Review’s Radio: Discussing Wars on Drugs and the Opioid Epidemic with DPA Founder Ethan Nadelmann
Almost five decades after Nixon infamously declared drug abuse as “public enemy number one” in the United States, the efficacy of the War on Drugs as a policy measure is clear to many. For Ethan Nadelmann, who founded the Drug Policy Alliance in response to the harsh criminal justice approach, the answer lies in advocating in drug policies “grounded in science, compassion, health, and human rights.” MIR’s Alec Regino sat down with Nadelmann during the Marijuana Legalization Conference hosted by the Institute for Health and Social Policy at McGill in April.
[0:00] Alec Regino: From the McGill International Review, I’m Alec Regino.
In today’s episode of Review’s Radio, I sat down with Ethan Nadelmann, the founder of the Drug Policy Alliance. Nadelmann and the DPA are considered by many to be one of the driving forces behind the legalization of marijuana in the United States.
In this podcast, we talk about the opioid epidemic as well as wars on drugs in the Americas and in the Philippines.
[0:30] Let’s talk a little bit about your time at McGill first. Why exactly did you end up going to McGill in 1975 and why did you end up transferring?
[0:36] Ethan Nadelmann: I was growing up suburb of New York City and my dad had heard about McGill and thought highly of it and then I came up with him the year before because he was a rabbi and he was doing a guest thing at a synagogue. and I loved Montreal. And it just seemed like an exciting place to go, the tuition was much less than the US. They were not charging more for Americans, so my tuition for the year was $570, which was the same as for Canadians and the US colleges then were $4,000. So it was a big difference and it was great. It was a wonderful experience, very international. The Americans were about 10 percent of student body, but we played a key role in student government and student life because we were living on campus and such. But as I said in the talk, it’s also the first place I smoked marijuana right over 3477A Hutchison Street, living in the student ghetto.
[1:23] AR: So was McGill where you first realized you had an interest in drug policy or..?
[1:27] EN: Not really at that point it was just struck me as something like, I didn’t see what was wrong with smoking marijuana. Actually, it was much more hash in those days, rather than marijuana. I also started drinking those days and it was clear, I liked both, alcohol was clearly more problematic, but friends were getting busted at the border with the US. So it just hit me that there was something wrong there. And then I remember taking a course on political theory my second year, there’s a professor here named Bhikhu Parekh. I remember I ended up writing a 50 page paper on John Stuart Mill’s classic book on Liberty, which also went to the issue about personal freedom and the proper lines where a government can intervene in people’s lives. So the consciousness it clicked. But I did not imagine that this would become my life.
[2:12] AR: And so when exactly did the drug policy reform become your life?
[2:16] EN: I transferred from McGill to Harvard after my sophomore year. I went to London School Economics for a year, came back to Harvard for graduate work in a law degree and all that time my key interests were international relations, US foreign policy and Middle East politics. And my first publications were about that. I taught the first course at Harvard on Israel and the Palestinians back in 1982. But I was really burning out on that issue and I decided to get into something else that just seemed more interesting. And that was the issue of drugs and international crime and law enforcement. And it was not seen as a serious subject of study, especially for somebody working in political science and international relations. But I wasn’t taking my studies very seriously. It seemed like fun. I started to do that and then one thing led to another.
I ended up going and working in the State Department’s Narcotics Bureau, getting a security clearance, writing a classified report on drug-related money laundering. I travelled around 19 countries in Europe and Latin America interviewing DEA and Customs and FBI and CIA and foreign law enforcement agents. I wrote a dissertation in a book called Cops Across Borders on the internationalization of criminal law enforcement, but at the same time I started speaking out in the late 80s, as the drug war was really heating up and I started writing and speaking about the futility and absurdity and harmfulness of the drug war and the fact that most of what people identified as part and parcel of the drug problem, were in fact, the results not have drug abuse per se, but in fact the results of a failed prohibitionist policy, in many ways analogous to the failures of alcohol prohibition in the United States back in the twenties.
[3:55] AR: Can you tell me a little bit about your founding of the DPA and a little bit about the highest accomplishments that you’ve had over there?
