Sunday, January 07, 2007

How to Pay For Cocaine and Heroin

Not to take away from the general discussion going on over at IOZ' How to Purchase Cocaine and Heroin post, but I did get into a side discussion with TenaciousK over the costs of addiction. Were one able to save drafts of comments, I would probably have posted this over there, but c'est la Blogger vie, no can do.

Both my work and my volunteer work have brought me into contact with drug users, addicts, crack babies, and the survivng family and friends of people who died from drug overdoses. I want all those drugs to just disappear from the face of the earth, particularly meth and the like. No matter how small, the human cost is too much.

Then again [and it pains me to be in sympathy with Rush Limbaugh on anything], I'm one of the 9% and I want to be able to walk into my local drug store and casually and anonymously buy syringes and morphine sulfate the way the rest of you can bebop in there and pick up a bottle of Tylenol for your occasional headaches.

Anyway, for a variety of reasons [a future post], I now agree: drop The War On Drugs, legalize all recreational drug use.

I haven't yet figured out where I stand on the various sub-arguments about control, regulation, taxation, availability, etc [also for a later post, if ever]. For now I just want to know:

how many people are going to need treatment for drug addiction and how do we pay for it?

Opponents are fond of quoting figures like $143.4 billion as the cost of the war on drugs, but they're figuring in stuff like lost productivity, which is all well and good for making a point, but I want to figure out where in the federal coffers we have money to be turned away from fighting drugs and toward treating drug users.

Believable estimates of what the federal government is spending on the war on drugs range from about $12 billion [various sources] to about $19 billion per year. From the National Drug Control Strategy, FY 2006 Budget Summary: the budget request was approximately $12.5 billion [of which approximately 26% was to be spent on treatment].

When SWAGing stuff, I like to truncate numbers to two-ish significant figures and lean toward the worst case scenario, so $12 billion it is. And as I said to TK in the comments over at IOZ' blog, if we tax the formerly-illicit drugs like we do alcohol and tobacco, I think that might bring in another $5 billion.

In 2002, the total US population was approximately 280 million people. At about the same time, probably 7 million people, age 12 years and older, needed treatment for drug use [table 16]. That's 2.5% of the total population.

It looks like maybe one third of the same age group has tried illegal drugs at least once in their lives. If drugs become legal, affordable, and widely available, and 100% of the population tries drugs, then we can expect maybe 7.5% of the population becomes addicted and will need treatment. That seems possible or even a bit high, as the same source where I got the 7,000,000 needing drug treatment also estimates that about 18,000,000 needed treatment for alcohol problems.

So, we have somewhere in the neighborhood of $12-$17 billion to treat 22 million people. That's a paltry $545-$772 to spend on each person needing treatment. Even if only 2.5% of the population needs treatment, it only raises it to maybe a couple thousand dollars per person per year.

I don't know how much it costs to effectively treat a drug addiction, but that doesn't sound like enough money.

This is depressing. I need some drugs.

I don't agree with everything Milton Friedman says here, but but I did appreciate the homily he launches into, about 16 minutes into the video:


TenaciousK said...

No need to be so depressed about drug treatment costs.

One of the more credible arguments the "War on Drugs" people can offer involves the proportion of people entering chemical dependency treatment voluntarily; the vast majority are coerced into treatment by law enforcement, with coercion by employers and families following in a rather distant second and third (I don't have stats, but you can trust me on this). Your estimate is based in large part on the number of people entering treatment because they have to. I think its fair to say that there were be a sustantial decline in drug treatment bed space, should use be legalized.

This is one of the several reasons I think the state should retain control over distribution, and yoke it to a treatment access point ala methadone treatment clinics.

A proportion of the people who become addicted that would eventually have become abstinent with treatment will not, should use be legalized. As far as I'm concerned, legalization of use involves the sacrifice of a percentage of those. There's far more than money in the counterbalance, however - there's the horrid impact of incarceration, crime etc. associated with the current system. Any analysis of the cost of the current anti-drug effort should take at least a substantial proportion of incarceration costs for drug offenders into account.

Honestly, we'd be coming out rather far ahead - especially if we made deals with Afghan farmers to purchase their poppies for opiate production. Economic stabilization of that country has got to save us - don't you think?

