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Chapter 14
Themes
Key
LitCharts assigns a color and icon to each theme in Chasing the Scream, which you can use to track the themes throughout the work.
Drug Legalization and U.S. Policy
Addiction and Human Connection
Prohibition and the Cycle of Violence
Stories and Human Psychology
Summary
Analysis
Visiting Vancouver gives Hari a sense of hope for the first time in his research. He decides to look for other “positive experiments” of drug reform, but he quickly realizes that he won’t find any more in the Americas. He goes to Europe instead—starting with his home, the U.K. He contacts John Marks, who ran an experiment prescribing heroin in Liverpool as a young psychiatrist. During the region’s industrial decline, the conservative government decided to cut its subsidies and leave its economy to collapse. There were widespread riots in the area, and then heroin use started to spread. John gave people prescriptions for a week’s worth of heroin at a time.
Hari’s chapters on Vancouver showed how governments can follow the science, listen to addicts themselves, and choose better drug policies. In this chapter, he looks at how these policies actually work. Liverpool’s heroin epidemic fits Bruce Alexander’s theory that drug addiction is a response to social dislocation and decline, and Marks’s heroin clinic shows what might have happened in the U.S. if Harry Anslinger hadn’t succeeded in shutting down Edward Williams’s clinic in the 1930s. It’s easy to see how just a small policy change—new laws allowing doctors to prescribe drugs to addicts—could spread Marks’s model far and wide.
Themes
Hari’s findings surprised him: he used to assume that the U.K. fought the war on drugs exactly like the U.S., just a bit less intensely. Historically, the U.K. also outlawed drugs in response to a racial panic, but unlike in the U.S., U.K. doctors refused to comply. For two generations, they prescribed heroin to addicts so that they could live stable, healthy lives. Drug addiction rates were far lower than in the U.S. Harry Anslinger worked hard to shut down this system, but he failed.
Like Vancouver’s drug addicts, the U.K.’s doctors won crucial, lifesaving drug law changes through political organizing. The key to their success was not merely establishing a consensus about the benefits of better drug policies, but actually building power around this consensus.
Themes
Tasked with planning a regional anti-drug strategy, John Marks hired the researcher Russell Newcombe to study his patients. Newcombe found no HIV infections, drug crime, or overdose deaths. Most of the patients had jobs, families, and clean bills of health. In fact, doctors know that pure heroin is safe to inject. Most street addicts’ problems, like abscesses and infections, come from dirty needles and the adulterants added to heroin (which range from dust and coffee to bleach and cement). When Marks realized this, he decided that the real problem wasn’t drugs, but the laws prohibiting them.
Hari has emphasized that drug prohibition causes far more damage than drugs themselves, but so far, he has focused on drug-related conflict and violence. Newcombe’s research takes this even further: he shows that even the medical problems ordinarily associated with drugs are actually the result of prohibition. This makes sense—as Hari has already pointed out, doctors frequently prescribe opiates like heroin in medical settings without serious adverse effects. Thus, Marks’s program shows that drug legalization doesn’t mean spreading addiction and crime across the globe—rather, it means sending more people to more doctor’s appointments.
Themes
Marks expanded the heroin prescription program, enrolling hundreds of new patients. Over the next 18 months, addicts committed 93 percent fewer robberies and became ordinary law-abiding citizens. After getting her prescription, one addicted mother switched from prostitution to waitressing overnight. There were also fewer drug dealers on the streets.
The effects of Marks’s program were remarkable: it’s difficult to imagine any other policy intervention reducing crime so sharply. His results offer compelling evidence that prohibition isn’t just responsible for most of drugs’ negative effects—rather, it appears to be responsible for nearly all of them.
Themes
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Unlike Henry Williams, John Marks didn’t think that heroin users would remain addicted for life—he assumed that his patients would recover. This is because he knew the data showing that most addicts grow out of addiction, usually after about 10 years. Thus, the public feared that the program would increase drug use, while Marks assumed that it would have no effect. But drug use actually fell. This is because, under drug prohibition, the best way for addicts to fund their habit is by selling drugs to others. Prescriptions eliminate this pattern, saving countless people from addiction.
