Stakeholder Considerations for the Decentralization of Drug Regulation in the USA

There is a stark difference between the discussion of policy changes while campaigning for an office, and the real process necessary to enact actual policy changes. Without support from stakeholders of various sorts at multiple levels of influence and involvement it's unlikely to be able to pass anything that will be carried through and go into effect. Therefore it's important to pursue a process that will engage these individuals and groups and lead to the achievement of strategic objectives. (Bryson, 2018, pgs 43-46) This report is designed to guide the person responsible for this process by pointing out key issues that will effect the design, delivery, and effectiveness of the three policy changes regarding the deregulation of drugs discussed during the campaigns, who the stakeholders are and their potential reactions, how the process could work, and expected results.

The first proposal is that the possession and consumption of almost all currently illegal drugs be decriminalized. It has been noted that this will reduce the pressure on the policing and criminal justice systems. The United States has the highest number of people in prison out of any country in the world, as well as the highest rate of imprisonment. (Walmsley, 2015) Multiple possible explanations can be given for this, e.g. American citizens break the law more frequently, the US has a higher rate of enforcing laws, the US has laws that lead to more imprisonment, the US criminal justice system has a higher rate of recidivism, and other potentialities; all of which may come up in ongoing discussions both among stakeholders and the public, whether true or not.

There are two clear examples in US history of the reverse: prohibition and the war on drugs. Prohibition was a popular grassroots movement that resulted in a constitutional amendment. The decriminalization of drugs is a popular movement, but not with the level of support or organization that was seen in the banning of alcohol, nor has it led in the direction of doing a constitutional amendment. Even with such a large movement the prohibition of alcohol had massive negative consequences.

These negative consequences are in parallel to the arguments we see today. The criminalization of the possession and consumption of substances with such a large base of users results in large numbers of the population ignoring the law. This not only increases the number of currently operating criminals, but also creates a disdain for the laws which are seen as unrealistic and not to be taken seriously, and this idea generalizes to laws in general. The immense increase in power and influence of the mafia organizations in the early 20th century is directly linked to prohibition. By cutting out legal means of manufacture and distribution criminal organizations were able to take the market and thus gain immense funding, which fuels their expansion into other areas and with enough funding such organizations can potentially grow large enough to challenge the government itself for control of land areas. Money laundering becomes a need for these organizations and therefore the financial sector becomes infiltrated and corrupted, alongside policing and criminal justice itself. And, because interest groups and donors have such a large influence on policy these become corrupted as well. To take down such powerful organizations new laws had to be created that enhanced and centralized power in the government thereby eroding protection of individuals overall with negative long-term effects of governmental growth and overreach. (Lerner, 2022)

Similar processes were seen once again with the so-called war on drugs. (History.com Editors, 2019) Some of the organizations were the same and some changed, for instance the Italian, Irish, and Jewish mafias were prolific during prohibition, in the war on drugs various domestic gangs grew along with the Mexican cartels and the Russian mafia. Some of the technology changed, for instance the free cash made available through the drug trade allowed the funding of more high-tech criminal skills and investments such as identity theft and hacking. Overall however, similar policies with similar effects, not to mention the cultural degradation of the growth in belief that such things are not personal choice with individual responsibility but rather a societal issue to be decided on by whichever group is powerful enough to pass and enforce it. From this overview we can surmise that moving in the opposite direction, as these policy proposals intend, could be a positive change.

The second proposal is, and I quote from the assignment paper, "retail supply of a limited set of those drugs judged to be less harmful to be controlled and managed by the state, reducing control of the market by criminal organizations and leading to increased tax revenues". This will be the most difficult of the proposed policy changes to manage because it proposes no change at all. It is synonymous with the current situation and part of what has led to the drug addiction problem in the United States. (HHS Staff, 2021) There is a retail supply of government-approved drugs controlled and managed through licensing, approvals, and restrictions through the medical, hospital, and pharmaceutical industries. The emphasis on treating symptoms leads to a high level of painkiller prescriptions, which are often the start of addiction. (Mayo Clinic Staff, 2022) Thus, we know that this measure does not reduce criminal organizations, and in fact will lead to more of what we already have. With this proposal having been promoted during the campaign it's highly possible that those stakeholders with an interest in maintaining the status quo, most likely because of conflicts of interest in the potential reduction of revenues from damaging their captivated client base and barriers to entry from competitors, will support and promote this policy as the best to pursue resulting in the promotion and even appearance that change is happening without any substantial change actually occurring.

The third proposal is to increase the availability of rehabilitation and treatment services reducing pressure on acute health services. Since people will seek clean drug sources as to their best ability it's probable that this need will lessen of its own accord to some extent by the availability of more clean sources because of market competition, increased access, and opening communication and social proof methods such as reviews. It is not necessary that the government create, fund, design, and run rehabilitation and treatment centers to make more such resources available to the public. Both for-profit and non-profit organizations are capable and willing to do this of their own accord. The primary role therefore of the government is to lessen the barriers to entry that currently exist in this important field. The United States has a large amount of regulatory capture in the entire medical field which has grown since the early 20th century, especially after the Flexner Report, and this includes the rehab portion of the industry. (Flexner, 1910) Reducing these barriers is synonymous with increasing access to rehabilitation and treatment.

