The few who use illicit drugs seem to pursue the same psychoactive effects as the many who make do with the legal drugs, roughly like this:

Psychoactive Effect Sought	Illegal Drugs	Legal Drugs
Stimulation, a "pick me up"	Cocaine, "Speed"	Caffeine, Tobacco
Comfort, relief from pain, "attitude adjustment"	Heroin	Alcohol
Sheer pleasure, a gladdening of spirit	Marijuana	Sugar

Recently I conducted a fascinating exercise: I put a month's "supply" of each substance on a table to see what they'd look like together. I found data in the almanac on the nation's consumption of the legal substances, and I also located recent D.E.A. estimates on consumption of the four illegal drugs. Then I calculated the average American monthly consumption of the 8 substances, by dividing overall consumption by population. For sugar and caffeine, I divided by the total population of 275 million, and for the other substances I divided by the total adult population of 210 million. Here are the results, expressed in milligrams per month per American:

SUGAR (pure)	5,900,000 mg.
ALCOHOL (100 proof)	750,000 mg.
CAFFEINE (coffee beans)	380,000 mg.
TOBACCO (cigarettes)	210,000 mg.
MARIJUANA (leaves)	300 mg.
COCAINE (pure)	125 mg.
SPEED (pure)	15 mg.
HEROIN (pure)	5 mg.

This "standard American monthly consumption", once assembled on the table, looked like this: the sugar was in 13 one-pound cartons, the alcohol was in a fifth of 100-proof vodka, the coffee was five-sixths of a pound of beans, and the tobacco was 149 ordinary cigarettes. The illicit drug consisted of marijuana leaves equal to about one-third of a cigaretteful, the cocaine was 1/32nd of a teaspoon of powder, the speed was about 1/8th of the cocaine amount, and the heroin about 1/3rd of that amount. The table groaned under the weight of the sugar. The vodka, cigarettes, and coffee were also weighty, a pound or so each. But the marijuana leaves, about the volume of a cashew-nut, were almost lost in this pile of consumables. And the cocaine, speed, and heroin were of derisory insignificance, little scatterings of grains much like what you'd see on the table if you knocked over a salt shaker. This exercise was a vivid reaffirmation that America's drug scene is totally dominated by the four legal drugs. We notice the four illegal drugs mostly because the relatively tiny minorities who use them are vigorously and conspicuously persecuted.

How Much Do We Pay?

When I purchased the four legal drugs, I was surprised to notice that I paid the same amount for each "monthly per capita share": about $7, excluding taxes. Of course there were no taxes on the sugar and coffee, but Federal and State taxes just about doubled the price of the vodka and more than tripled the price of the cigarettes. Thus, after hundreds of years of competition among growers, refiners, wholesalers, and retailers, the before-tax price of a month's worth of each of the four main drugs has come down to about an hour's wage for an unskilled worker. I reflected on that as I gazed at my tableful of legal drugs: how marvelous that so many pick-me-ups, so much warmth and comfort, such ample gladness of spirit, is to be had so cheaply in our times!

This thought soon gave way to melancholy reflection upon the four illegal drugs. The street costs of the amounts shown in the table are also not far from $7 per person per month, but that's a population-wide average: in reality, maybe one-fiftieth or one-one-hundredth of adults are regular users and each spends about fifty or a hundred times as much. Presumably they get the same basic psychoactive effects as the rest of us do from the legal equivalents, but more intensely so (after all, they're smoking crack rather than drinking coca tea, while we're sipping coffee rather than snorting caffeine powder.) They do so in the face of great tribulations, and usually manage to keep at it only so long as the stamina of youth endures. Then they rejoin the rest of us in a docile middle age of Starbucks and doughnuts, booze and Marlboros.

In the Aggregate

The above table can also serve as a handy measure of overall American consumption, simply by replacing "milligrams" by "tons" and changing "monthly" to "every four months" (for sugar and coffee) or "every five months" (for the other six substances). For example, the aggregate American consumption of sugar is 5,900,000 tons every four months; of cocaine, 125 tons every five months. It immediately becomes obvious that commerce in the legal drugs is characterized by huge amounts of sheer labor: millions of people to pick the winegrapes and coffeebeans, staff the factories, drive the trucks, shlep the cases of booze around, restock the supermarket shelves, etc., etc. The amount of labor needed for the marijuana, cocaine, speed, and heroin industries is trivial by comparison. Yet every one of these eight drugs is a multibillion dollar industry in America in 1999. It is obvious, therefore, that the profit margins on the illegal drugs are far greater, if only because the billions in income are distributed among far fewer workers. But there were also big profit margins for coffee, tea, sugar, and tobacco in the 17th and 18th centuries: planters and shippers became fabulously rich because they served insatiable demands of consumers who craved the new pleasures and eagerly paid good money for them.

What Are the Consequences for HIV and HCV?

Gazing again at my tableful of drugs, I see three legal ones that are eaten or drunk, plus a fourth legal one which is smoked. A prodigious amount of illness and premature death is blamed upon these four substances, starting with 400,000 deaths per year from tobacco and 100,000 from alcohol in this country alone. The mortality from the illegal drugs is by comparison tiny, but throughout this decade the greatest part of it resulted from AIDS, and in the next century the greatest part will probably come from hepatitis-C. Here are the annual averages for the 1990s:

Deaths from HIV infections which resulted from injection drug use	15,000
Accidental deaths (overdoses, etc.) resulting from use of illegal drugs	5,000
Drug-related murders	1,000
Drug-related suicides	1,000

To which we can add annual averages (see "Hepatitis C: The Great Time Bomb") starting around 2010 for:

Deaths ultimately resulting from HCV transmitted via injection drug use

5,000

I have long argued that the problem of illegal drugs can be resolved by "legalize, tax, regulate, and discourage". I would like to see illegal cocaine and heroin replaced by legal coca tea and laudanum (see "A Short History of the Conquest of the Crack Epidemic"). With milder forms of the drug, swallowed rather than injected, there would be no HIV or HCV infection and far fewer overdose deaths. Moreover, there would be no legions of inner-city youth imprisoned, alienated, and disenfranchised. But- sweet irony!- the "tableful of substances" could groan all the more with the pounds of coca-leaf tea and laudanum bottles, all costing just a few dollars of the future citizen's earnings, but adding their own share to morbidity and mortality consequent upon long-term regular use...

(MidCity Numbers, August 2000)