Marks’s data about recovery is significant: not only does it contradict the common assumption that drug addicts are a stable, unchanging population, but it also highlights how interventions to help addicts have profound long-term benefits. Namely, rather than merely supporting addicts and allowing them to continue using drugs for the rest of their lives, such programs can actually turn them into fully functioning, productive members of society. Finally, Marks’s finding about the reduction in addicts selling drugs to others underlines how so many of the harms associated with drug use are specifically driven by the high price that the black market requires addicts to pay for drugs. Legal clinics don’t just give addicts safer drugs—they also ensure that drug users don’t have to make money through crime or spend all of their money on drugs.
Themes
While some opposed John Marks’s prescription policy—like the Communists, who thought he was delaying the revolution by drugging the masses—the regional government took notice and replicated his program in every town. But then, Marks went on a widely-publicized tour of the U.S. to talk about his policy, and the U.K. embassy in the U.S. pressured the U.K. government to shut down Marks’s program. In a matter of days, Marks’s patients returned to street drugs, lost their jobs, and returned to crime. Within two years, a tenth of them had died of overdoses. Blacklisted in the U.K., John Marks left and moved to New Zealand.
Marks’s program was shut down because it contradicted the same conventional stories about drugs and the drug war that Harry Anslinger first popularized in the 1930s. It’s easy to think that the program was shut down because it succeeded, and the government didn’t want to admit the truth about the drug war. But that isn’t what happened. Actually, Hari presents the government’s reasoning as far less sophisticated: it didn’t even bother to ask whether Marks’s approach was successful. Instead, it simply viewed a doctor prescribing heroin to addicts as scandalous, and the reasoning ended there. Needless to say, creating more effective drug policies requires pushing governments past this kind of knee-jerk reaction.
Themes
Next, Hari visits Geneva, the city where Harry Anslinger first forced the international community to join his war on drugs—and where the Swiss government is now starting to dismantle it. In the 1980s and 1990s, Switzerland saw a spike in addiction in visible public places like a Zurich train station and a Bern park. But then, President Ruth Dreifuss changed everything. Hari meets her for an interview in her apartment.
President Dreifuss is a rare example of a powerful politician who actually chose to follow the scientific evidence rather than the drug war’s truisms. Dreifuss’s story can provide a model for other politicians who want to end the drug war, as well as for activists who want to change their elected leaders’ minds.
Themes
Growing up, Ruth Dreifuss was bullied for her Jewish identity and her political ambitions—at the time, Swiss women couldn’t even vote. In 1993, as Switzerland suffered from Europe’s worst HIV epidemic, Dreifuss took over its national health policy. She met with addicts, sex workers, and doctors. One told her about Marks’s experiment in Liverpool, and she decided to replicate it. She convinced the Swiss government to build a nationwide system of heroin and methadone clinics.
Dreifuss arrived at her policy solutions in the same way as Vancouver mayor Philip Owen: she actually met the people affected by the drug war, learned about their needs, and then looked for proven policy solutions that would meet those needs. Unlike so many of the drug war’s leaders (particularly in the U.S.), she didn’t base drug policy on self-interest or ulterior political motives. This suggests that the first step to a humane drug policy is treating addicts with dignity and respect. It also speaks to the power of personal connections and stories in changing people’s minds. Of course, this explains why Hari structures this book around the stories and voices of people affected by the drug war (rather than just providing dry policy analysis).
Themes
Hari visits a heroin clinic in Geneva. Inside, he meets Jean, an old man wearing a tweed suit. For years, Jean spent all day every day using, selling, and finding money to pay for adulterated street heroin. Then, he joined one of Dreifuss’s heroin clinics. Now, he goes to the clinic for his fix and has the rest of the day free to work. He’s healthy and happy; he feels “reborn.” In the clinics, addicts don’t endlessly increase their doses over time; instead, most increase for a time, then stabilize at a consistent dose, and then finally start to decrease it. Jean is no exception.
