Drugs, Addiction, and the Law: Policy, Politics, and Public Health. By Peter J. Cohen, M.D., J.D. Durham, NC, Carolina Academic Press, 2004. Pages: 412. Price: $40.00.

This remarkable book is the creation of an author uniquely qualified to comment on the multiple facets the “drug problem.” Dr. Cohen has spent much of his career as an academic anesthesiologist with an interest in assisting addicted physicians. Later in his career, Dr. Cohen attended law school. This book represents an approach to a problem altogether too familiar to anesthesiologists, but from a completely different orientation than is the norm. This book is not about the “medicine side” of drugs; rather, it is about the legal past and present of drug laws. It provides an exhaustive look at the societal challenges created by drugs of abuse and how the legal system predicated upon such principles as “Life, Liberty, and the pursuit of Happiness” has responded during the past century and a half to address these complicated issues—that is, the tension between an attitude of “live and let live,” the desire to prevent harm to others, and the desire to “legislate morality.”

The author uses the very useful and engaging device of phrasing multiple questions in the opening of many of the chapters. In doing so, he forces the reader to question many of their preconceptions and biases. For example, in chapter 12, “Crack, Powder, and Justice—Illegal Drugs and Sentencing,” the author provides this list of questions:

  • Which branch of government has the ultimate responsibility for sentencing? Judicial—how much discretion should they be allowed? Legislative—authority to enact statutes setting mandatory minimums, maximums, or both Executive—role of prosecutorial discretion

  • Should there be a distinction between selling and using?

  • Should the law distinguish among the various drug sellers? Drug kingpin v. regional dealer v. local dealer v. “dealing to a friend” Addicts who sell to support their addiction v. no-addict selling to make money Police officer selling drugs used as evidence v. “ordinary civilian”

  • Should the law distinguish among various drug customers—child v. adult; drug-naïve v. addict?

  • Role of “proportionality”—how to “make the punishment fit the crime”

  • Should the law impose different sentences for different drugs sold or used? If the answer is yes, how can we develop objective criteria for distinguishing among the many drugs (marijuana, heroin, cocaine {powder v. crack}, LSD, “date rape” pills) involved in the illegal trade? Can, or should, legislators distinguish between scientific fact and public perception?

  • Should the amount of drug sold be a factor in sentencing? How should we determine this amount: actual weight v. only the weight of the active ingredient?

  • Should the “threat” to society that the specific drug represents be a factor in sentencing, e.g. , marijuana v. cocaine v. crack? If so, how should we measure such threat?

  • Should the location of drug sales (e.g. , near schools) be a factor in sentencing?

  • Should the law be concerned with how customers pay drug dealers—money drugs, sex for drugs, committing other crimes for drugs?

  • What should be the sentence—prison, civil commitment, drug court, monetary fine (how much to impose and to whom should it be paid?)?

  • How should the law deal with third party involvement? Should (can) mens rea (i.e. , the person committing the crime intended to do something wrong) be taken into account (knowingly v. negligently v. innocently or naively)?*

Having thus “laid the table,” the author then goes on to provide historical context and precedents in an effort to define how the current laws evolved. These discussions are accompanied by extensive quotation from actual court rulings; often, the cases have sufficient complexity that they have risen to the level of the U.S. Supreme Court.

This book is clearly an effort to present the dizzying complexity of U.S. drug laws in a format that will be approachable to nonlawyers. Although it is understandably heavy on legal concepts and phraseology, the author makes a valiant attempt to help the reader understand the more arcane aspects of the laws. It is, again understandably, at times quite a dry read, mostly during the lengthy quotations from court rulings. These quotations are essential, however; mere paraphrasing would do a disservice to the reader, and the author has wisely chosen to provide them in appropriate places.

As one who viewed the recent right-to-life case in Florida as the most impressive civics lesson in my lifetime, I thoroughly enjoyed this book. As one who has often wondered whether a policy of drug legalization might be preferable to the chaos of our current “war on drugs,” I found this book helpful in shoring up arguments both pro and con. In this light, I was struck with the incredible complexity merely unwinding the tangled threads and layers of existing drug laws would involve if legalization were attempted.

In summary, this book is superb. It informs, challenges, educates, and demystifies our system of drug laws. I came away with deep respect for the monumental challenge faced by the author and for the excellence of his final product.

Mayo Clinic College of Medicine, Rochester, Minnesota. berge.keith@mayo.edu