A prescription of drug abuse -- Addiction: From Biology to Drug Policy by Avram Goldstein

Issues in Science and Technology, Spring 1994 by Bloom, Floyd

For legal drugs such as alcohol and tobacco, Goldstein recommends higher taxes, restrictions on advertising, and stricter and more uniform enforcement of existing laws, such as drunk-driving laws or laws prohibiting the sale of tobacco to minors. Although he would like to ban tobacco altogether, he is willing to settle for restricting its use in public and ceasing the exportation of tobacco products from the United States. Even caffeine use may require stronger government intervention: Goldstein notes that there is "increasing concern that it may not be entirely harmless." He recommends an educational campaign to reduce caffeine consumption and suggests that the Food and Drug Administration (FDA) mandate removal of caffeine from all food products except natural sources, such as coffee and tea.

By contrast, Goldstein argues that government regulation of cannabis use is excessively strict, given that it has been found to cause relatively little harm. He recommends discretionary enforcement of existing laws, except for cases in which cannabis use could threaten public safety.

Although Goldstein would maintain legal restrictions on opiates, cocaine, and other illicit drugs, he argues that the government should greatly expand efforts to treat addicts. For instance, there are now two medications available to ease withdrawal from opiate addiction: methadone and LAAM, which was recently approved by the FDA. Goldstein wants to make access to these medications available to all who want treatment. He also wants to make medication more accessible, by having dispensing vans, for example, visit registered addicts in their own neighborhoods. Further, he recommends eliminating government interference in overseeing addicts' treatment, making it the exclusive business of physicians and other health workers. Finally, he encourages research to develop comparably effective drugs for the treatment of cocaine and amphetamine addictions.

THE ROLE OF SCIENCE

Because he has strong views shaped by his personal involvement in drug-related research, Goldstein makes a convincing argument--except in the area in which I expected the most from him. Despite the book's subtitle, "From Biology to Policy," Goldstein does not make an explicit case for increasing government investment in biological research as part of its anti-drug strategy. Indeed, he gives readers only the briefest glimpses into the ways that further scientific research can advance the cause of treating or preventing drug addiction. In addition, the policies he proposes have little or nothing to do with the biology that he has reviewed.

A few carefully crafted scenarios showing how one might now draw from biology the information to set drug policy could be extremely important as we face budget decisions in health. What specifically do we need to know to identify and then combat the conditioned craving that deflates all but the most intense attempts to kick habits?

For instance, could scientific research help to increase the effectiveness of drug-prevention programs? Last year, the National Research Council (NRC) reported that, despite the millions of federal dollars spent on preventing drug abuse, on balance "no drug-abuse prevention activities have been adequately evaluated and found to be reliably effective in all cases, with all groups." Suppose there was a reliable way to use genetic testing to predict an individual's susceptibility to addiction. Policymakers could then identify which children of an alcoholic, say, or a smoker had a genetic vulnerability and invest in intensive educational campaigns targeted to them. Would Goldstein support this kind of research, and how would he recommend its findings be applied?