Jean’s story demonstrates the incredible upsides of legalizing and regulating drugs. Heroin addiction once ruined Jean’s life not because his chemical dependence on the drug prevented him from working and living normally, but rather because prohibition left him with neither the time nor the money to do anything but take heroin. By reclaiming heroin from the black market and returning it to the medical system, Dreifuss’s policy has solved nearly all of these harms. Just like many ordinary people take psychoactive medications every day for mental illnesses, Jean takes his heroin every day but otherwise lives a perfectly normal and productive life.
Themes
A clinic doctor tells Hari that the treatment’s purpose is to help addicts gradually fill their lives with other meaningful connections and activities, until they no longer need heroin. Eighty-five percent of patients quit within three years. Addicts have traded a violent, exciting street subculture for a boring clinic waiting room. Meanwhile, Swiss cities have reclaimed the public spaces, like parks and train stations, that were once swarmed by addicts. Crime, HIV infections, and overdose deaths have fallen steeply. Beyond finding jobs and homes, addicts have also stopped selling drugs on the street. And it’s much cheaper to fund the clinics than to put drug users through the legal system.
Like Marks’s experiment in Liverpool, Switzerland’s clinics dramatically reduced all the significant social costs of drug use, which again shows that these costs are really the result of prohibition, not drugs themselves. The doctor’s explanation shows that Switzerland’s system takes the scientific evidence about addiction seriously: it understands that addiction is a response to pain and disconnection, and that truly ending it requires solving these root causes first. Making drug use utterly boring is one important part of this. Bruce Alexander pointed out that many addicts bond to the subcultures surrounding drug use, but Switzerland’s system eliminates these subcultures and encourages addicts to find meaning and excitement in other parts of their lives. Of course, this also helps make drugs less politically controversial.
Themes
Hari points out that Dreifuss managed to pass the world’s most progressive drug policies in one of the world’s most conservative countries. When Swiss citizens challenged Dreifuss’s clinics, she made the opposite argument from Harry Anslinger: the drug war causes chaos and disorder, whereas the clinics create order and peace. In two different referendums, more than two-thirds of Swiss voters favored keeping Dreifuss’s reforms. Her success shows Hari that, to truly change drug policy, reformers must learn to convince conservatives.
Dreifuss’s success shows that the key to making better drug policy politically possible is changing the stories that people believe about drugs. Rather than promising the Swiss people an endless war against evil, Dreifuss promised them peace, quiet, and safety. In turn, Switzerland’s success allows it to become an example for other countries.
Themes
In one clinic, a shy young patient handed Dreifuss a letter explaining that the clinic helped him get off the streets, learn self-respect, and find a job. In fact, he worked for the government, in Dreifuss’s department. For Dreifuss, this was proof of the program’s success. Yet she has had to defend it against international meddlers, particularly the U.S. and U.K. governments, which have tried to lobby her to stop it. She refused—instead, she helped found the Global Commission on Drug Policy, which lobbies against the drug war.
Dreifuss’s encounter with this patient demonstrates that, when it comes to drug policy, her real priority is helping addicts recover and lead healthy lives—not punishing them for their poor decisions or moral failings. Moreover, the fact that the patient works in Dreifuss’s department underlines Switzerland’s belief that well-managed drug addiction is compatible with a meaningful life and even taking on serious public responsibilities. This would never happen in the U.S. or U.K. today. As Hari notes, these countries continue to spread misinformation about drugs and support the war on drugs internationally—just as Harry Anslinger did a century ago. Thus, overcoming the drug war will require not just changing policies in individual countries, but also changing the global political consensus about drugs.
Themes
When Hari discusses Swiss heroin clinics, Americans frequently tell him that the U.S. does prescribe strong opiates, like Oxycontin and Vicodin, and they have led to a disastrous drug epidemic. Baffled, Hari turns to experts. They explain the U.S. opiate epidemic by answering three important questions.
The U.S.’s severe opiate epidemic shows that merely providing people with drugs through legal prescriptions isn’t enough to fight addiction. Rather, effective policy depends on the way that drugs are available and the kind of services that are available to treat addiction.