But I think Ioz is way off, regarding the relatively innocuous impact drugs have on many rational adults - he's failing to take into account the self-selecting quality of people he's thinking of. I wonder if he noticed any of his "PNP" friends dropping off the face of the earth, because some of them certainly did.

Anyone who has worked in a treatment center can attest to the validity of some of the horror stories being perpetuated by the antidrug propagandists - despite what High Times might have to say about it. There really is such thing as "Avolitional Syndrome" associated with pot use, for example. It's also not uncommon for truly heavy, chronic users to eventually experience a paradoxical effect after smoking up: agitation, primarily, though thinking seems to be getting pretty loose for these same folks.

I worked briefly with a couple of people who really were intentionally injuring themselves (including horrid things like intentionally infecting wounds) in order to obtain opiates. Legalized use would've saved at least one of their lives, that I'm aware of (though I have no doubt, finally, both).

Providing controlled doses of predictable purity will save lives (thinking Heroin here), and there's some evidence that in the case of Heroin, all the impurities in the drug are responsible for the vast majority of ill health effects.

I'm less concerned about marijuana, frankly - don't really care if it'd be possible to walk into 7-11 and purchase a carton of blunts. But I think relaxing social prohibitions against use, mostly of other drugs, is a terrible mistake. When you're talking about proportion of the population who need chemical dependency treatment, you're looking at the proportion who get into trouble under the current access-limited and use-prohibited system. Despite Ioz's assertions of availability, I think it's ludicrous to imagine use wouldn't increase if legal prohibitions were dropped and substances became much more readily available.

I suppose some of the people entering treatment would be some of the same folks entering treatment for alcoholism - people who've been coerced into it due to DUI conviction(s). But otherwise, unless you allow relatively free access, even legalized use would entail fewer people entering treatment than the current system.

Last thought: some of the more conspiracy-minded have argued the entire "war on drugs" serves to find an excuse to arrest minority men and lock them up. I'm not prepared to discount this entirely as a motivation for some, though I'm more inclined to attribute it to more subtle manifestations of racism, rather than an overt conspiracy. The people who are most inclined to argue this are the same people who argue that an underclass is unavoidable, and that we best plan on how to deal with one, rather than pretending we can make ours go away. Oddly enough, this is a sentiment encountered (I think) more often among Libertarians than other political groups (though many Republicans also seem hip on the concept). I wonder - if Ioz doesn't think we ought to just lock up all these "inconvenient" people, what will happen?

And once we remove the most reliable means for motivated, hard-working inner-city minority youth to improve their economic circumstances, what do you think they will do? And what should we, as a culture, do about it? The Libertarians seem short on answers, beyond the usual "if they're a resource, someone will utilize them" party line.

Just curious about your thoughts...

Keifus said...

At the great risk of being the dumbest kid in the room on this subject (again), I'll chime in.

I read IOZ because he's often right and often brilliant, but found him to be something of a supercilious jackoff in his post the other day. Usually when this happens, I don't notice it till I come down from the high of his rhetoric, sometimes days too late. Anyway, what irritated me was his anecdotal version of "drugs are peachy" evidence. Those party people seem well-adjusted, right? TK's input was welcome.

I've known a couple of people well enough to see them go off the pier with opiates. Unrecoverably it would appear--the principle occupation of either seems to be muttering on street corners and aquiring years of wear in double-time. That's one reason opiates scare the shit out of me (another is a having a family full of high-functioning alcoholics). Hey IOZ, do my anecdotes trump yours?

And hipparchia, your anecdote is different still. What a horrible dilemma. Am I presumptious to worry about you and your options?

I'll try to follow your numbers when I have a little more time. I know I've read them before, but interested in a breakdown wrt incarceration, war prosecution, idiotic anti-drug campaigns (which surely won't go away) etc. (I also shudder at the power of the legal opium lobby!) There's a lot to parse there, and not being into that overmuch, I tend to put it off. I appreciate you taking it on.


(bkkxzkqq: backdoor Khazak sex queens? What did I do to deserve that one?)

TenaciousK said...

Don't be silly.

However - it's not very polite to make a really obscure reference (such as backdoor khazak sex queens?) without at least giving a little hint about what you're referring to.

