Eight Questions for Drug Policy Research: The Current Research Agenda Has Only Limited Capacity to Shrink the Damage Caused by Drug Abuse. Some Promising Alternative Approaches Could Lead to Improved Results

Article excerpt

Drug abuse--of licit and illicit drugs alike--is a big medical and social problem and attracts a substantial amount of research attention. But the most attractive and most easily fund-able research topics are not always those with the most to contribute to improved social outcomes. If the scientific effort paid more attention to the substantial opportunities for improved policies, its contribution to the public welfare might be greater.

The current research agenda around drug policy concentrates on the biology, psychology, and sociology of drug-taking and on the existing repertoire of drug-control interventions. But that repertoire has only limited capacity to shrink the damage that drug users do to themselves and others or the harms associated with drug dealing, drug enforcement, and drug-related incarceration, and the current research effort pays little attention to some innovative policies with substantial apparent promise of providing improved results.

At the same time, public opinion on marijuana has shifted so much that legalization has moved from the dreams of enthusiasts to the realm of practical possibility. Yet voters looking to science for guidance on the practicalities of legalization in various forms find little direct help.

All of this suggests the potential of a research effort less focused on current approaches and more attentive to alternatives.

The standard set of drug policies largely consists of:

* Prohibiting the production, sale, and possession of drugs

* Seizing illicit drugs

* Arresting and imprisoning dealers

* Preventing the diversion of pharmaceuticals to nonmedical use

* Persuading children not to begin drug use

* Offering treatment to people with drug-abuse disorders or imposing it on those whose behavior has brought them into conflict with the law

* Making alcohol and nicotine more expensive and harder to get with taxes and regulations

* Suspending the drivers' licenses of those who drive while drunk and threatening them with jail if they keep doing it

With respect to alcohol and tobacco, there is great room for improvement even within the existing policy repertoire (for example, by raising taxes), even before more-innovative approaches are considered. With respect to the currently illicit drugs, it is much harder to see how increasing or slightly modifying standard-issue efforts will measurably shrink the size of the problems.

The costs--fiscal, personal, and social--of keeping half a million drug offenders (mostly dealers) behind bars are sufficiently great to raise the question of whether less comprehensive but more targeted drug enforcement might be the better course. Various forms of focused enforcement offer the promise of greatly reduced drug abuse, nondrug crime, and incarceration. These include testing and sanctions programs, interventions to shrink flagrant retail drug markets, collective deterrence directed at violent drug-dealing organizations, and drug-law enforcement aimed at deterring and incapacitating unusually violent individual dealers. Substantial increases in alcohol taxes might also greatly reduce abuse, as might developing more-effective treatments for stimulant abusers or improving the actual evidence base underlying the movement toward "evidence-based policies."

These opportunities and changes ought to influence the research agenda. Surely what we try to find out should bear some relationship to the practical choices we face. Below we list eight research questions that we think would be worth answering. We have selected them primarily for policy relevance rather than for purely scientific interest.

1) How responsive is drug use to changes in price, risk, availability, and "normalcy"?

The fundamental policy question concerning any drug is whether to make it legal or prohibited. Although the choice is not merely binary, a fairly sharp line divides the spectrum of options. …