[4:03] EN: Basically when I left Harvard grad, went to Princeton, taught at Princeton, late 80s, early 90s law and public policy and drug policy, was speaking and writing, organizing working groups on the issue, getting involved with the sort of emerging activist world in this area. And then one day in the summer of 1992, I got a phone call from a guy named George Soros, who was not quite so famous then, but you know, he’s the one who’s become this very famous financier and investor and philanthropist, promoting open society values around the world. And we had a two-hour lunch and we hit it off and at the end of it he said, “look, let’s start doing something.”
And I gave him a proposal and a few years later in 1994, I left the university to start up a little activist think tank. Initially, it had a different name, it was within his foundation. And then in 2000 spun that little institute out, merged it with another organization to create Drug Policy Alliance. So basically I spent 23 years from 1994 to until last year, 2017, building up this organization from more or less just me, to when I stepped down last year, there were 75 people working at Drug Policy Alliance all around the country, a few people working on the international work, and doing a lot of work in three major areas: The first was changing marijuana policy, basically decriminalizing marijuana possession, reducing the racially-biased marijuana arrests, legalizing marijuana first for medical purposes and then more recently legalizing marijuana more broadly for adults. So that was one-third of our work.
The second-third was essentially taking on the issue of mass incarceration in the United States. I think most people know the US, we had barely four percent of the world’s population, but over 20 percent of the world’s incarcerated population and the war on drugs was the number one thing driving that rise in incarceration in the 80s and 90s and into the 2000s, less so now, but very much then.
So we started doing ballot initiatives and legislative reform both in the marijuana area, but also to reduce the harshness of criminal penalties, to provide treatment instead of incarceration for people with drug problems who are getting arrested, and all sorts of other ways of rolling back the war on drugs and its harshness.
And then the third issue we worked on was basically making a commitment to treating drug use and addiction as a health issue rather than a criminal issue, and really teaching Americans about the more effective policies that were being implemented in Europe and Australia, sometimes in Canada and elsewhere. And so in the 90s that meant legalizing clean needles through pharmacies and needle exchange programs to reduce the spread of HIV/AIDS. It meant the last 15 years addressing the opioid overdose epidemic by making the antidote Naloxone more available and passing other laws to enable people to treat this as a health issue, not a criminal issue. And then promoting honest drug education. Basically a more sex education-like pragmatic model with respect to drugs and all sorts of things like that.
So those were the three major areas. Most of our work was in the US, but I also worked substantially around the world as well, you know, speaking, meeting with governments, testifying before national parliaments, on my staff providing assistance in drafting laws and all of that. Drug Policy Alliance really is and has been for many years, the leading organization in the world, and especially in the US, advocating for drug policies grounded in science, compassion, health, and human rights.
[7:29] AR: What have you been up to since stepping down as the Director of the Drug Policy Alliance?
[7:32] EN: You know, basically I’ve been mostly taking life easy. I was sort of going nonstop for 35 years and I had just turned 60 last year and so I’m just kind of, you know, I’m going, I’m speaking at conferences, I’m helping local activists. I’m doing some work internationally. Yeah. I’ve been to South Africa. I’ve been to Japan and Macao. I’m just up in Canada now, I’ll be in Mexico next month. Was there a few months ago. So some of it’s the international work which I want to spend more time on. Some of it is paying attention to what’s going on with the opioid overdose epidemic and seeing if I have a role to play there. Some of it’s plain old keeping a hand on the whole marijuana legalization effort and trying to do what I can and make sure it goes the right way.
And I’ve also become fascinated by this issue around tobacco and nicotine harm reduction. They’re trying to get people to switch from smoking cigarettes to e-cigarettes or to vaping, which is a fascinating issue with fascinating politics involved. I mean, the fact is if you could snap your fingers and tomorrow the 1 billion people around the world who smoked cigarettes were to switch to e-cigs or vaping, it would be one of the greatest advances in public health and human history, but it’s a complicated issue in part because it’s the big evil tobacco companies that are trying to profit now from this new area and we’re actually playing a somewhat positive role in advancing this stuff even as they continue to sell their cancer sticks around the rest of the world.
[8:56] AR: Talking a little bit about the opioid epidemic, as you mentioned it previously, do you think the legalization of marijuana in Canada and United States has a role to play in the current opioid crisis in North America, or do you think they’re unrelated issues?
