High Price (37 page)

By the early 1990s, concern about the dangers of crack intensified and lots of money was pumped into the war on that drug. Not only were law enforcement budgets increased but more money was also allocated for research. Now scientists had a stake in the crack hysteria game. As a result, the scientific database on crack cocaine grew substantially within a few years. As I stated earlier, the data showed that both forms of cocaine produce identical effects; these effects are predictable. That is, as the dose is increased, so are the effects, whether they are blood pressure and heart rate
or
subjective “high” and addictive potential. The evidence clearly indicated that the 100:1 ratio exaggerated the harms associated with crack and that the sentencing disparity was not scientifically justified. To punish crack users more harshly than powder users is analogous to punishing those who are caught smoking marijuana more harshly than those caught eating marijuana-laced brownies.

At the same time, some began raising concerns that crack-powder laws disproportionately targeted blacks. Congress directed the U.S. Sentencing Commission to issue a report examining the federal cocaine laws. The commission is the federal agency responsible for, among other tasks, reducing unwarranted sentencing disparities. In February 1995, it issued its report. The report examined pharmacology, the ways the drug is taken, societal impacts, cocaine distribution and marketing, cocaine-related violence and crime, the legislative history of cocaine penalties and constitutional challenges, and data related to federal drug offenses. It was thorough. It found that nearly 90 percent of those sentenced for crack cocaine offenses were black, even though the majority of users of the drug were white. This conflicted with most people’s perception because news reports and popular media almost always showed black crack smokers. As a result of these findings, the commission submitted to Congress an amendment to the sentencing guidelines that would have equalized penalties for powder and crack cocaine offenses, that is, the crack-powder ratio would have gone from 100:1 to 1:1. Congress passed and President Bill Clinton signed legislation disapproving the guideline amendment. In a statement Clinton explained the rationale for his decision to block the amendment: “We have to send a constant message to our children that drugs are illegal, drugs are dangerous, drugs may cost you your life—and the penalties for dealing drugs are severe.” He continued: “I am not going to let anyone who peddles drugs get the idea that the cost of doing business is going down.” Subsequent reports and recommendations by the commission in 1997, 2002, and 2007 were equally unsuccessful in bringing about meaningful changes to the cocaine laws.

Many prominent individuals criticized the unwillingness of lawmakers to eliminate the cocaine sentencing disparity. In 1997, Michael S. Gelacak, then vice chairman of the Sentencing Commission, wrote, “Congress and the Sentencing Commission have a responsibility to establish fair sentencing standards that protect the public. . . . We have jointly failed in our approach toward crack cocaine sentences, and the result is seriously disparate sentences. We should not lose sight of that overriding reality. . . . The only real solution to the injustice is to eliminate it.” Ten years later, even presidential candidate Barack Obama had added his voice to the growing chorus of criticism: “[L]et’s not make the punishment for crack cocaine that much more severe than the punishment for powder cocaine when the real difference between the two is the skin color of the people using them. Judges think that’s wrong. Republicans think that’s wrong. Democrats think that’s wrong, and yet it’s been approved by Republican and Democratic Presidents because no one has been willing to brave the politics and make it right. That will end when I am President.”
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On August 3, 2010, President Obama signed legislation that decreased, but did not eliminate, the sentencing disparity between crack and powder cocaine offenses. The new law reduced the sentencing disparity from 100:1 to 18:1.

Some celebrated this change as a significant step toward ending a historic wrong. I am not one of them. In 1964, when asked whether the United States had made sufficient progress toward racial equality, Malcolm X said, “If you stick a knife in my back nine inches and pull it out six inches, there is no progress. . . . The progress is healing the wound.” Accordingly, I think the sentencing differences should be completely eliminated because there is no scientific justification for the differential treatment of crack and powder cocaine under the law. This seems the ethical thing to do in light of the evidence and ONDCP’s claim to rely on science and evidence.

