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Rationalizing Modern Drug Prejudices

Congressman Jared Polis: Is crack worse for a person than marijuana?
DEA Agent Michele Leonhart: I believe all illegal drugs are bad for you.
Congressman Jared Polis: Is methamphetamine worse for somebody’s health than marijuana?
DEA Agent Michele Leonhart: I don’t think any illegal drug is good for you.
Congressman Jared Polis: Is heroin worse for someone’s health than marijuana?
DEA Agent Michele Leonhart: Again, all drugs.
Congressman Jared Polis:  I mean either ‘yes’, ‘no’, or ‘I don’t know.’ I mean if you don’t know you can look at this up. You should know this as the Chief Administrator of the DEA. I’m asking you a straightforward question, is heroin worse for someone’s health than marijuana?
DEA Agent Michele Leonhart: All illegal drugs are bad.

*   *   *

How dangerous are different substances compared with each other, and do the laws get it right in banning some substances but not others? This question is not as immediately answerable as it might seem. For a start, no final and absolute answer can ever be given to the age-old question of how relatively dangerous different substances are to each other. Tobacco for instance will likely contribute to a shorter life for half of its smokers while the vast majority of ecstasy users will remain unscathed by the drug. But tobacco doesn’t snatch away a teenager’s soul in the prime of life the way an ecstasy pill might. Nobody has ever died of a marijuana overdose, but people do slip in and out of psychosis and harm themselves while using marijuana – and it likely induces long term psychosis in predisposed individuals. But how does a life of schizophrenia compare to the risk of a fatal overdose of heroin? Value judgments seem inevitable in trying to establish the relative comparisons between drugs, and any attempt to compare apples and oranges will inevitably fall short of the scientist’s objective goals.

To try to get a grasp on the complexity of this problem, forty scientists met in 2015 to carry out a ‘multi-criteria decision analysis,’ an analysis of drug harms that encompasses multiple categories of harm including mortality rates, bodily damage, dependence, mental impairment, loss of tangibles, relationship breakdowns, injury to others, crime, environmental damage, economic costs and community issues surrounding drug use. Each commonly used drug was looked at and given a harm score on sixteen separate categories of harm, and these scores were then weighted and tabulated together to form an overall harm score:

European ranking of drug harms, 2015

This ranking shouldn’t be over-interpreted as ‘scientific proof’ that one drug is worse than another. Because this sort of analysis requires value judgments as to how separate harm scores are to be weighted, the scientists carrying out this relative ranking found that significantly changing the weights of different categories of harm sometimes led to a different result. Depending on which weights are changed in the sensitivity analysis, alcohol, heroin, crack cocaine and tobacco all vie with each other in the position of overall most harmful drug. But some familiar patterns appear to be constant across all sensitivity analyses. No matter how many variations in weighting procedures were used by these scientists, alcohol always came out as significantly more harmful than marijuana, and staggeringly more harmful than LSD and magic mushrooms.

While it’s probably not a large surprise to many that marijuana isn’t considered as harmful as alcohol, the nearly non-existent harm score attributed to the psychedelics LSD and magic mushrooms is an eyebrow raiser. Years of misreporting by the mainstream media have imprinted a particularly negative image of these drugs that has little correspondence to reality. By way of example, a 2012 article in The Daily Telegraph ran a story titled ‘Gifted Teen Dies in LSD Overdose.’ The story focused on an Australian teenager’s death after consuming some type of substance, and without any toxicology data on what that substance was, goes on to lambast LSD as a “deadly substance.” This is an extremely bold assertion to make without toxicological confirmation, as a medical review in Neuroscience & Therapeutics found no example of an LSD overdose death in recorded medical history. When one follows up on stories like this reported in the mainstream media, very often you will find the injury attributed to psychedelics is actually the result of some other factor or a mixture of factors. In this case, toxicology eventually found that the boy had died while using some new synthetic drug misleadingly sold as LSD on the black market.

Another headline reads ‘Coroner Warns Students over Deadly Mushrooms,’ in which magic mushrooms were linked to the death of a young New Zealand girl who apparently had “toxic levels of psilocin” in her body (psilocin is a metabolite of psilocybin from magic mushrooms). Once again, the medical literature stresses that no case of toxicity poisoning has ever been recorded from magic mushrooms and that it would be almost humanely impossible to consume enough mushrooms (17kg in fact) to reach toxicity. In this case, later context revealed that the girl had received a heart transplant and was unable to attend university or work due to her heart condition, but had decided to consume magic mushrooms nonetheless. As many people do, she became panicked at the onset of the psychedelic experience, likely placing stress on her heart thereafter suffering heart failure. In this freak case, magic mushrooms played a role in the death, but original reporting by the media was highly misleading in projecting the image of a “deadly” drug like magic mushrooms.