Stakeholders will include some who are easily represented and others that are less so (Bryson, 2004): drug users, addiction recovery organizations, prisons, schools, police, hospitals, pharmaceuticals, parents, states, local municipalities, family and friends of drug users, and the average taxpayer. Addiction recovery organizations may seem the best through which to gain access to drug users, family and friends of drug users, and key personnel of the addiction recovery organization itself. However, it should be remarked that it would be easy to fall into the mistake of believing that the key personnel of the organization properly represents the interests of all of these stakeholders. There has been some selection mechanism and therefore bias in the clients and therefore also their family and friends, whether of a voluntary or involuntary nature. (Catalogue of Bias Collaboration et al., 2017) So too it may be that the interests of the organization and the clients do not necessarily align. One potential conflict of interest is that for the addiction recovery organization to continue to exist there must be addicts to be treated. Hopefully such a conflict does not cause ill-intentioned decisions consciously, but that still does not rule out the inherent bias and unknown subconscious forces at play within the representative stakeholders. (NCSL Staff, 2021) The addiction recovery organizations will support increasing government funding to such organizations because it's the easiest way to increase their revenue and especially favors the large and represented organizations, which are likely the ones also represented in such stakeholder discussions. In general it is those with power that influence policy and they will influence it in such a way that they can continue to benefit, especially disproportionately, from such policy whether as the status quo or with reform. (Hague, Harrop, and McCormick, 2016, pg 333) This is one of the primary reasons for the almost continual failure of centralized reforms.

The prison industry has a conflict of interest in lowering the number of criminals held that are producing money for those businesses. Therefore, they will gradually and slightly attempt to move the conversation away from decriminalization which will be easy to do by offering and emphasizing the proposal to have a government-created market, the reform that is not a reform, and thus keep the criminal population up. Then, they will emphasize the need for more government resources for treatment and rehabilitation centers either directly or indirectly tied to the prison system as this would create further potential revenue sources and business opportunities, which would also go disproportionately to the influential forces, which are most likely those represented as stakeholders. There is no way to centrally fund or organize reforms without this tendency. (Joyce, 2015, pg 293)

Hospitals are in a similar position to prisons. There will probably be general support from the frontline workers such as nurses, doctors, and administrative staff, but from an executive decision-making standpoint they would prefer to have a restricted market with barriers to entry and regulatory capture of that market with a push for more government funding of rehabilitation and treatment either directly or indirectly through them.

The pharmaceutical industry has the most to lose along with the most influence through direct lobbying of politicians and indirect sway over the perception of the public through media ad buying. (Guttmann, 2021) Therefore it is from pharma that the most resistance can be expected in carrying out an actual decriminalization reform, thus they will applaud the efforts and push the government markets from which they will benefit as suppliers, along with the rehab and treatment centers from which they will also benefit by supplying the drugs as treatment for drug addiction. (NIDA Staff, 2022) The power of pharma through such avenues means that a serious reform of this sort may prove unlikely without a wider general movement of support to counteract big pharma's interests.

The police are a less well-known entity in their potential reaction. They will be skeptical of improvement in any light because of their perspective. If they believe that such reforms will result in defunding they will be against it. If they don't believe it will effect funding then they may very well be okay with it.

It would seem that the other segments of the populace will all split to a certain extent, but may very well come out in general favor of the reforms when considering the failures of the recently and obviously lost war on drugs.

A successful reform is possible using these campaign points as a launching platform, with one adjustment that has a successful record both historically and contemporaneously. The decision-making authority in this sphere can be decentralized to the subsidiary governments. This is the process that was used in the growth of zoning laws. A few localities started modern zoning laws in the early 1900s. The federal government designed a model enabling act that it recommended to the states. (Advisory Committee on Zoning, 1926) Over the next few decades states across the country adopted something similar to the act, and now zoning is prolific. In the case of zoning this increased regulation. The same process can be used to decrease regulation. To a certain extent this process has already started in opposition to the federal government, as seen in states moving toward legalizing marijuana and mushrooms.

Therefore, at the national level it must be acknowledged that the criminalization or decriminalization of drugs and associated regulations is a state right under the tenth amendment to the Constitution, preferably by federal congress, although executive orders and supreme court cases carry weight as well. Simultaneously, a model enabling act will be drafted and given to the states as a recommendation in which all three policies are addressed: that the legality of the possession and consumption of drugs shall be determined by the local municipalities such as the county, city, township, and village, having been deregulated at the federal level and enabled from the state to the local level; that regulations for the manufacture, distribution, and sale of drugs will be determined at the local municipal level having been deregulated at the federal level and enabled to the local level by the state; and that medical and other care in rehabilitation and treatment centers will also be determined by the local level having been deregulated at the federal level and enabled from the state government to the local municipalities.

This brings the decision closer to the people and allows for a broad stakeholder process revealed to the general public, which as we've seen is where the potential support is because of the inherent conflicts of interest from the most easily represented groups if stakeholder meetings are held with limited parties. The decision-making authority moving down brings onboard state and local governments as likely allies in approving such measures, and brings them to the fore in the discussions. Thus in drafting, the agencies in the states that represent local municipalities can have representatives as the primary stakeholders. Also, for those organizations with conflicts of interest this does not necessarily mean that they will lose their market advantage acquired through regulatory capture, so it could engender less resistance from the pharma and prison industries. The decentralization means that these organizations would then have to attempt to gain regulatory capture in a very widely distributed number of municipalities rather than a single centralized national government, therefore reducing their influence over such policies and thus creating greater potential variation and choice for the public in differentiation between living regions.

A model resolution for local municipalities supporting these measures could be drawn up and widely distributed to boards and councils across the country. This would begin a movement that could gather support and legitimacy as representatives from the most local governments debate and pass such resolutions. If traction were to be gained in this fashion it seems likely that the process would result in success and provide the basis for more decentralization in the future.

Reference List

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