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A.M.A. Tables Controversial
Draft Report on Harm Reduction


September 1996

A report commissioned by an influential American Medical Association committee was tabled after some medical experts reviewed a draft copy. The report recommended legalizing marijuana and decriminalization of other illegal drugs (Christopher S. Wren, "A.M.A. Shelves Disputed Report on Drugs," New York Times, June 23, 1996, p. A22; Christopher S. Wren, "Uproar in AMA: Paper touts legalizing drugs," San Francisco Chronicle, June 23, 1996, p. A1).

The draft report was commissioned to look at ways for reducing the harm of drugs. It declared that "overall, abstinence-based treatment has a high failure rate," arguing that "under all circumstances, participation in drug treatment should be voluntary." It also recommended that "moderate steps toward drug decriminalization be taken" in order to reverse "the clearly negative consequences of the present prohibition status." John Morgan, M.D., a professor of pharmacology at the City University of New York Medical School and author of the report, said "it struck most of us that the biggest harm reduction we could see would be to stop putting people in jail."

In addition, the draft report suggested that marijuana "should be decriminalized, and a mechanism created for retail sales to those 18 years of age or older" and that the "use, possession and low-level sales of all psychoactive drugs should be a subject of police action only when these activities are associated with a disruption of public order." It also recommended that "all 'buy-and-bust' police actions should cease."

Dr. Morgan said the report was commissioned by the A.M.A.'s Council on Scientific Affairs, which examines issues of public health for discussion by the House of Delegates, the group's policy making body. He said that some language on harm reduction in the report was found in previous resolutions by the House of Delegates. "To my surprise," Dr. Morgan said, "the House of Delegates wanted to explore the issues of drug legalization." Dr. Morgan was assisted by Lynn Zimmer, Ph.D., a sociologist at Queens College in New York, and Ethan A. Naldemann Ph.D., the director of the Lindesmith Center in New York.

Objections were raised by some medical groups and doctors in the A.M.A., who were asked to comment on the report. One of these doctors provided a draft to the New York Times. Several doctors in the 300,000 member national organization said the A.M.A. should not be endorsing the greater availability of hazardous substances. Dr. Sally Satel, an addiction psychiatrist at Yale University said, "I think it has no understanding of how people begin to recover. The whole motivation for recovery is to come up against the consequences of your use."

The draft report was circulated to the American Psychiatric Association, the American Society of Addiction Medicine and the American Academy of Addiction Psychiatry. In a joint letter to the A.M.A., officials of the three groups urged the report to be reconsidered and raised concerns that the policy recommendations were based on ideology.

Dr. Morgan said that he was told that reaction within the A.M.A. was favorable. "The fact that there's been some criticism is O.K.," he said. Dr. Nadelmann said doctors in other countries have taken more initiative in changing attitudes about drugs. "The A.M.A. has not been quick to own important issues in drug policy," he said.

Dr. John J. Ambre, the director of the association's Office of Medical Information Services, recruited Dr. Morgan to prepare the report. He said, "it is not a document until it's approved by the council." Mark Stuart, a spokesman for the A.M.A., said "The council decided it wasn't ready for the House yet. " As a result, the issues raised were not addressed at the association's annual meeting in Chicago on June 22.

Herbert D. Kleber, M.D., a psychiatrist and medical director of the Center on Addiction and Substance Abuse at Columbia University, said he heard that the report was set aside after A.M.A. officials realized what it recommended. "It is my understanding that the A.M.A. was not aware this was put together by someone whose writings were clearly in favor of drug legalization," Dr. Kleber said.

In a June 27 letter to the editor of the New York Times, Nancy W. Dickey, M.D., chairwoman of the A.M.A. Board of Trustees, said, "other drug policy experts asked by the A.M.A. to review the draft were critical of the report's recommendations. As a result, it is unlikely that the initial draft will complete the A.M.A. process intact." She added that "past A.M.A. reports have tried to guide the nation's drug policy efforts based on a balance of treatment and punishment (Nancy W. Dickey, M.D., "A.M.A. Drug Policy Is Still in the Making," New York Times, June 27, 1996, p. A22)."