As the above example illustrates, psychedelics are not risk free, especially when one is already facing a life threatening illness. But as I describe in my Quillette article ‘On the Eve of the Great Psychedelic Debate,’ most of the terrible harms attributed to psychedelic drugs like LSD and magic mushrooms turn out to be urban myths. As I describe in that article, scientists agree on four basic things about psychedelic drugs that seem to hold outside of extreme circumstances: you cannot die of an overdose of them, they cause no physical damage to bodily organs, they are not addictive, and they do not seem to attend any net deterioration in mental health in a population of users (they perhaps attend an improvement). On all four of these measures, alcohol towers above the psychedelics as an addictive, lethal chemical that attends overdose, cancer, organ failure, heart attack, stroke, psychological damage and death via withdrawal (delirium tremens). And that’s only half the picture: alcohol’s negative impact in road fatalities, violence, emotional abuse and community breakdown are unparalleled in the drug world. For these reasons, scientists carrying out the multi-criteria analysis give magic mushrooms one-tenth the harm score of alcohol.

In the United States, under the Controlled Substances Act the Drug Enforcement Administration (DEA) holds a great deal of discretionary power in deciding which schedule a substance will be placed in. Marijuana and psychedelics are classified as Schedule I substances alongside heroin, a classification created for drugs that are considered medically useless and highly dangerous (though heroin is used medically outside the United States). Other schedules contain less stringently controlled substances, such as ketamine, cocaine, anabolic steroids and methamphetamine, as these drugs may not be considered quite so harmful or may have medical uses. Alcohol and tobacco, of course, are unscheduled and perfectly legal to purchase. This means that possibly the safest of all psychoactive drugs is classified as the most severely punishable while one of the most dangerous drugs available is not even scheduled (the other drugs are spread throughout the scheduling system in a seemingly random fashion). While some people see conspiracy theories at play to explain this paradoxical situation, the question that most peaks my curiosity is how defenders of the status quo could attempt to defend drug laws as they currently stand, which seem like historical artifacts rather than the product of a well thought through process.

*   *   *

Congressman Steve Cohen: Would you agree that marijuana causes less harm than meth, crack and cocaine?
DEA Agent Michele Leonhart: As a former police officer, as a thirty-two year DEA agent, I can tell you that marijuana is an insidious drug.
Congressman Steve Cohen: That’s not the question I asked you mam. Does it cause less damage to American society and to individuals than meth, crack, cocaine and heroin?
DEA Agent Michele Leonhart: I can tell you that more teens enter treatment.
Congressman Steve Cohen: Can you answer my question please?
DEA Agent Michele Leonhart: I’m trying to.
Congressman Steve Cohen: You’re trying to answer the question like I’m Senator Sessions. I’m not Jeff Sessions. I’m asking you a question…Does heroin and meth cause more deaths than marijuana?
DEA Agent Michele Leonhart: All drug trafficking causes deaths.

*   *   *

Some people simply refuse to accept that the relative risks of psychedelics or marijuana are not as harmful as other drugs. The DEA implicitly takes this approach by pretending that the question of relativity is incoherent and ignoring politicians who raise it, while others explicitly reject the notion of a relative assessment of harms. Psychiatrist Edward Gogek takes the explicit approach. In his 2015 book Marijuana Debunked: A Handbook for Parents, Pundits and Politicians who Want to Know the Case Against Legalization, Gogek declares, “There is no way to say one drug of abuse is safer than another. Each drug has at least one way in which it’s worse than all the rest.” According to Gogek, people drop like flies using heroin, but teenagers using marijuana are more likely to drop out of school than other drugs, and being worse than any other drug in this one dimension we are therefore debarred from a conclusion about its relative risk to other drugs. So marijuana cannot be said to be less dangerous than heroin. Not only does Gogek fail to demonstrate in his book that teens addicted to heroin are more likely to stay in school longer than teens addicted to marijuana, the argument is clearly fallacious. A diet of excessive calories might lead to a higher risk of obesity than a diet of cyanide, but it would foolish to say that because both diets are worse than the other in at least one way that neither is safer than the other. It should seem blatantly obvious that some drugs are safer than others. And what if Gogek’s argument holds anyway? He has simply asserted that alcohol and tobacco are just as dangerous as any illegal drug, hardly escaping the pressing question of consistency in our drug laws.

