The drug war in the United States has been highly contested since its start, and subsequent failure, over the last forty five years. What can we do in light of the opioid crisis that has taken our nation by storm? Is criminally cracking down on addicts what we truly think will help them recover, heal and reintegrate into society? Let’s take a deeper look into this issue by looking at what other countries are doing.
Some Basic Background on Drug Policy
Drugs are a worldwide problem. There are many different ways countries have attempted to help their citizens become healthy, taxpaying members of society. Many of these ideas focus around three main actions: how to help addicts, how to remove the stigma of substance abuse and how to starve the black markets which exploit vulnerable people. There is a giant puzzle the world needs to put together to help people and each and every country has a part of it. Figuring out what to do or what not to do is incredibly challenging.
According to the former Director of the National Drug Control Policy, Gil Kerlikowske, “85 percent of all drug treatment research is conducted or funded in the United States.” You can see how well we have done with finding and implementing solutions to this issue based on our current drug epidemic. In 2012, Kerlikowske went to Portugal, Italy, Mexico and Colombia to understand their addiction treatment programs through speaking with government and health officials.
Most Notable Piece of the Puzzle, Portugal.
Portugal made headlines years ago when it decided to decriminalize doing drugs. Instead of treating addiction as a criminal problem, they started treating it as a health problem. In 2001, Portugal changed their laws to no longer arrest, try or imprison people with personal supplies of recreational drugs (no more than a ten-day use amount, the commercial drug trade is still illegal and a criminal offense there). This move was sparked by the country’s debilitating drug problem and a serious heroin epidemic at the end 20th century. By the 1990s, almost 1 percent of Portugal’s citizens had a heroin addiction; needle sharing caused HIV and hepatitis to spread like wildfire.
The drugs they lifted criminal penalties on ranged from marijuana to cocaine to heroin to meth. The new policies and programs they implemented aimed to treat the issue as a medical problem by helping addicts and preparing them for reintegration into Portuguese society. To do this, when people were arrested they were offered the option of entering a treatment program in lieu of going to jail.
Dr. João Castel-Branco Goulão, one of the architects of Portugal’s drug policy, made the case treating addicts and removing the stigma saves the government money by saving on emergency hospital visits (they have a socialized healthcare system in Portugal) and the fact incarceration costs more than treatment. If the stigma is removed, people will not feel forced to go underground to feed their addiction and may choose help instead. People who were apprehended with recreational amounts of drugs would be sent to a panel made up of a psychologist, a social worker, and a legal advisor and given an “appropriate” treatment plan.
Of course, at first, people rejected the idea thinking it would lead the country further into drug chaos. After five years of the program, the effects have surpassed everyone’s expectations and show solid promise. A report from DC’s Cato Institute found that: illegal drug use by teenagers dropped, rates of HIV infections by sharing contaminated needles dropped and the number of people seeking treatment for substance abuse more than doubled. For more on the impressive results from this experiment, read the Cato paper here.
Other Pieces of the Puzzle
Many other countries have recognized the traditional criminalization approach is a failed approach when it comes to drug treatment. Germany, Denmark, Switzerland and the Netherlands offer heroin clinics for addicts as part of their national health programs and coverage. These government funded, permanent facilities treat addicts with serious heroin problems by administering heroin or methadone in a controlled environment in hopes of curbing the spread of HIV and hepatitis and decreasing their drug usage and dependence over time.
Spain and Italy implemented “depenalization” – meaning drugs are still illegal, but citizens can use small amounts without fear of prosecution. The Netherlands also followed this with marijuana, allowing people within the country to sell it legally for personal use (like many states have been moving towards in the United States, but much more societally accepted). Even though the Netherlands decriminalized marijuana and opened their “coffee shops” many years ago, only eight percent of the country consumes marijuana. They are ranked 20th on the list of international cannabis consumption – the United States is second.
Critics of the Decriminalization Approach
Obviously, many people do not believe these types of treatment programs will solve the issue and we should only be encouraging abstinence of drug use. But “enforcing” no drug use is not something that has been working out for the United States and countries around the world. People know there are penalties for doing and having drugs, but they still do it.
