of vital importance for themselves and their physicians. But people are not so willing to reveal that they use socially-frowned-upon drugs, and perhaps especially illegal ones. (Yet another cost of drug prohibition: it acts as a supplement to the disincentive to reveal, even to health-care professionals, important medical information.)

Self-reports of vice activity in general tend to be quite untrustworthy. Some people might be motivated to own up to their drug use, however, if they hope to be accepted into a treatment program, for instance. It might be thought that admitted heroin users would come clean about their use of other drugs, but that seems not to be the case. Perhaps heroin users look down upon cocaine users?

A research report that appears in the May 2004 issue of the journal Addiction finds that more than one-third of admitted heroin users who tested positive (via tests of hair samples) for cocaine use did not report that use, even in a secure environment and in knowledge of the fact that their hair would be tested for cocaine. Men were particularly unforthcoming about their cocaine use.

The article offers several hypotheses to explain the findings, including the possibility that those who did not self-report cocaine use tended to be light cocaine users, so they did not think their occasional cocaine consumption worthy of mention. This hypothesis is consistent with the findings that the concentrations of detected cocaine were much smaller in those who tested positive but did not report cocaine use than for those who admitted cocaine use. Perhaps surprisingly, heavier opiate users were less likely to own up to their coke use than were lighter users of heroin.

Labels: cocaine, heroin