While Gogek denies that one drug is worse than another, other defenders of current drug laws busy themselves in trying to find some disqualifying criteria to establish the harmfulness of illegal drugs in contradistinction to legal ones. For example, conservative commentator Ann Coulter argued on The John Stossel Show, “I think there is a difference between [other] drugs and alcohol. People can drink wine over dinner without getting drunk, people smoke and stay up all night working. A lot of work gets done on tobacco, whereas [other] drugs are pretty much specifically just to get high.” Coulter here takes issue with the moment of temporary mental impairment while intoxicated on a drug, a moment in which one is unable to function in ordinary life and carry out daily tasks such as work. Should this mental impairment be taken into account? Certainly. And the multi-criteria analysis previously discussed does take mental impairment into account, as one of sixteen forms of recognisable harms caused by drugs. The entire harm score attributed to magic mushrooms in that report came merely from mental impairment while intoxicated – on this one measure it receives a higher score than alcohol. But despite carrying a higher harm score on this one specific measure, it is evidently clear that alcohol is worse in every other way. The harms of drug use are multivariate, so Coulter’s attempt to establish a justified demarcation between legal and illegal substances on the univariate measure of mental impairment alone simply begs the question as to why this one particular form of harm categorically trumps all others. Once again, this vacuous evasion doesn’t offer any answer to us.

Once defenders of the status quo have reached the bitter realisation that marijuana and other drugs may be less harmful than alcohol and tobacco, they may try confounding a discussion of relative risk with absolute risk. Conceding the case that alcohol and tobacco may very well be more harmful drugs than marijuana, William J. Bennett and Robert White excrete chapters of effort in their 2015 book Going to Pot: Why the Rush to Legalize Marijuana is Harming America to convince the reader that this does not mean that marijuana is harmless. “The point is this: There is no level of marijuana use that is actually completely safe,” evince Bennett and White, “Let us repeat: we have found no serious scientific or medical study that concludes marijuana use is actually safe or healthy.” Obviously. Nothing on earth is “completely safe.” People have been killed by exploding lava lamps and whipped cream cans, impaled on beach umbrellas, lit on fire by sodium covered seashells and had their skulls crushed by rocks thrown by animals in zoos. No study on anything, anywhere in the world, ought to describe of anything as being completely safe and healthy. But since when did “completely safe” become a sensible criterion for being permitted to carry out some activity in any society? Wouldn’t that obviously cripple a society? And why doesn’t this formula apply to alcohol or tobacco? The question of inconsistency remains open.

*   *   *

Congressman Earl Blumenauer: What is more dangerous and addictive, methamphetamine and cocaine, or marijuana?
ONDCP Deputy Director Botticelli: I don’t think anyone would dispute the fact that there’s ah, ah, relative toxicity related to those drugs.
Congressman Earl Blumenauer: What is more dangerous and addictive, cocaine and meth, or marijuana, pretty simple?
ONDCP Deputy Director Botticelli: Ah, ah, I think that conversation minimizes the harm.
Congressman Earl Blumenauer: No, I’m not trying to minimize the harm. I want to know, which is more dangerous and addictive?
ONDCP Deputy Director Botticelli: I, you know, ah, again, I go back as a public health person, you know, ah, one of the things we look at is not what is the relative risk of one drug against another.

*   *   *

People have a diverse set of ideas as to what level of harm ought to be permitted in any society under the protection of liberty. Liberals may have a somewhat relaxed view, and libertarians an extremely permissive attitude towards harmful activities. Public health advocates on the other hand may be totally indifferent to liberty in the pursuit of what they consider the nobler value of harm reduction. In fact some harm reduction advocates might bite the bullet and openly assert that anything as dangerous as illicit drugs ought to be banned too. Peter Hitchens for instance has supported the prohibition of alcohol in theory to remain consistent in his call for keeping marijuana illegal, “I would support the most severe legal measures to penalise its use and drive it out of our society. But this is not the case. Alcohol is too well established here for such measures to work.” Hitchens is right to suggest that such a law wouldn’t likely succeed in practise, given historical precedent with alcohol prohibition in the 1920s. As most people enjoy alcohol, such a law might turn most citizens into criminals and any government would simply lack the resources to carry out such a large-scale full frontal attack on the consumption patterns of a majority of its people. But what if the government did have the capability to arrest a majority of its own citizens and could thereby successfully suppress alcohol use? It’s unclear if Hitchens would support arresting Jesus Christ for his notorious party tricks involving wine (perhaps Christ would also be barred from entering the country on grounds of poor character). But for now, God incarnate and the rest of us can escape the prohibitionist’s wrath on account of the powerlessness of government to control alcohol, and this discrepancy in government capabilities is said to be the reason demarcating the justified boundary between illegal and legal substances.