This is difficult. Some states go way too far with their policy and regulations when it comes to “enforcing abstinence” with drugs. Many countries in the Middle-East and Asia have mandatory death penalties if you are presumed to be trafficking (which in some places is 2 grams of heroin, or 15 grams of cannabis). I agree with the theory that making people terrified of getting caught does not help. It only encourages them to go underground and to not be open and willing to get help when they need it, possibly leading everyone in the country to a worse outcome.
When it Comes to the United States
The United States has a notoriously failed “war on drugs”. To find out more about this and how it is “America’s Number One Public Enemy” read this post I wrote last year. It is clear our punishment model is not working and has severely contributed to our reputation as the “Incarceration Nation” – the country who incarcerates more people than anywhere else in the world. The statistics are staggering: 5 percent of the global population lives in the United States, and 25 percent of the global prison population live in United State’s jails. Not only do we jail people for personal drug use (in many cases for recreational marijuana) for extended periods of time, we usually do not help them with treatment while they are incarcerated.
When it comes to our drug epidemic, about as many Americans died just last year of overdoses as were killed in the Vietnam, Afghanistan and Iraq Wars combined— around 64,000. Methadone and other drug treatment programs exist in the United States but are expensive or difficult to access most of the time. When talking in terms of the health care debate, addiction has previously been considered a pre-existing condition. Where the future of our heath care system goes could severely impact how people can receive and pay for treatment. The ACA no longer considers addiction a pre-existing condition and allowed for coverage for addiction treatment.
The Bills.
The United States has not been standing idly by while we experience these issues and has been moving to take legislative action to help people.
Here is a map of all of the “addiction and treatment” bills from the last two years.
Many other states have bills directly aimed at fighting the opioid epidemic. GA SB81, which crossed over this year, wanted to prevent against accidental overdoses and combat the opioid epidemic by increasing access to naloxone (an overdose reversal and life-saving opioid antagonist). Georgia also made January 12, 2017 “Addiction Recovery Awareness Day”.
Indiana wanted to pass a bill to appoint a committee to study heroin use, treatment, and recovery in the state. Tennessee wants to change the law to regulate Suboxone and Subutex in the same manner as methadone which has been found to have a similar effect. It is not currently regulated this way because the Drug Abuse Treatment Act of 2000 permits physicians to prescribe Suboxone in a little-regulated office or outpatient clinic setting, fueling the epidemic.
In New Jersey, the overdose death rate is currently three times the national rate. They passed a bill this year establishing law enforcement assisted addiction and recovery programs to increase access to treatment for heroin and opioid addiction.
A bill passed in Colorado creates the medication-assisted treatment (MAT) expansion pilot program, administered by the University of Colorado college of nursing, which expands access to medication-assisted treatment to opioid-dependent patients in local counties.
My Conclusion.
Prohibition did not work with alcohol, why do we think it would work with other drugs? It is clearly not working in the United States, as we are going through one of the worst drug epidemics in history. Part of solving this issue is giving people access to painkillers for chronic pain that are not as dangerous as opioids, like marijuana. Check out what is happening with that and Sessions here.
I am not saying we need to implement similar models to what Portugal did or that it is some type of magic wand, but we need to do something different. Improved, rational education and information about drugs would be a place to start. Programs like D.A.R.E. aimed to scare kids into not doing drugs, but in reality, they did not have a real effect on the choices kids make when it comes to cigarettes, alcohol, and drugs. This is also not an issue that can be solved by one country; different countries have different roles in this global issue. We can do our best to combat drug use and teach kids not to do them, but if dangerous drugs can still be smuggled in from other countries, drug dealers will continue to prey on vulnerable people. Ideally, the countries currently supplying drugs to the world will eventually enforce restrictions on their production so dangerous drugs don’t even come into existence. But until then, we need to treat our drug epidemic much more like a health crisis than a crime wave.
Photo by Myriam Zilles on Unsplash
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