All of us, at least once in our lives, have been misguided in our beliefs surrounding the nature of drugs. Whether we have resorted to faulting drug addiction on moral failures or subconsciously characterized addicts with our own anecdotal evidence, it’s difficult to deny that our society and government choose to judge and characterize addicts on the subsequent actions of their addiction rather than their struggle and circumstances. This occurrence is further exacerbated by the laws and regulatory policies created by the American government. 

Drug policy within the United States is a multidimensional strategy encompassing drug scheduling, arrests, and the regulation of the drug supply chain. A fundamental pillar of this policy is drug scheduling, where substances are categorized into different schedules based on their potential for abuse and medical use, subsequently dictating their legal status and associated penalties [1]. The policy's enforcement aspect is apparent through widespread arrests and prosecutions pertaining to drug-related offenses, with a specific emphasis on disrupting illicit drug distribution networks and apprehending those in participation. Additionally, the supply chain regulation facet involves efforts to intercept and manage the production, importation, and dissemination of illicit drugs, often entailing collaborative efforts between federal, state, and local law enforcement agencies [1]. 

While some view the current drug policy as providing an organized and structured framework for maintaining law and order, ongoing debates and criticism arise regarding drug research legality, incarceration policies, and other related areas. An examination of the historical trends in drug policy reveals that in certain scientific, POC, and addiction recovery communities, there are prevailing beliefs that American drug policy stifles neuroscience research, disproportionately affects POC communities, and perpetuates the war on drugs that prioritizes incarceration over rehabilitation. 

POC

“You want to know what this [war on drugs] was really all about? (...) We knew we couldn't make it illegal to be either against the war or black, but by getting the public to associate the hippies with marijuana and blacks with heroin, and then criminalizing both heavily, we could disrupt those communities. (...) Did we know we were lying about the drugs? Of course we did” [2]. This quote comes directly from John Ehrlichman, who served as Assistant to the President for Domestic Affairs under President Richard Nixon in the 1970s. This ideology, dubbed the “war on drugs” [3] during the Nixon presidency, instigated widespread prejudice towards people of color, more specifically, Black Americans. Nixon’s government declared substance abuse to be “public enemy number one” [3], which some perceive as a declaration to vilify substance use disorder. Recognizing that the foundation of federal sentencing policy was rooted in this example of systemic racism and the targeting of people of color is essential for comprehending how American drug scheduling contributes to disparities in drug enforcement, mental health issues among communities of color, and the subsequent challenges associated with both. 

Crack vs. Cocaine 

The penalties for drug offenses are significantly harsher for drugs more commonly associated with communities of color. For example, crack cocaine, which has a higher prevalence in Black or lower socioeconomic communities, has historically carried much harsher sentences than powdered cocaine, which is more often associated with white and higher socioeconomic users [4]. 

Crack cocaine, also known as cocaine base, is a derivative of powdered cocaine, also known as cocaine hydrochloride. Crack cocaine essentially encompasses all the chemical components found in cocaine hydrochloride, and is created by mixing hydrochloride with baking soda or ammonia [5]. The physiological and psychoactive effects of cocaine are consistent, whether it's in the form of cocaine hydrochloride or crack cocaine, although crack cocaine's interaction with the brain differs slightly due to its higher absorption rate and more potent effects. Whether in the form of cocaine hydrochloride or crack cocaine, the drug exerts its potent physiological and psychoactive effects primarily by impacting the brain's reward system. This intricate network of neural pathways plays a pivotal role in modulating sensations of pleasure, motivation, and the reinforcement of specific behaviors [6]. While crack cocaine has been more closely associated with criminal activity compared to cocaine hydrochloride, it's vital to recognize that many of these crimes are linked to cocaine addiction in general [5]. 

Although the mechanistic and neurobiological effects of cocaine hydrochloride and crack cocaine remain marginally different, American drug policy has upheld crack-related arrests to a 100:1 sentencing ratio [7]. Under this ratio, an individual convicted of a crack cocaine offense would receive a mandatory minimum sentence that was 100 times more severe than what an individual convicted of an equivalent powdered cocaine offense would typically face. To illustrate, this means that for every one gram of crack cocaine, an individual could potentially be sentenced as severely as someone apprehended with 100 grams of powdered cocaine. Efforts have been made to address and rectify these disparities in cocaine-related arrests, notably through the Fair Sentencing Act of 2010, which significantly reduced the 100:1 sentencing ratio to a far more equitable 18:1 ratio [8]. Although this has significantly decreased the racial disparities involving cocaine-related arrests, many have argued that further reforms and ongoing efforts within drug policy are needed to ensure a more just and equitable criminal justice system.