Themes
The first question is when American opiate addicts start to cause problems. Drug policy expert Meghan Ralston tells Hari that, whereas Switzerland prescribes opiates to addicts, the U.S. does the opposite: it forces doctors to cut off opiate prescriptions to addicted patients. This is when addicts turn to street drugs and start overdosing, committing crimes, and causing other social problems. But this also shows that the U.S. can eliminate many of the opiate epidemic’s detrimental effects by simply letting doctors prescribe opiates to addicts.
The U.S. government steps in to prevent doctors from making the best medical decisions for their patients. Thus, the U.S. gives ordinary people access to potentially addictive drugs but abandons them if they form addictions. There is a clear parallel between this policy and the U.S.’s original drug prohibition laws. Just as prohibition pushed drug use from the legal market into the black market, the law against prescribing drugs to addicts forces them to stop using safe, legal drugs and start using dangerous, adulterated black market drugs instead.
Themes
The second question is why the U.S. prescription drug crisis is growing so fast. Most Americans blame greedy doctors and pharmaceutical companies, who get patients “accidentally addicted” to opiates. But doctors have always given surgery patients heroin, without creating accidental addicts. Hari argues that Bruce Alexander’s research offers a better explanation: Americans are experiencing an unprecedented wave of distress and isolation, mainly because of falling middle-class wages and the Great Recession. If it weren’t for opiates, Americans would probably turn to other drugs instead.
The “accidental addict[ion]” story doesn’t explain the opiate epidemic because it’s based on the disproven pharmaceutical theory of addiction (which Hari also calls the “drugs-hijack-brains” theory). Instead, Hari points to the U.S.’s equally widespread epidemic of dislocation, isolation, and trauma—which is also the result of government policies that encourage severe inequality. Thus, while the war on drugs encourages people to think of drug addiction as an individual problem that the addict alone is responsible for, in reality, it’s just the opposite: it’s a collective problem that calls for collective solutions.
Themes
The third and final question is why patients transition from weaker opiates, like Vicodin and Oxycontin, to stronger ones, like heroin. Most Americans blame this on chemicals: they think that addicts constantly need stronger drugs, or higher doses, to stay satisfied. But the real reason is “the iron law of prohibition.” During Prohibition, Americans switched from beer to liquor, which was more widely available because it was more profitable for traffickers to transport drinks with a higher alcohol content. In general, people prefer mild intoxicants, but prohibition encourages suppliers to offer the strongest intoxicants they can. Thus, prohibition causes people to use stronger drugs.
In John Marks’s clinic, most heroin users quit after around a decade, and in Switzerland’s heroin clinics, most users stabilize and then reduce their dosages over time. These examples both show that addicts don’t automatically need higher doses over time (although they may certainly choose higher doses if their feelings of pain and disconnection grow). Instead, the iron law of prohibition shows that the real culprit is economic forces in the drug market. This result parallels many of the other findings Hari has explained throughout his book—like the fact that the level of violence in the drug trade tends to steadily increase over time.
Themes
Similarly, Americans once consumed opiates and cocaine through drinks and cough syrups. But drug prohibition encouraged traffickers like Arnold Rothstein to sell stronger drugs: powder cocaine and injectable heroin. This iron law also applies to the opiate crisis. Oxycontin users want to keep using Oxycontin, but heroin is much easier to find on the street—and a third of the price. Even though the real problem is drug prohibition itself, Hari concludes, people keep blaming the chemicals and using this to justify more prohibitionist policies. The pattern keeps repeating; a Geneva heroin clinic doctor compares it to society relapsing. But she also promises that “at every relapse, you learn something new.”
The iron law of prohibition also implies that if drugs are made legal, people will choose to use weaker and less dangerous forms. Hari shows that Oxycontin users make a rational decision when they switch to heroin, simply because of how the black market is structured. Needless to say, in a legal drug market, the government could give them the opposite incentive by making more dangerous drugs more expensive. The doctor’s comments about relapse and growth are a metaphor for her (and Hari’s) hope that after repeating the drug war’s mistakes enough times, modern societies will eventually move past them.
Themes