"Backdoor Khazak Sex Queens"? Sounds like a piece of Spam that might've slipped past my block by cleverly hiding behind that latest intriguing "offshore Viagra" offer.

Keifus said...

Why can't I be silly?

TenaciousK said...

Oh fine, be silly then.

But jokes aren't nearly as funny when the person telling is the only one laughing - at least that's what my kids keep telling me.

Keifus said...

TK: Khazak(h) sex queens is part of a game. (Quite silly, you'll like it.) Check out some of the comments below. I'm sure it'll come to you quickly.

(I feel like I should say something topical.)

TenaciousK said...

PS. Regarding your blog title - you know that whole Lemming thing turned out to be a tragic (well, for a few lemmings anyway) hoax, right?

There's Arvicolinae blood on the hands of that Disney huckster! Fucking exploitive capitalist...

obfuscati said...

heya, tk! i love ya, dude, but you have to figure out the kazakh sex queen game on your own.

hiwulmtr hiawatha was a mountaineer

i an sooooo slow....
crwngyib crowning your ibsen

obfuscati said...

keifus: they heard about the earwigs.

pgeqzq -- przewalski equality

obfuscati said...

it's monday, guys. i'm not up to hitting the serious stuff today. give me till tomorrow at least to dig in again.

tk: i knew the suicide was an urban[?] legend, but didn't realize any of the other stuff. great link.

but hey. pushed over the edge by outside evil forces? falling over the edge from utter confusion? i think they both work here.. i'm keeping the title for now.

dqersuuq dairy queen, ersatz suuuuuugar

kxhaulkg kazakhs hauling locdog

hipparchia said...

Keifus: You are most emphatically not the dumbest kid in the room.

IOZ is almost always supercilious, and almost as frequently he is a real jerk, but i'm with on that high that comes from reading the words that he strings together. Loverly stuff.

No, you needn't worry about me and any of my dilemmas. I promise never to cross over to the dark side.

I'm also with you on the anecdotal evidence he presented. Like IOZ, I too have partied with many a PNP fag, and my anecdotal evidence suggests that while they throw mah-ve-lous pah-ties, they do have a disturbing tendency to disappear from the face of the earth. And like you, I have alcoholics in the family tree. They've tended to drop off the face of the earth too.

The power of the legal opium lobby! If they hired IOZ as their speechwriter, they'd be unstoppable.

I didn't address some of those other numbers you're interested in because I don't really want to see a reduction in police forces or judges and courts [they're all overwhelmed, under-manned, and under-funded], which means I didn't want to apply any of that money to treatment for addiction. I'm ambivalent on juggling the dollars around the imprisonment issues. Your homework assignment ...

Anyway, the FY 2006 budget link above had some of the numbers you're looking for. here's another link that has some of that information. lots to wade through at both those, i warn you.

hipparchia said...

Intentionally infecting wounds?! eeeuuuuwwww. Thanks for that image, TK [not].

I haven't seen that but I can identify with the desperation. I've felt a few of those tugs myself, and watched others give in and do stuff that no one in their right minds would ever do.

Yes, I trust your assertion on the routes into treatment. It fits with my [limited] observations. For that reason, as well as for our own self-defense, I'd like to keep "driving while intoxicated" as an offense meriting some kind of forced treatment and in some cases probably jail time.

We'd need to come up with a valid measure of "intoxicated" for all the other drugs. Testing positive for traces of metabolites that hang around for days or weeks after ingesting a drug is NOT valid.

My guess: IOZ and crew are too coked up at some of these parties to notice or care whether their PNP pals drop off the face of the earth. Like I said to Keifus, in the world I used to party in, they did disappear.

Still, if 40% of adults try drugs and only 2% or so become addicted, I have to say that I have some sympathy for the Libertarians [who seem to care not a whit if a small percentage of folks get sacrificed]. It's unfortunately true that we can't save them all [though I'd always want to try].

And I compare it to what a war-gaming friend of mine once let slip after one too many glasses of wine: the percentage of soldiers the Army considers an acceptable loss in various scenarios is alarmingly high. IOZ and his buddies look like Mother Teresa in comparison.

I had more thoughts, but they all seem to have turned into pumpkins for the evening. I'll be back.