[9:07] EN: The principal relationship between marijuana/cannabis reform and the opioid epidemic right now, is that there’s this remarkable evidence that has emerged or less four or five years, mostly in the US, I don’t know how much in Canada, showing that in those jurisdictions where marijuana is more readily available, oftentimes through a medical marijuana system, that what they find are that opioid overdose fatalities are significantly less than in the non-medical marijuana states. And they’re also finding that doctors prescribe fewer pharmaceuticals, that people request fewer pharmaceuticals, that there are fewer pharmaceutical drug problems. So what you’re seeing is nobody’s proven that there’s a direct relationship between making marijuana more available and reducing opioid and other pharmaceutical drug problems, but the circumstantial evidence is becoming overwhelming and major medical associations are now accepting it and addressing it. So I think that’s a fantastic thing that’s happening.
And there’s a few theories for why this is happening: one is that for certain people, for certain types of pain, marijuana is more effective in dealing with that pain than is opioids, for example, perhaps neuropathic pain or things like Parkinson’s, MS, things like that. People find marijuana more beneficial. So that’s one thing. The second thing is that marijuana is an enhancer, right? It makes food taste better. Music sound better. If you combine it with alcohol or other drugs that can make those drugs more intense. It won’t kill you. The nice thing about marijuana is you can combine it with any other drug in the world and it will not kill you, may make you nauseous or tired or dizzy or whatever, but it won’t kill you. That’s unlike if you combine alcohol and opioids that can kill you. If you combine alcohol and Benzos like Valium or ambien-type drugs that can kill you. But marijuana combined with anything does not kill you. It will, however, increased the effect.
It’s why if you smoke and drink at the same time, you’re going to get more drunk or high, but it also means that if you combine marijuana with opioids, there’s reason to believe, [with] opioids as painkillers, that you can cut the prescribed dose of the opioid by 50 or 60 or 70 percent and by consuming it together with a little bit of marijuana, you can achieve the same pain relief effect.
That, once again, it’s a theory out there. There seems to be some evidence behind it, but what this suggests is that marijuana offers something of a solution or at least a help on the opiate crisis. The other thing is there’s some evidence out there that people [that] have been addicted to various drugs, not just opioids, but even stimulants like cocaine or amphetamine. Some of them can be persuaded to switch from that to marijuana if they’re unable to be drug-free and the negative consequences of using marijuana or even being dependent on it are so much less than being addicted to opioids or stimulants.
[12:02] AR: Just about a month ago, President Donald Trump proposed a death penalty for some drug dealers. In light of this and his recent election, do you think the current trends for drug policy reform is going backwards in the United States?
[12:13] EN: Well remember the large majority of drug policy in the US happens at the state and local level. Most criminal justice, most health programs are state and local and what that means is that there’s only so much that Trump and his Attorney General Sessions and some of the other key people can do. The federal level is important because it’s symbolically very important. The federal prison, 50 percent of the people in federal prison are there for drug charges, whereas at the state and local level it’s more like 15 percent at this point, higher for women. But it’s not at that level.
I was more concerned a year ago that they would really be able to throw a wrench in the works on the momentum behind marijuana legalization and I think that the Justice Department will try to block it in some ways, but at this point, the politics, there’s so much political momentum behind moving from a prohibitionist approach to marijuana to a legal regulatory approach that I don’t think that Trump and Sessions are going to be able to do that much to stop it.
And remember Sessions the Attorney General, is a real reefer madness ideologue. A drug war dinosaur. He’s just a throwback to another age. Trump doesn’t care. He doesn’t care about the drug issue. 20, 30 years ago he said: “we should just legalize all drugs.” He doesn’t care. So he’s willing to back off on this thing. The thing I’m bummed about that is that when it comes to the people are getting locked up on cocaine or heroin, methamphetamine charges, where the whole momentum was to try to stop treating somebody who sells the drug to another adult as if they’re a rapist or a murderer. And we were making progress in that direction, bipartisan progress, I mean Obama and his attorney general Holder, we’re providing leadership, but Republicans were getting behind it as well and now that’s come more or less to a stop at the federal level. Still happening at the state and local level, but that’s a problem.