Whether this argument is empirically sound is a debate of tremendous size and scope. With half of all Americans using marijuana at some stage of their lives, many believe the government to be just as powerless in trying to control marijuana with any efficiency as with alcohol. Sidestepping this wider debate for another day, let’s keep focused on the underlying formula here of those who assert that certain things as dangerous as illegal drugs ought to also be prohibited. When asked about the relative danger between drugs and motorbikes Hitchens also confided, “If motorbikes were banned I might well oppose a campaign to legalize them.” Aside from motorbikes, plenty of other activities seem to rival marijuana and psychedelics in terms of risk of injury and death, including football, horse riding, swimming, quad biking, boxing, skydiving, and scuba diving. Believe it or not, there are people who would prohibit these dangerous activities too. “American football is too dangerous and it should be abolished,” wrote The Guardian’s Dave Bry in 2016. “Pools need to be banned. They are way too dangerous,” argues the Australian writer Joe Abi. These harm reduction totalitarians are dead-set serious about banning everything under the sun, and so we can naturally understand why they would also support prohibiting all drugs. While most of us would choose to flee from their bubble wrapped dystopia, here is a group of people with a consistent, straightforward harm reduction policy.

Of course, drug prohibitionists aren’t going to rally many friends to their cause if people have to accept that they can’t drink alcohol or watch football, or if they had to lose their backyard pool. Most defenders of current drug laws wouldn’t dare mention the views expressed by these harm reduction totalitarians, so for them the problem still remains: how to convince people that marijuana and other drugs ought to be illegal, without threatening other legal activities that are just, if not more, dangerous. In Going to Pot: Why the Rush to Legalize Marijuana is Harming America, William J. Bennett and Robert White offer a response to the question of inconsistency that is illustrative of an ideology unsure of itself. Cognisant that much of their audience is composed of drinkers, they reassure their readership that it is not their inclination nor their desire to prevent alcohol consumption, “None of us want to go back to the days of [alcohol] prohibition, nor do we support illegalizing that which has been enjoyed for millennia.” Then in a different chapter they tell their readers how to respond to legalizers about the question of consistency, “[…] that alcohol and tobacco are more dangerous than marijuana suggests that we should further restrict or make illegal alcohol and tobacco, not make legal something else that is already damaging, as well.” In other words, they first convince their readers that they do not support a ban on alcohol, and then they tell the same reader in another chapter to offer to legalizers that very idea to cover for the inconsistency.

Reading between the lines, Bennett and White virtually tell their readers, “You and I want to keep our alcohol, so let’s not prohibit it. But we want weed to be illegal. So let’s just tell them that alcohol should be prohibited.” Most of the responses to the question of inconsistency seem to be ad hoc rationalizations to cover for what Bennett and White so clearly demonstrate: a deep gut reaction against the use of most drugs, except for the drugs that they themselves use. While we can never say that a good reason doesn’t exist to justify the drug laws as they currently stand, it can be said that the most recent wave of prohibitionist literature hasn’t been able to deal with the fundamental problem of consistency.

 

Matthew Blackwell is an Australian writer and graduate of the University of Queensland where he studied economics and anthropology. Follow him on Twitter @MBlackwell27

Comments

  1. I’ve never seen weed harm anyone other than legally.

    The addictive drugs, thought… I’ve seen two friends through serious, no kidding drug addiction: one coke and one morphine derivatives. It was… ugly. That stuff grabbed them and would not let go, and these were intelligent, fairly strong willed people. The addiction changed their judgment.

    I agree that some of the current illegal drugs don’t seem to do any more harm than current legal recreational drugs.

    But the opiates, coke, meth? That stuff is a slow death.