I sat there in the methamphetamine roundtable and wondered whether the same mistakes would be made with this drug as were made with crack cocaine. There certainly were plenty of signs suggesting this. Like with crack cocaine in the mid-1980s, a relatively small number of individuals from a derided group were seen as users of methamphetamine. They were white but gay, poor, or rural. In 2005, about a half million people reported that they had used methamphetamine in the past thirty days (an indication of “current use”). This number is small when compared with the 15 million people who smoked marijuana within the same period. Whenever a “new” drug is introduced to a society and a relatively small number of marginalized individuals use that drug, incredible stories about the drug’s effect can be told and accepted as fact. This is so because few people have the experience with the drug to challenge questionable claims. We saw this in the 1930s when authorities said that marijuana caused people to become psychotic and commit murder. These claims were often unchallenged and taken as fact. In fact, they were a major reason that the federal law (Marihuana Tax Act of 1937) essentially banning marijuana was passed. At the time, marijuana use was confined to a small number of minorities and “hipsters.” Of course, today, if an individual says that marijuana use leads to insanity and murder, he or she would not be taken seriously.

Another similarity with the “crack scare” of the 1980s was the increasing number of stories written about methamphetamine in the national press. On August 8, 2005,
Newsweek
ran a dramatic cover story called “The Meth Epidemic.” Use of this drug, according to the magazine, had reached epidemic proportion. The evidence suggested otherwise. At the height of methamphetamine’s popularity, there were never more than a million current users of the drug. This number is considerably lower than the 2.5 million cocaine users, the 4.4 million illegal prescription opioid users, or the 15 million marijuana smokers during the same period. The number of methamphetamine users has never come close to exceeding the number of users of these other drugs.
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Coverage was filled with accounts of desperate users turning to crime to support their use of the “dangerously addictive” drug. Many articles focused on the “littlest victims.” The
New York Times
headlined one story,
DRUG SCOURGE CREATES ITS OWN FORM OF ORPHAN
, describing an apparent rise in related foster care admissions and reports of addicted biological parents who were impossible to rehabilitate. The paper quoted a police captain who said methamphetamine “makes crack look like child’s play, both in terms of what it does to the body and how hard it is to get off.”
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The paper also claimed, “Because users are so highly sexualized, the children are often exposed to pornography or sexual abuse, or watch their mothers prostitute themselves.”
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Attorney General Alberto Gonzales called it “the most dangerous drug in America,” and President George W. Bush proclaimed November 30, 2006, National Methamphetamine Awareness Day. Back in 1986, President Ronald Reagan proclaimed the entire month of October Crack-Cocaine Awareness Month. The parallels were frightening.

At the end of the ONDCP discussion, we were asked to meet with writers in small groups to answer any lingering questions. Dozens lined up to meet with the police officer and attorney. They wanted to hear more about how methamphetamine caused gay men to engage in sexual practices that increased HIV rates; how it kept people up for consecutive days without sleeping; how the drug made people behave irrationally; and how it ruined people’s teeth and made them unattractive. While some of the writers were undoubtedly there simply seeking a sexy story to sell, I think most genuinely wanted to learn about the drug and, if needed, to warn the public about its dangers. They weren’t thinking about separating anecdote from evidence. They had just heard from a U.S. attorney and a cop that this drug was nasty stuff. The government invited both of these individuals as experts on the topic. As a result, there didn’t seem to be a need to separate fact from fiction. Of course the information was factual. Otherwise, it would not have been presented in a forum sanctioned by the government, would it?

