Should physicians be permitted to prescribe marijuana to alleviate suffering? The Administration and Congress say no. For example, in such a setting is to be horrified by the senseless carnage. "Violence is as much a public health issue for me and my successors in this country as smallpox, tuberculosis, and syphilis were for my predecessors in the last two centuries," declared former Surgeon General C. Everett Koop, M.D. in 1984.27. To design effective interventions we need to understand the precursors to violence both in children and adults, the genesis and effects of violence among family members, and the nature of street violence. Efforts such as a large prospective longitudinal study of several thousand children at risk for antisocial behavior are already underway.
The public perception that drugs "cause" violent crime, particularly predatory street crime, is a prominent factor in shaping public policy. How accurate is this perception? Medically, there appears to be little direct causation between drug effects and violence. Research findings show consistently that the psychopharmacological influence of drugs themselves appears to be a minor factor in violence.
A study of crack violence among adolescents in Miami found that about 60 percent of the violence was related to crimes committed to secure money to buy drugs; only 5.4 percent was related to the psychopharmacologic effects of drugs. A study of cocaine-related homicides in New York City showed that most violence was due to territorial disputes among drug dealers; about 2 percent could be ascribed to direct psychopharmacologic effects.30 These studies and others confirm that most drug violence is an economic side effect of drug prohibition, not an effect of the drugs themselves. One important exception is alcohol for which there is strong data that intoxication directly influences violent behavior.
Here we see an instructive Catch-22 situation. It appears that drug prohibition policies lead to violent crime and that greater drug prohibition leads to more violent crime. Yet, the supposed crack connection with street violence was a major factor, at least in political rhetoric, in determining President Reagan's 1984-1985 escalation policy in his war on drugs. My perception at the time was that the focus on crack cocaine was a deflection (a displacement in psychological terms) from certain basic underlying issues regarding crime. The political response then, a war on predatory street crime, was misnamed a war on drugs. Sadly, fundamental social and economic issues such as poverty and community and family disorganization, and at an individual level, today's antisocial behavior among young children and adolescents, were subordinated to fighting drugs. Not only did the drug focus fail to stem the street violence, but it diverted attention from the more difficult and costly political task of tackling the known causes of violence.
This administration wishes to keep the focus on drugs. To attack the underlying causes is a diversion from their war on drugs. On January 10, 1992, director of the Office of National Drug Control Policy, Robert Martinez, said that blaming drug problems on social causes "victimizes drug users and strips them of their freedom of choice."32 This is doublespeak, rivalling George Orwell's best. |
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