  2. From the time we go through puberty, we’re all slowly dying.

  3. It’s always fun to watch someone you dislike - a government official, perhaps - squirm under hostile questioning by elected congressmen on television.

    “Yes or no. Give me a yes or a no, you spineless coward. I’m going to keep at this for as long as it takes for the American people to see what a gutless worm you are! (And, incidentally, that I am a courageous scourge of America’s internal enemies.)”

    But it has to be said that the “yes or no” game is a fallacy all its own. The questions are seldom presented in a way that they can be honestly and accurately answered with a simple yes or a no, and the escape hatch “I don’t know” is seldom accurate either, because part of the answer is always known or suspected, and saying “I don’t know” always sounds like a dodge, whether it’s true or not.

    Were I in the shoes of those hapless DEA agents, I would have said:

    “Congressman, I refuse to answer your question yes or no, and if you like, I will explain why it is inappropriate for you to ask this of me, and why it represents a disservice to your constituents.”

  4. Is ricin worse for a person than hemlock? What a stupid line of questioning.

    As the author points out the U.S. drugs are ranked in schedules according to the potential for harm and abuse. Schedule 1 drugs are the most harmful. Schedule 6 and below drugs are less harmful. Marijuana is a schedule 6 drug. Heroin is a schedule 1 drug. https://www.dea.gov/drug-scheduling

    Yet all these people weighing drug usage and harm to determine not only which drugs should be illegal but which require a prescription are wrong.

    The same old tired argument about alcohol being more dangerous yet legal always over looks one critical aspect. Alcohol can be consumed in moderation with a meal or social gathering without the consumer becoming inebriated or impaired. The point of consuming marijuana or psychedelics is to become stoned or impaired. It is simply a question of dosage. One dose equals impairment verses several doses equaling impairment.

    “There is no way to say one drug of abuse is safer than another. Each drug has at least one way in which it’s worse than all the rest.”

    Would you rather your child be a casual consumer of alcohol or marijuana and psychedelics?

    Where is the book “ Drug Usage a Path to Success”?

    Arguing for legalizing drugs, especially the libertarian argument, is a debatable point. However venturing into drugs aren’t really bad for you is grasping at straws. Final question does alcohol consumption have a second hand smoke component where persons around the user are potentially affected?

  5. “The same old tired argument about alcohol being more dangerous yet legal always over looks one critical aspect. Alcohol can be consumed in moderation with a meal or social gathering without the consumer becoming inebriated or impaired. The point of consuming marijuana or psychedelics is to become stoned or impaired. It is simply a question of dosage. One dose equals impairment verses several doses equaling impairment.”

    Nonsense. Any of these substances can be “moderately” dosed. And some individuals get “impaired” with a single “dose” of alcohol, while others do not. And our bodies tend to build a tolerance with regular use. A person who knows their limits can absolutely “dose” cannabis “in moderation with a meal or social gathering without … becoming inebriated or impaired.” Or perhaps they prefer to watch a movie or read a book. For a lot of people (and I mean a LOT of people), the POINT of drinking alcohol is to become stoned or impaired, and the only thing that stops them is when they pass out.

    The whole war on drugs is simply a war on people led by authoritarian assholes. The constant propaganda makes it worse, since it is based on lies. Kids figure out when adults are lying. Adults also figure out when other adults are lying (or are just ignorant). Michele Leonhart is an evil individual. What I put in my body is my business. Not the government’s business. She can fuck right off.

    My kids are in their late 20s. They can be a “casual consumer” of whatever the hell they want. It’s not my business. The key word is “casual”. But, since you asked, I would greatly prefer them to use cannabis and psychedelics over alcohol if I was simply concerned about their physical health. But, because I also worry about authoritarian assholes like Leonhart caging them for years due to draconian “drug” laws, then I suppose alcohol is a better choice, since - apparently according to Leonhart, it is the legality of a substance that makes it harmful. By her logic, cannabis is perfectly safe in Canada, since its legal, but is as dangerous as heroin in Alabama, since it is illegal. Shes right if the “danger” is being incarcerated.

    And, the book “Drug Usage a Path to Success” is right on the shelf next to “Better Living Through Alcohol and Tobacco”

  6. It would be nice, though, to see one of the members of our degraded institutions say something that accords with what most people can see with their own eyes.

    Something on the order of: “Senator, I would look pretty foolish if I tried to maintain that smoking marijuana was equally as risky as smoking crack or meth, so I’m not going to do that. I do have to say, though, that there are a set of risks associated with smoking marijuana that shouldn’t be ignored or minimized.”

