Robert J. MacCoun and Peter Reuter, Drug War Heresies: Learning from Other Vices, Times & Places.

New York: Cambridge University Press, 2002. $75.00 hardcover, $25.00 papercover.

In 1970, Troy Duster wrote a groundbreaking book entitled The Legislation of Morality in which he argued that "... moral beliefs upon which we have based our public policy are themselves founded on myths about both the physical effects of drugs and errors about the total quality of persons addicted (p. 239)." Now, 32 years later, MacCoun and Reuter have taken this argument further by carefully developing a set of frameworks by which specific drug policies can be assessed. They rightly argue that unnecessary and unproductive dichotomies have been presented in the literature that polarize policy options. Total prohibition is one view strongly held by almost all political leaders, law enforcement, and to a large extent, the general public. It argues that illicit drugs are harmful and should continue to be legally prohibited with stronger enforcement and somewhat more severe penalties because they are morally unacceptable. Harm reduction/legalization, the other view, is held primarily by a few academics and researchers who argue that the sheer fiscal costs associated with prohibition in terms of criminality and law enforcement demonstrate that these policies need to be loosened or possibly abandoned. This book makes a creative effort to narrow or bridge the gap between these two views and provide a neutral assessment of different policy in light of a critical assessment of historical and international trends.

The book is divided into four parts. The first section provides an overview that sets the tone for how the analysis will proceed. The authors describe a set of dichotomies which define how drug policy is generally perceived. These include abstinence versus harm reduction as goals for drug policy; criminalization versus legalization as national drug strategies; and, criminal versus public health problem for how drug use/abuse is defined. The rest of the book goes well beyond these dichotomies in an attempt to "depolarize" these views and resolve their differences in the hopes of developing a truly effective national drug policy. The reframing of dichotomous extremes and their likely effects on society is the main contribution of this work; it provides a refreshing break from the work of scholars advocating for a particular view. While it is clear that these authors are not supporting current drug policy per se, MacCoun and Reuter are not blinded by their own views, and they succeed in presenting a neutral assessment of what is and what might be.

While the book does provide in depth description of drug policy in The Netherlands, Switzerland and other countries in Europe, its unique contribution stems from the last part of the book in which the authors project possible outcomes of different strategies, such as depenalization, a regulated adult market, and maintenance of drug use for different drugs including cocaine, heroin and cannabis. In a fairly cautious manner, MacCoun and Reuter attempt to project how these various regimes may affect the prevalence of use, harms related to use, and distributive issues in the U.S. if adopted. They also are clear about how much uncertainty is related to their projections. For example, for some drugs, there is better knowledge of some outcomes given the experiences of other countries, such as the Dutch experience with cannabis. For other drugs, there is much uncertainty given that there is less or no experience with these strategies, for example, cocaine and heroin. What is exceedingly clear from the authors' analysis is that this is an extremely complicated area ladened with morality and uncertainty thus it is easy to determine why the U.S. has generally maintained an abstinence, prohibitionist position over the years.

While this book does illustrate some possible policy alternatives, there are several places that could have been developed more fully. First, while one can construct rational arguments for why our current prohibitionist drug policy does not and cannot work and propose other policies that might well be somewhat better, there is always the political process which itself is often entrenched in moral claims. The book provides few insights into what it would take to change this process so that drug policy reform could possibly occur. At present politicians and the public support the zero-tolerance, abstinence approach to illicit drugs and overwhelmingly reject legalization with the exception of "compassionate use" of medical marijuana legislation that has passed in some states. What will it take for these public perceptions to change so that harm reduction approaches can gain better and stronger support? Another area that is problematic in the book is the brief inclusion of gambling and prostitution as "other vices." These few pages seek to draw a parallel between these behaviors and illicit drug use, but their brevity precludes a thorough assessment. Thus, it might have been better to eliminate these areas from the book. Sadly, there is also considerable redundancy in the book--the overview reviews several arguments in depth and the reader sees them again in later chapters of the book. Throughout the book, the authors constantly refer backwards and forwards to different chapters which is confusing and probably indicates more overlap than necessary.

Despite these limitations, the book is well written, and it provides a fresh perspective on several options for drug policy. It offers a reasonable approach to the often irrational arguments in this field which often claim moral certainty. One hopes that those in a position to develop and/or influence drug policy will read this book as it certainly gives a valuable perspective on these enduring issues.

Lorraine T. Midanik
University of California at Berkeley