Mental health 

The stark disparities in drug-related arrests have deeply harmful consequences for the mental well-being of people of color in the United States. Over many decades, POC have been subject to disproportionate targeting and arrests for drug offenses, leading to harsher sentences and enduring social stigmatization/association with certain drugs. This unequal treatment not only breeds injustice and inequality but also cultivates an atmosphere of fear and mistrust toward law enforcement, the government, and the system it runs on. The ever-present specter of arrest and incarceration, coupled with the knowledge that drug-related policies have disproportionately impacted their communities, fosters a pervasive sense of vulnerability and mistrust for the government, as seen through the recent upsurge in refusal for government-regulated COVID-19 vaccinations within POC communities due to past traumatic events such as the Flint water crisis [9]. The persistent trauma and emotional distress resulting from these disparities can give rise to heightened levels of anxiety, depression, and other mental health challenges, as children with incarcerated parents have often lower scores in school and can have problems with aggressivity [10][11]. These systemic injustices not only directly harm the individuals affected but also undermine the overall well-being of POC communities, perpetuating a cycle of mental health struggles that necessitates comprehensive policy reforms.

Incarceration over rehabilitation/War on drugs

The drug scheduling system in the United States was established through the Controlled Substances Act of 1970, signed into law by President Richard Nixon [12]. This system is enforced by the Drug Enforcement Administration (DEA), which categorizes substances into five distinct schedules, spanning from Schedule I to Schedule V. These schedules serve as the DEA's means of classifying drugs based on certain criteria, such as their potential for abuse and recognized medical applications, with Schedule I containing substances that have the highest potential for abuse and no accepted medical use, and Schedule V including substances with the lowest potential for abuse and recognized medical applications [1].

Consequently, the drug scheduling system directly influences the severity of substance possession penalties, oversimplifying the nuances of addiction and penalizing chronic, relapsing substance use disorders. 

Neurobiology behind drug addiction

The neurobiology of drug addiction delves into the intricate mechanisms underlying substance abuse and dependency. It centers on the brain's reward system, notably the release of dopamine, which is a neurotransmitter triggered by pleasurable experiences and is excessively activated by drugs, reinforcing addictive behaviors [13]. Chronic drug use leads to neuroplasticity, causing structural and functional changes in the brain, particularly in regions related to motivation and decision-making. Tolerance and withdrawal emerge as higher doses are needed to achieve the same effects, and cravings become powerful, driving compulsive drug-seeking despite negative consequences [13]. Stress and emotional regulation are impacted, often leading individuals to use drugs as coping mechanisms. Genetic and environmental factors influence addiction risk, and the neurobiological changes associated with addiction can persist long after drug use ceases, contributing to the chronic and relapsing nature of the condition [13]. Understanding this neurobiology is crucial for developing effective prevention and treatment strategies that address the complex interplay of biology, psychology, and environment in addiction rehabilitation.

Therapy is notably more effective for addressing drug addiction than incarceration for several compelling reasons. At its core, therapy views addiction as a complex health issue rather than a criminal offense, enabling a more compassionate and holistic approach to recovery [14]. It aims to understand and address the root causes of addiction, such as trauma, mental health disorders, and environmental factors, while providing individuals with the necessary coping strategies to overcome their substance abuse. In contrast, incarceration often fails to tackle these underlying issues and may even exacerbate them within the confines of a correctional facility. Moreover, therapy actively promotes rehabilitation, personal growth, and accountability, empowering individuals to take responsibility for their actions. The therapy process fosters a sense of community support through group therapy and counseling, which can be crucial for long-term recovery. The cost-effectiveness of therapy, compared to the high expenses associated with the criminal justice system, such as Bennett’s direct funding of law enforcement, makes it a more efficient use of resources. Ultimately, therapy offers a more humane and evidence-based approach to addiction [14], reducing the risk of relapse, and recidivism, and equipping individuals with the tools they need to rebuild their lives as productive members of society. 

Neuroscience Research

The advancement of scientific research in the fields of neurological and psychological conditions faces significant limitations due to drug scheduling and policies in the United States. The regulations surrounding controlled substances, particularly Schedule I drugs, create barriers for researchers interested in exploring the therapeutic benefits of these substances. As a result, researchers struggle to secure the necessary research permits and funding to further explore and analyze the efficacy of these drugs. Moreover, the stigmatization of such substances, a situation exacerbated by American drug scheduling, results in a scarcity of research and literature concerning substance-based therapies.