    Instead, they doggedly stick to the script, and we’re apparently supposed to respect them for their obtuse inflexibility.

  7. Also, on the topic of chronic use of various drugs of addiction, is the question of why they are used.

    If, and Mike Tyson is an example of this, which is why I’m posting this here, one is using cannabis to mediate their aggressive impulses, this is a very bad long-term strategy. I have known people who tried it, and, while this is very good short-term at make you unable to be aggressive, it also dis regulates your aggressive tendencies in the long-term.

    I, in fact, use a drug of addiction for a similar purpose. In my case, I really hate the modern style of dancing. You know, that whole get out of the floor and Twerk It, Shake Your Groove Thing or whatever. I am a very skilled dancer in more formal settings, and I’m helping to teach a class in square dancing this year. However, the lights, the chaos, the darkness, the thumping blast of noise, the people acting like idiots and twerking on each other close to me, means that I generally have to have one to two drinks before I go dance in that kind of setting. It’s kind of anesthesia.

    I do not, however, wish to have this cause a problem long-term. So I only get into these sorts of situations when I have to, maybe once or twice a year. This is how I mediate this to ensure that this does not become a problem, while still being able to fulfil a somewhat distasteful social obligation. I should point out that I get compliments on my dancing in that setting, I just really dislike doing it.

  8. So far not many comments mentioned the benefits of drugs like psylocibin, LSD and ayahuasca. I have gone through some difficult mental health times, mostly dealing with depression and anxiety. For the past 2 years I have been educating myself in psychology, understanding human nature and the mind. All those drugs have helped me see more clearly, I usually do meditation and introspection to learn about myself.
    Since most “dangerous” stuff has an age limit, driving, gun ownership, drinking, I think drugs should also have one and I would put it around 30. In your 20s, you will probably use them for impairment and party, however later in life you have a better appreciation for it’s actual application.
    I have read some reports of people with PTSD, alcoholism, smoking, doing psychedelics and making some great improvements.
    I do wonder what people’s interpretation of their experiences is. I am an engineer, and curious/open personality, so I find the psychedelic experience something amazing, however some other person might only see the “fun” part of it, and don’t notice or understand the rest of it, the expansion of your consciousness.

  9. All that schooling finally comes in handy on an internet comments section.

    Maybe they (Quartz) had a contest for who could write the most ridiculous white supremacy article?

    But Babylon Bee beat them to it:

  10. Did you read the Quartz article? I just scanned it, but it looks like a fine piece on a particular part of Americana.

    Titles aren’t written by the authors: they’re written by the editors. And editors are keenly aware that what counts is clicks: they will deface a good article with a clickbait headline.

  11. Ordinarily, I would agree with you.

    But, having seen a person I knew well fall into opiate addiction, you need to understand that his condition wasn’t freedom of choice. The drug changed his judgment, to where he would rationalize anything to get more. So there’s a wrinkle… what do you do when the drug changes the person’s mental processes, in a manner that they might not have originally chosen?

    I wouldn’t have believed that if I hadn’t seen it with my own eyes. Opiates change your personality and your judgment. And not for the better, by anyone’s standards.

    Otherwise, laws against pot are silly… I would argue that it does less damage than alcohol… one gets really stoned, they don’t get into a car and smash into whatever is in their way. A stoned person… just… sort… of… sits… there…

  12. You observe that every listed drug does some harm. Indeed. But so do sugar, red meat, processed foods, airplanes, automobiles, kitchen knives, many sexual practices,…

    It is both impractical and tyrannical to embark on a project of banning everything that has inherent harms.

    I would suggest that the question policy makers should ask is what the balance is between both the benefits of allowing something (there are, for instance, health benefits associated with moderate alcohol use) and the harms which would be inherent in banning it (including loss of liberty and pushing trade into the hands of criminal gangs that lacking recourse the law use street violence to settle disputes) against the harms inherent in permitting the thing.

    In the case of currently illegal drugs many of the harms associated with them are not inherent in use of the drug, but are the result of their illegality. Besides drug-gang turf wars with their attendant fatalities, many, perhaps most, opiod overdose deaths are the result of variations in drug purity, including most notoriously the lacing of heroin with fentanyl, something that would not happen with legal drugs subject to regulatory quality control.

  13. Fetal alcohol syndrome is one.

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