Abstract

U.S. drug policy has sometimes implicitly — and incorrectly — assumed that all drug-related harm is caused by drug use, so reducing drug use necessarily reduces drug harm proportionately. Instead, drug policy should try to reduce the sum of both harms incident to drug consumption — including harms to users as well as harms to others — and policy-generated harm in the form of illicit markets, enforcement costs, and increased harmfulness of drug-taking due to controls. A strict prohibition can meet these criteria when it succeeds in keeping illicit markets “thin” and consumption very low. However, promulgating wise policies toward “thick” markets with widespread consumption necessarily involves trade-offs among competing objectives. Recent U.S. history illustrates both the futility of trying to control already “thick” markets using very long prison sentences for dealers (as in the cocaine market) and the risks of allowing “thin” markets to “thicken” by neglecting regulatory and enforcement efforts as prevalence starts to rise (as in the market for prescription opioids).