I pondered this and other questions as I rode the subway back to my lab. Why was my data so inconsistent with the stories told by the other panelists? Was I out of touch with the way people use drugs in the real world? Maybe the doses that I tested were too low, I thought. I had intentionally started off with low doses to ensure the safety of my research participants. At that point, the largest dose I had given was 20 mg, which is considerably lower than doses reportedly used by methamphetamine addicts. Perhaps the individuals described by the prosecutor and police officer used much larger doses than those tested in my studies. This might explain our disparate conclusions. I also thought about how methamphetamine is typically used outside the lab—snorted, injected, or smoked. This ensures that the drug hits the brain more quickly and produces more intense effects. In my studies, it was swallowed. When taken this way it produces the least intense effects. Given these caveats, I questioned whether the data collected in my studies was relevant to the situation in the real world. I figured the hysteria about methamphetamine had to reflect something about reality and that my studies, up until that point, had not captured it.

Over the next seven years, I went about trying to resolve this issue. I searched the human literature to see if anyone had studied larger methamphetamine doses when the drug was snorted, smoked, or injected. There was virtually nothing. I thought about José Martí’s famous quote in his 1882 essay “On Oscar Wilde”: “A knowledge of different literatures is the best way to free one’s self from the tyranny of any of them.” So I read the literature on animal studies looking for information that might be relevant to human addiction. These studies showed that the drug caused extensive damage to certain brain cells and produced severe learning and memory problems. Aha, I got it! Finally, here was some data that was in line with popular anecdotes about methamphetamine. But as I looked more closely it became clear that the animal results had serious limitations and might not be applicable to people. For one, the amounts of methamphetamine given to animals are far more than amounts taken by methamphetamine addicts. If one gave similarly high doses of caffeine or nicotine to animals, the same serious toxic effects would be seen. But when animals were given methamphetamine doses comparable to those used by people, the destructive effects were not observed. During my graduate education, the notion that methamphetamine damaged brain cells was an unquestioned fundamental truth in drug research. Now this basic belief needed to be qualified, making it difficult to extrapolate to people.

Next, I studied the literature on the long-term effects of methamphetamine in addicts. These were people who had used the drugs for many years. In these studies, abstinent methamphetamine addicts and a control group (usually non–drug users) completed a comprehensive set of cognitive tests over the course of several hours, and the results were compared to determine whether the cognitive functioning of the methamphetamine addicts was normal. Of course, normality is a relative concept that is determined by not only comparing performance of the methamphetamine group with the performance of a control group but also comparing the methamphetamine group’s scores with those from a normative dataset, taking into consideration the individual’s age and level of education. These requirements are important because they allow us to take into account the relative contribution of age and education in terms of the individual’s score and adjust the score accordingly. Simply stated, it would be inappropriate to compare the vocabulary scores of a sixteen-year-old high school dropout with those of a twenty-two-year-old college graduate. The older college graduate would be expected to outperform the younger dropout.

With members of my lab at an end-of-year celebration.

Study after study found that methamphetamine addicts had severe cognitive impairment. In one study by Sara Simon and colleagues, the apparent impairments were so bad that it led them to warn: “The national campaign against drugs should incorporate information about the cognitive deficits associated with methamphetamine. . . . Law enforcement officers and treatment providers should be aware that impairments in memory and in the ability to manipulate information and change points of view (set) underlie comprehension . . . methamphetamine abusers will not only have difficulty with inferences . . . but that they also may have comprehension deficits . . . the cognitive impairment associated with [methamphetamine abuse] should be publicized. . . .”
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As I read this and similar papers more critically, I noticed something intriguing. While it was true that the controls had outperformed methamphetamine addicts on a few tests, the performance of the two groups wasn’t different on the majority of tests. More important, when I compared the cognitive scores of the methamphetamine addicts in the Simon study against scores in a larger normative dataset, none of the methamphetamine users’ scores were outside the normal range.
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This meant that the cognitive functioning of the methamphetamine users was normal. This should have tempered the researchers’ conclusions and prevented them from stating such dire warnings. What’s more, the methamphetamine literature was filled with similar unwarranted conclusions; as a result, the apparent methamphetamine addiction–cognitive impairment link has been widely publicized—numerous articles have appeared in scientific journals and the popular press.