MDMA

Ecstasy, also known as methylenedioxymethamphetamine (MDMA), is a Schedule I substance that has demonstrated potential in the treatment of certain mental health conditions [15]. Clinical trials have shown promising results in the use of MDMA-assisted therapy for individuals suffering from post-traumatic stress disorder (PTSD), a psychiatric disorder in which a person who either witnesses or experiences a traumatic event suffers anxiety, heightened reactions, nightmares, and intrusive flashbacks long after the event. In a recent study conducted at the University of California, San Francisco, PTSD symptoms were reduced after MDMA administration [15]. This substance's ability to alleviate and possibly mitigate symptoms of PTSD has been unrecognized by the DEA, although responsible clinical administration of MDMA-assisted therapy could provide a groundbreaking treatment option for those who have not responded to traditional therapeutic approaches to PTSD treatment [15].

Cannabis

Cannabinoids, particularly cannabidiol (CBD) and delta-9-tetrahydrocannabinol (THC), have shown promise in the management of neuropathic pain [16]. Neuropathic pain, often chronic and challenging to treat, is caused by damage or dysfunction in the nervous system and can result from various conditions, such as multiple sclerosis, diabetes, or injury [17]. Cannabinoids interact with the endocannabinoid system in the body, which plays a role in pain regulation and immune responses. Research indicates that cannabinoids can modulate pain perception and reduce inflammation, providing relief for individuals experiencing neuropathic pain. In a recent study conducted by Dr. Serpell and colleagues, 303 patients diagnosed with peripheral neuropathic pain, or PNP, noticed important improvements in pain, sleep quality, and “SGIC of the severity of their condition” when administered CBD/THC oromucosal spray, a form of drug facilitation in the form of a spray absorbed through the mouth [17]. Utilizing cannabis in medical and research settings offers an alternative to traditional pain management strategies. 

Obtaining the necessary permits and permissions to study such substances is a complex and time-consuming process, often deterring researchers from pursuing valuable investigations [17]. The fear of legal consequences, including criminal penalties, may also discourage scientists from delving into this area. Moreover, the stigma associated with many controlled substances can further hinder the progress of neuroscience research, limiting our understanding of how these substances might be harnessed for medicinal purposes, especially in areas such as addiction, mental health, and pain management. In essence, the fear of legal consequences, lack of federal funding, and heavy stigmatization perpetuated by the American drug scheduling system act as an obstacle to drug research, impeding scientific progress and potentially obstructing the development of a deeper understanding and more effective treatments for neurological and psychological conditions.

Future Directions

After policy reformation, the future of neuroscience research on neurological and psychological disorders is expected to be transformative. With reduced regulatory barriers and greater flexibility, researchers will be able to freely investigate the causes, mechanisms, and treatments for a wide range of conditions. Neurological and psychological disorders, such as depression, anxiety, and neurodegenerative diseases, will benefit from a more robust and diversified research landscape. The reform will allow scientists to explore potential therapies, including psychedelics and other previously restricted compounds, that may hold promise in treating these disorders. This paradigm shift can lead to the development of more effective and precise treatments, as well as a deeper understanding of the neural pathways and processes involved in these conditions. Furthermore, this form of drug research can pave the way for innovative interdisciplinary collaborations, harnessing the power of neuroscience to inform the development of therapies, and ensuring that individuals facing these disorders receive more tailored interventions. Overall, a reformed approach to drug scheduling is poised to unlock new frontiers in neuroscience research, offering hope for improved treatments and a brighter future for those affected by neurological and psychological disorders.

When considering the historical context, it becomes evident that the current drug policy system may hinder progress in the field of neuroscience research, disproportionately affecting communities of color and perpetuating a punitive approach that prioritizes incarceration over rehabilitation in the ongoing war on drugs.

Recognizing these issues is a vital step in addressing the need for more equitable, research-informed, and compassionate drug policies in the United States.

Resources

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2. (n.d.). GovInfo. https://www.govinfo.gov/content/pkg/BILLS-115hres933ih/html/BILLS-115hres933ih.htm 
3. (n.d.). Research guides and class pages: The War on Drugs: History, policy, and therapeutics. Research Guides and Class Pages at Dominican University. https://research.dom.edu/the-war-on-drugs--history-policy-therapeutics/history#:~:text=The%20War%20on%20Drugs%20Defined,-The%20War%20on&text=The%20War%20on%20Drugs%20began,agencies%20and%20drug%2Dtreatment%20efforts. 
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