And internationally, the United States government was basically the principle champion and protagonist of the global drug war for more or less than 1920s or 30s, until roughly 2012 or 13. And at that point, in part because of legalization in Colorado and Washington, [the] Obama administration began to back off and essentially handed off the baton to the Russians to become the new global drug war champions. Unfortunately, with Trump in charge, I think you’re going to see the US once again playing a more destructive role internationally on the global drug policy.
And just to take one example: the fact that right early on he was essentially praising President Duterte in the Philippines, who has this—who will hopefully one day will be brought up on war crimes charges— Duterte with this murderous, extrajudicial drug war, telling cops they can go kill people without any sort of due process and if they kill innocent people, well don’t worry about it. The fact that Trump was praising Duterte for that sort of thing, was just a despicable thing to do.
[15:11] AR: Aggressive wars on drugs in Latin American states like Mexico and Colombia usually have their roots stem from the War on Drugs in the United States. How do you make sense of the war on drugs in the Philippines? Where do you see the origins of these kinds of issues?
[15:24] EN: Well, it’s a good question. Mexico and Colombia, it’s also true for Peru, Bolivia, [the] Caribbean elsewhere… for them, the United States is the largest consumer of the drugs they provide on the one hand. And on the other hand has been the principal for us pushing them to have the drug war approach. Now what’s happened in recent years is that there’s been a growing support, especially among the elites in these countries, to push in a different direction, to move towards reform, to open up the debate. So for example, you have the former Presidents of Mexico— Vicente Fox, Ernesto Zedillo who are now openly in favour of legalizing drugs. You have Colombia also once again, former Presidents like Gaviria, also the former President of Brazil, Cardoso involved in the Global Commission on Drug Policy, all pushing for a radically different approach, much more in the direction of a legal regulatory approach as the best way to reduce the prohibition-related violence, crime and corruption in these parts of the world.
But drug wars exists everywhere and you don’t need the United States to always be present. So in the case of the Philippines, which has had a somewhat significant drug problem for many years. The Philippines plays actually remarkable history in all of this, because when the United States occupied the Philippines in 1898, opium consumption was legally regulated in the Philippines, mostly for the Chinese minority population. And there were certain studies done evaluations done by the US government and they came to the conclusion that it was all working pretty well. That it was mostly older people, that it was regulated and what happened was Protestant ministers and other sorts of moralists and prohibition advocates insisted on cracking down in the Philippines and almost sort of pushing back in the US to do a more moralistic approach as well.
So the Philippines played an interesting role in that. It’s been shaped I think by the US approach because of their very close relationship with the United States. The Philippines even before Duterte had one of the most aggressive policies of drug testing students in schools. It’s something that very few countries do except the Philippines and the US. Marijuana has been kind of growing and parts of the Philippines and sometimes it’s tolerated or not. but I think that in the Philippines you have a real drug problem mostly with amphetamine. You have people worried about rising rates of crime and social disorder and in a way Duterte comes along and he’s the tough guy, and in a way picking on the drug thing, even though it’s not the Philippines number one problem, became kind of— I mean, every society essentially needs a boogeyman. Somebody who’s already somewhat demonized and who can be picked on and blamed for all one’s problems.
It might’ve been, hundreds of years ago, witches. It might be [a] religious or ethnic minorities and throughout much of Western history it’s been the Jews. More recently it’s oftentimes Muslim immigrants now in Europe. You get this picking on minorities and the drug users, drug addicts, drug pushers— are the easiest in the world to demonize. We did that. The United States with horrific consequences beginning in the 1980s and 90s. And I think Duterte was able to run with this and to do it and unfortunately sort of see him and Trump is being so similar to one another. And the sad thing is that whereas troubling as 40 percent of the public support [for Trump], Duterte, I mean who knows how accurate the public opinion polls are now, but may have two-thirds of the Filipinos support. And it’s really debasing basic civil values. It’s debasing many of the things that we respect about open societies and democratic societies.
So will he be successful vis-à-vis this thing? I mean so long as the Philippines is mired in significant levels of poverty and inequality it’s going to be vulnerable to problems with drugs, and methamphetamine is something that can be produced just about anywhere. The funny thing about Duterte is he does support medical marijuana.
