Last week I wrote a piece at Spot-on criticizing the Calvinists in the medicine cabinet —  the theocratic fascists social conservatives who use the DEA to dictate prohibition and are increasingly bringing this irrational posturing into mainstream Republican (and thus government) policy. One thing I touched on is the suggestion that buying up the Afghan opium crop and using it for medicinal opiates might be one way of mitigating the problems of opium being the only viable cash crop there, with the consequence that the Taliban et al benefit from controlling it. Harvey Frey, an occasional contributor to THCB, trotted out some very tired and just plain wrong comments about the drug war and prohibition:

The idea that legalizing and licensing opium in Afghanistan will decrease the illegal opium trade is fantasy. Medical morphine sulphate is cheap – far cheaper than the far less effective modern concoctions of Big Pharma. Why would any opium farmer sell his crop cheaply to legitimate buyers, when he can get orders of magnitude higher prices from the black market?

So, if we go with a social libertarian policy, and decriminalize recreational opium use, how will we deal with the medical and social problems of the vastly increased numbers of users? We seem to have trouble paying for medical care now. How will we pay for care for millions of unemployed, uninsured addicts? Will we end up like China after the Opium Wars?

I wouldn’t usually go after this type of comment here, but Harvey’s arguments are flat out wrong. And someone needs to try to convert those people who are reachable. Harvey’s a scientist, so presumably he believes in data. So here goes:

a) the concept that the farmers get more for illegal poppies than legal ones is bullshit. I have met illegal opium farmers in Laos living in huts with mud floors, and legal ones in Tasmania living in fabulous farm houses. No question who’s getting more for their crop. The difference in cost is due to the middle men’s cut which is huge, again due to the illegality of the end product…which boosts its cost to the end user. And of course that boosts the amount available for criminals (including some very nasty ones in the Middle East). This is one occasion when I’m much rather J&J and GSK had the money. If we bought out the crop then the opium farmers would have the same amount of money and the criminals/terrorists would have much less. (Hey we do it with all kinds of other agricultural crops….)

b) there is no evidence that regulating and controlling the distribution of any illegal substance increases its use compared to attempting (and failing) to maintain its prohibition. Countries that have a harm reduction policy (Switzerland, Germany) for heroin/opiate/methadone have lower addiction and use rates than those with prohibitionist policies (the US). Kids in Amsterdam use marijuana at lower levels than those in the US, while it’s freely and legally available there, and theoretically illegal here.

More importantly the costs of addiction are not predominantly those of caring for the unemployed addicts. Several programs (again see Switzerland, Germany, and even the UK in the 1990s) show that legitimized maintenance programs allow addicts to maintain a normal life, including working and holding down jobs. BTW one of the forefathers of American surgery, William Halsted,  was a morphine addict, which never prevented him from practically inventing much modern medicine. It’s driving addicts into the black market and into the hands of criminal pushers that causes them to descend into the state Harvey suggests causes so much social malaise. Furthermore, in the only ever successful case of a steep decline in the use of a highly addictive drug (tobacco in the US in the last 30 years), its use rate fell because of education about its health effects. It was and is a legal product. And should stay that way. And we should treat other drug use the same way.

Finally, the societal costs of drug addiction absolutely pale in comparison to the societal costs of prohibition. We spend some $90 bn a year trying and failing to prohibit drugs in this country. There are fewer than 3 million drug addicts. So we’re already spending around $30,000 per addict on attempting to prohibit drugs–way more than the cost of supporting addicits even if they were not contributing at all to society and the economy. And that doesn’t count the cost to society such as the crime they commit to fund their drug habits, which is eliminated in Switzerland, Holland, etc.

The whole way we approach this — justified by the type of wrong information that Harvey puts out — is completely irrational, unless of course you are one of those in the prison-industrial complex benefiting from that spending. But of course the other supporters of the drug war, the theocratic fascists, glory in being post-enlightenment and completely irrational anyway.

Here’s my FierceHealthcare editorial today

Last year the most viewed article in Health Affairs was an article suggesting that 50% of bankruptcies in America were in some part related to medical costs. The article was written by a group led by two of the intellectual leaders of the single payer movement, Harvard professors David Himmelstein and Steffi Woolhandler. This week their findings were challenged by two Northwestern-affiliated researchers, David Dranove and Michael Millenson, who reviewed their data and claimed that the number was closer to 17%. They also suggested that the not as many of people declaring bankruptcy were as solidly middle class prior to their medical catastrophe as the Harvard group had suggested. Himmelstein et al shot back saying that the Dranove and Millenson had got their math wrong, and that they were lackeys for AHIP the health insurance industry group that sponsored their study — even though it was a peer reviewed article which AHIP funded but didn’t control. Some of their supporters accused Dranove and Millenson of "swift-boating".

Why is this obtuse academic dispute so important? Whatever the facts, and facts are very malleable in our political debates, the role of the middle class in health reform is vital. There is incontrovertible evidence that lower-income Americans have disproportionately higher health costs out of pocket than poorer people in other countries. But 100 years of history shows that politically this doesn’t matter too much. If it becomes accepted that middle-class, middle income Americans are equally vulnerable to financial catastrophe due simply to bad luck with their health, then the political discussion might shift. So this is one of those occasions where, as Keynes said, the scribblings of some (not-yet) defunct economist might actually matter in terms of politics and policy.

UPDATE:  If you haven’t had a chance yet, you can listen to this week’s podcast of my converstation with Millenson on this very topic.