The media are abuzz with the news that popular prescription painkillers, including Celebrex, Vioxx, and Bextra, turn out to have potentially deadly side effects. For me, the revelations underscore the maddeningly arbitrary difference between legal and illegal drugs.
Legislators and drug czars tell us that certain drugs are against the law because using them would be harmful and dangerous. Prescription and over-the-counter drugs, on the other hand, are safe, because they are made under the watchful eye of the Food and Drug Administration. Right?
Not on your life.
More Americans die from legal drugs than from illicit ones. In fact, the numbers are surreal. Earlier this year, in the Journal of the American Medical Association (JAMA), a team of researchers concluded that illegal-drug use kills 17,000 users annually. The article is excerpted here. Incidentally, that number takes into account that many serious drug users engage in all kinds of risky behavior — including in traffic and in the bedroom. I had an e-mail exchange a few days ago with Ernest Drucker, an epidemiologist at the Montefiore Medical Center in the Bronx who's an expert on the subject; he and others put the number of overdoses involving illegal drugs closer to 10,000.
Now let's look at legal drugs. First, tobacco and alcohol. According to the same JAMA study, tobacco causes about 400,000 annual deaths in the U.S.; alcohol kills roughly 100,000 more. That's right. Every year, booze and cigarettes kill half a million Americans — roughly fifty times more than illegal drugs do.
Next step: prescription drugs. The most recent statistics I found were revealed in a 1998 study also published by JAMA. The authors put the number of deaths caused by legal drugs at 106,000. In other words, prescription and over-the-counter medications, from Aspirin to Zoloft, killed more than ten times as many Americans as cocaine, heroin, XTC, and all the other substances we're constantly being told to fear and fight — combined.
Sure, that was six years ago, but the situation doesn't seem to have improved. Two-thirds of the scientists at the FDA recently said they had less than complete confidence in the agency's monitoring of existing prescription drugs. And that was before the current ruckus broke out.
As Nicolas Eyle, the founder of the drug policy reform group Reconsider, pointed out to me, the death numbers cited here don't reveal the half of it; they make prescription drugs look better than they really are. After all, illegal drugs are not controlled and regulated, and most OD deaths occur because the user could not reliably judge the purity of the illegal substance. By contrast, purity and dosage are tightly regulated in legal drugs. If we were to level the playing field — that is, if we gave recreational drugs like heroin the same oversight we give Advair or Aspirin, which would mean legalizing the lot of them — the number of OD fatalities would nosedive.
Clearly, then, deciding which drugs are legal and which are not has nothing to do with how dangerous they are. Marijuana use has never resulted in a single death by overdose — not one. But to the drug warriors, that doesn't matter: every year, about 600,000 Americans are arrested for simple marijuana possession. What's strange is that I never see the DEA or the FBI hauling away any Pfizer or Merck employees, even though their pills and potions kill ten times as many people as all illegal drugs put together.
No, I'm not advocating a law-enforcement crackdown against pharmaceutical companies. I'd like to see the exact opposite. We need fewer rules, and fewer drug cops. We need a few clear-eyed lawmakers who decide they've had enough of the gang warfare, the accidental overdoses, the billions of law-enforcement dollars dumped down the drain, and the whole sorry mess that is the War on Drugs. We need principled politicians — don't laugh, there are a few of them out there — who want to overhaul our drug laws because they understand it's the safe and sane thing do for this and future generations.
In a recent e-mail to me, Reconsider's Nicoloas Eyle said that "Legalization of drugs is not a cure for the drug problem. It is a cure for the crime problem." He explained that when America re-legalized alcohol in 1933 (after a disastrous experiment with prohibition), we didn't eliminate alcoholism. But we did get rid of the bootleggers, and of the organized-crime syndicates that fed on prohibition like maggots on a corpse.
The prohibition metaphor is apt. The interesting thing is that if a handful of teetotaling zealots started agitating to reintroduce alcohol prohibition, I'm sure they'd get laughed right out of town — with good reason. But if outlawing alcohol is such a dumb idea on the face of it, what's so smart about outlawing drugs?
Drug policy reformers like Eyle believe — correctly, it seems to me — that there are really only three ways our society can respond to the market's hunger for recreational drugs.
• One: We allow bona fide pharmaceutical businesses to manufacture and distribute drugs after we do away with our current drug laws.
• Two: We allow only the state to distribute now-illicit drugs, the same way some states own and control liquor stores.
• Or three: We turn the $400-billion-a-year market over to gangsters who will obey no law, who'll sell their wares to fourteen-year-olds, whose impure and unreliable products kill 10,000 users a year, who cost taxpayers billions of dollars in futile enforcement attempts, and who never pay taxes themselves.
We've chosen number three.
By all accounts, the side effects of Celebrex and Vioxx are serious, and the matter warrants the media's attention. But the same is true for the side effects of an arbitrary, ineffectual, unwinnable drug war that has already killed more people than it could ever hope to save.