[19:14] AR: It’s very fascinating, I’ve read about that as well. So why aren’t we seeing a more aggressive response to the opioid epidemic in the United States and Canada like we did in the 70s and 80s?
[19:23] EN: What people are pointing out with respect to the opioid epidemic in the US is that we appear to be taking a kinder, gentler approach with heroin and the opioids than we did with cocaine and crack back in the 80s and 90s. And the principal reason is that the crack cocaine epidemic was overwhelming seen as a black thing, and the tolerance for being really tough and nasty and harsh was greater in American society because the people being locked up were “those people,” black people.
Also problematic was that an older generation of black people back in the 80s and 90s were scared out of their minds by this epidemic and supported these repressive policies. Now, of course what’s happened in the last 10, 15 years, is that black leadership in America has really mobilized against the drug war and brought attention to the harms of the drug war, so you see some transformation, but there’s some resentment that now that this opioid crisis is affecting disproportionally middle class and lower class white people and white legislators from rural areas who had no hesitation about supporting draconian penalties for people selling crack or using crack cocaine are all of a sudden becoming much more supportive of drug treatment and “let’s not increase criminal penalties” because now it’s their constituents. It’s the children of their white constituents, Republicans, Democrats, living in rural parts and exuberant parts of the country. So that’s part of what’s going on. That’s a big part.
The second part is probably that we kind of burnt out on the drug war. We’ve locked up millions and millions of people. We’ve arrested tens of millions. We’ve spent over a trillion dollars and the drug war since Richard Nixon first declared it back in the early 70s, so I think that even if there was not this racial distinction here, I think people would be going, “been there, done that” with these draconian policies and there might be less support for it this time around as well.
Keep in mind the opioid crisis is really three things in the US: One-third of it is really about the pharmaceutical opioids thing. Pharmaceutical companies aggressively promoting these drugs for types of pain that it that should not be used for. Insurance companies finding it easier to pay for pills than to pay for real physical therapy. Doctors and nurses not being well trained in pain management and not wanting to say no to patients who were crying for “take away my pain doctor.” So you have all of those things going on which helped accelerate the whole crisis. The second thing that’s happening is that more heroin is coming in cheaper prices for Mexico than ever before. Mexico has always been a major source of heroin for the US, but now it’s just in abundance, easily marketed throughout the country, and the third most tragic thing that’s happening is the emergence of fentanyl. Fentanyl is a synthetic opioid. It’s 50 to 100 times more potent per gram, or grain than is heroin.
With most drugs like heroin or pharmaceuticals, people don’t typically overdose on them by taking too much. They typically overdose because they combine the opioids with alcohol or some other drug. But with fentanyl, people take too much of that and they die, and in Canada, most of Canada’s opioid epidemic now involves fentanyl. It’s these drugs being produced. We think in China, being shipped to the US through the mail, Fedex, what have you, in little amounts and drug dealers not knowing how to cut it properly and it’s so potent and so it’s showing up, not just in heroin supplies, it showing up in cocaine supplies. Which sorta makes no sense because there are different types of drugs, so it’s a real crisis now and you see the Trump administration, not everything is doing and this is bad— they are supporting more money and more positive things, but they’re also doing a lot of this stupid old drug war stuff just to show that they can be tough and cool and mean.
[23:13] AR: I mean in the case of the Philippines, it seems like with the aggressive war on drugs over there, there’s a huge overall approval for Duterte’s war on drugs. They’ve captured about 188 meth labs and seized about $40 billion dollars worth of drugs. Is there any place for more aggressive wars on drugs? Are these things actually effective?
[23:30] EN: I mean by and large, they’re not effective. What we know and meth labs is [that] they’re very easy to create, so you can knock out 200 meth labs and it’s very easy to set up 200 new meth labs. And we know that when the cops claim that they’re seizing a billion dollars worth of drugs what they’re doing: is they’ll seize bunch of meth that maybe cost $25,000 to make and then they’ll say, “oh well, but if this stuff had been distributed, broken down, and ultimately sold— this $25,000 worth of meth, If it had finally gotten to the consumer would have been worth 10 million. Oh, so we see is $10,000,000 worth of meth!” Even though it only costs the drug traffickers 25,000 to make it. So the numbers about the value of the drugs that are being seized by the cops are always dramatically inflated and silly and journalists should know better than to take those claims seriously. But the fact of the matter is that there are some societies, fairly totalitarian societies, like communist China in the old years, like Albania maybe, like Singapore to some extent now, which can be relatively successful in suppressing illicit markets.
