WHERE DO WE GO FROM HERE?

WHERE DO WE GO FROM HERE?

There is an ongoing debate in the United States about the legalization or decriminalization of drugs by society. Several states have either passed laws or are considering laws that allow the use of marijuana for medical and possibly recreational purposes, but these laws are still controversial, and there is the additional problem that these state laws can be in conflict with federal laws. As a result, no one knows what the outcome will be even though it appears that federal officials are beginning to limit some prosecutions.

A number of prominent Americans—including the conservative Repub­lican senator Rand Paul—have concluded that the War on Drugs is leading to injustices. As this is being written, Senator Paul and Democratic senator Patrick Leahy want to change the law and have introduced the justice Safety Valve Act, which will allow judges more discretion in sentencing.

On the other side, many people believe that any effort to reduce the pressure on drug users and dealers will result in a flood of illegal sub­stances that, in their worst nightmares, will become readily available to children. Unfortunately, drugs are already readily available to anyone, including children, from all economic levels. So that nightmare is here right now.

To reduce demand, we need to increase education. As we have said elsewhere in this book, effective drug education is not just a matter of exhortations to refuse all drugs, because many individuals believe that the drugs they use are harmless. It is a matter of teaching the basic science that can help us appreciate what complex and delicate organisms our brains are, how body chemistry may vary from person to person, and how little we know about the many ways, both positive and negative, short-term and long-term, that the powerful chemicals we call "drugs" can affect us. Good education is expensive, but with it we will be healthier, and as a society, we will save the enormous costs of lost wages, law enforcement, and prisons that drugs have brought us.

GETTING CONVICTED: THE PENALTY BOX

GETTING CONVICTED: THE PENALTY BOX

The penalty laws of most states and countries are built on a series of leg­islative acts that happened over a long period of time, and thus, they are complicated and not easily summarized. Possession of modest amounts of marijuana can result in a slap on the wrist in some places and serious jail time in others. The same is true for other drugs, although they are usually taken more seriously, even in very small amounts. Often the prosecuting attorney has some leeway about the level of crime with which to charge an individual. The problem is that it is difficult to be sure of (1) the latest changes in the law, (2) the attitude that the prosecu­tor is taking toward drug crimes, and (3) whether that individual will be charged under state or federal statutes. Thus, conviction for the posses­sion of a small, recreational amount of heroin or cocaine could result in either a modest sentence or a huge fine and a long prison term, depend‑

ing on the exact circumstances and the mood of the legal officials over­seeing the case.

It is important to recall that in some states and in the federal system there is structured, or guideline, sentencing. That means that once an individual is convicted of some drug crimes, the sentence is regulated by law and might not be alterable by the judge no matter what the circum­stances. Coupled with the fact that there is no parole in the federal system (and increasingly in the state systems), a conviction can mean long prison time, even if the prosecutor and judge wish it were otherwise.

Here's an example of how things can go terribly wrong as a conse­quence of alcohol, a prescription drug, and harsh laws. One of us (WW) testifies as an expert in legal cases, and a recent one illustrates how the law, the prosecutor, and the courts can interact to ruin the life of an indi­vidual. A man was at a party with his neighbors outside of his home. He consumed a modest amount of alcohol throughout the evening, but at some point he decided to go to bed and took his nightly medicine, which included the sleeping pill zolpidem (generic for Ambien). Before going to bed, he came back to the party but soon appeared intoxicated. He then prepared for bed and went to sleep. Shortly thereafter, he awoke and came out of the house without his shoes, false teeth, or hearing aid, clearly hav­ing just awakened. But he had a gun, which he had retrieved from his bedside where he kept it. He fired twice as he yelled an obscenity to the individuals at the party. No one was hurt. The police were called, and he was arrested.

The man was charged with aggravated assault, and everyone thought he was intoxicated with alcohol. In the law of most states, that is consid­ered "voluntary intoxication" and thus is not a defense against any charges. His defense team argued that he was not intoxicated with alco­hol, but with his prescribed zolpidem, which is known to produce odd behaviors such as sleep driving, sleep sex, sleep shopping, sleep eating, and so forth. If it were the zolpidem, that would be "involuntary intoxica­tion," and that is a defense against such charges.

The jury heard the case and decided that he was intoxicated by alcohol and was therefore guilty. Now, here is where the disaster occurred. In that state, commission of many crimes (such as aggravated assault) with a gun is a mandatory ten-year sentence. If the gun is fired, the mandatory sen­tence is twenty years. In this case the prosecutor chose to charge the man for each of the six people present at the party, and the law requires that the mandatory sentences apply to each charge and be served consecu­tively. This means the man (who has not been sentenced at this writing)

must, by law, be sentenced to 120 years in prison. The judge has no discre­tion in this case.

This is a terrible example of the interaction of intoxication, harsh laws, vigorous prosecution, and finally, the presence of a gun where a sleepy, intoxicated person could access it and fire it. This man had no history of behavior like this and was a decorated soldier. It is very likely that the zolpidem produced the bizarre behavior, but the prosecutor and jury did not see it that way.

The lesson from this is that if a person chooses to intoxicate himself and then commits a crime, that intoxication is usually not a defense against any crime he committed, no matter how impaired he was at the time of the crime.

MDMA SUBSTITUTES

MDMA SUBSTITUTES

Some of the drugs that are in pills that are supposed to be pure MDMA have effects that are very similar or overlap with those of Ecstasy. Methylone is one of the "bath salts" (see the "Stimulants" chapter) because its struc-ture resembles cathinone (its chemical name is 3,4-methylenedioxy-N-methylcathinone). However, its neurochemical effects resemble those of MDMA. It preferentially releases serotonin, but also dopamine and norepinephrine, and users find its behavioral effects similar to MDMA. Its toxicity is also similar to MDMA, and multiple overdose deaths caused by methylone have been reported in the scientific literature around the world. The pattern of toxicity is the same, with stimulation of the sympathetic nervous system, high body temperature, and the cascading organ failure associated with sero­tonin syndrome. Little is known yet about its long-term effects, although some preliminary reports indicate that it does not cause long-term decreases in serotonin like those caused by MDMA. How­ever, there are only a few research reports out, so it is early to conclude

much about its long-term effects.

The piperazine drugs (mCPP, TFMPP, BZP) are another group of drugs that have appeared increasingly in pills that are supposed to be MDMA. These aren't exactly MDMA-like, although there is some over­lap in what they do. Each is a little different. BZP is like a stimulant: it causes stimulant-like behaviors in rodents and increases the release of dopamine and to a lesser extent serotonin. It also has properties com­mon among addictive drugs in animal tests. TFMPP and mCPP are more serotonin selective and have been used to assess serotonin func­tion in research laboratories for many years. Both release serotonin but have hallucinogen-like behavioral actions that probably reflect a stimula­tion of serotonin receptors. The combination of BZP and TFMPP most closely resembles the effects of MDMA. TFM PP or mCPP alone resemble hallucinogens more than MDMA and can cause severe anxiety, halluci­nations, and sympathetic nervous system stimulation.