But by and large, any society that’s fairly dynamic, fairly capitalist, fairly open— punitive approaches rarely work well, they can take out, they can lock up traffickers and dealers. They can push the markets around, but ultimately if people are feeling desperate, they’re going to keep turning to these markets both to either take the drugs to deal with their pain or their existential whatever it might be, or to make some money on the side. So I don’t think Duterte’s campaign is going to turn out to be successful in terms of what he wanted. Obviously you can create a feeling of fear and intimidation and that’ll cause people to lie low, but if you’re not addressing the underlying issues, that’s just going to bubble back up.
And we saw that in the US of course, the US locked up more people on drug charges than like all of Western Europe locked up for everything, and they have 100 million more people than we do. And nonetheless more people continue using drugs and selling drugs in the United States than in Europe. So the notion that a repressive approach delivers the results in terms of reducing drug addiction and drug dealing. The evidence doesn’t really support it.
[25:43] AR: So what is the ideal response to dealing with drug problems?
[25:45] EN: Well the ideal response is to try to move as much as possible away from our reliance on criminalization and criminal justice institutions towards policies much more grounded in science, in health, in human rights. What that means with respect to marijuana/cannabis is moving in the direction of legally regulating it in a responsible way as possible. And Canada is going through that process now and Uruguay doing it and a growing number of US states are doing it, and some European countries are looking at doing it and there’s conversations in New Zealand and elsewhere. Even Morocco is having a conversation this now.
I think the second thing is really when you’re dealing with drug addiction, it’s about treating it the way you would other types of medical problems. So the way you would treat alcohol addiction or cigarette addiction. Could we reduce the number of cigarette smokers in our countries if we criminalized cigarettes? Probably because you would discourage people, it would get more expensive, You can’t just buy it in a shop. but what would happen? Would everybody stop smoking? No! You still have millions of people smoking even though it was illegal, and where would they get their cigarettes from? From a shop where they’re paying high taxes? No! From the black market where the gangsters are making the money from it. And as dangerous as cigarettes are today, would they become even more dangerous? So the notion that we should treat these psychoactive substances and these essentially global commodities markets because that’s what the international markets are. Remember the international markets in marijuana, cocaine, heroin, whatever, are fundamentally like the international markets in tobacco and alcohol and coffee and sugar and tea and everything else.
They’re global markets, so long as there is demand there is going to be a supply. The notion of putting law enforcement in charge of trying to regulate a global commodities market is absurd. We wouldn’t do it in any other area, but somehow we think that putting the cops and security forces in charge of regulating a global commodities market makes sense here? What’s been the result? The Pablo Escobar’s and the El Chapo’s and gangsters, making hundreds of millions of dollars and billions of dollars and corrupting governments and killing tens of thousands of people and flooding prisons. I mean, it’s an absurdity, right?
So what you want to do is to move away from the reliance on coercive institutions and more and more towards a health approach. It’s why when you look at Portugal, which is primarily a health-driven drug policy, it’s remarkably successful. Look at what the Netherlands has accomplished, where you have almost nobody dying of overdoses or HIV and where there are drug trafficking problems, but nothing like the way they are in the Philippines or the US. Look at Uruguay, which has a more progressive policy. Look at other parts of Europe. Norway, which had a very repressive drug policy is now moving in this direction. That’s what we need to do, and there’s no reason that should happen just in the developed world, there’s every reason why these same policies can apply and work just as well in the developing world.
[28:35] AR: Thank you very much.
[28:36] EN: Okay. You’re very welcome.
[28:45] AR: That’s it from the McGill International Review. I’m Alec Regino. Thank you for listening.
Special thanks to the Institute for Health and Social Policy at McGill University for allowing us to interview five speakers during the Marijuana Legalization Conference in April. These interviews would not have been possible without your assistance.
Music: What Could Appear by Puddle of Infinity.
Feature Image: Taken by Unna Regino/Bilal Virji.