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THE Impact OF DRUG POLICY
The United States is at a fork in the road in its journey to confront drug use. Since the days of President Richard M. Nixon, the U.S. has relied upon an enforcement approach to control drug use. Our goals have been to protect young people from using drugs, to save lives from the risks of drug overdose and the suffering of addiction, and to reduce crime and violence. The goals are the right goals, but the means to achieve them are flawed.
For four decades, from the 1970s, through the first decade of the 21st Century, laws have been toughened, and more money has been dedicated to fighting a "war on drugs." However, since 1996, state after state has adopted laws to provide marijuana to sick people who are not getting relief from traditional medications to prevent nausea, to stimulate appetite, to control muscle spasticity, to treat epilepsy (especially among children), and to reduce pain. Since 2012, nine states (Colorado, Washington, Oregon, Alaska, California, Nevada, Massachusetts, Maine and Vermont) and the District of Columbia have legalized adult recreational use of marijuana, and licensing businesses to produce and sell marijuana (but not D.C.).
The nation is well aware of the suffering that addictive drugs can cause. The effects varies by region. Many cities and regions lived through an epidemic of smokable cocaine in the late 1980s and early 1990s. Later, methamphetamine addiction was found in some states and cities and not others. For a decade, addiction to prescription opioids such as oxycodone (Oxycontin (R)) was especially intense in Appalachian region, New Hampshire, Florida and other states. By 2016 and 2017, addiction to opioids (legal prescription pain medications, illegal heroin, and illegal fentanyl) became widespread in many states, and overdose deaths from these drugs increased 500% in 5 years. Nationally, by 2016, the number of deaths from overdoses and drug-related poisonings was estimated to be greater than 60,000, according to the Centers for Disease Control and Prevention. As of April 2018, the 2017 national data has not been released.
In recent years, the response to the opioid addiction crisis has differed profoundly from the reaction to the crack cocaine addiction crisis. The August 2017 interim report from the President's Commission on Combating Drug Addiction and the Opioid Crisis called for harm reduction measures, not more law enforcement. CJPF believes that the primary reason for this change is that the public and policy makers have concluded that the enforcement-focused effort has been a failure -- more than 30 years since it was intensified in the 1980s and 1990s by Congress and President Ronald Reagan (1981-1989).
A contrasting analysis for the embrace of harm reduction is that the current opioid addiction crisis has dramatically afflicted rural, suburban and more white regions of the nation, and is no longer characterized as primarily a problem of people of color. Many historians of drug abuse have noted the identification of drug abuse with "outsiders" -- people who were in turn primarily Chinese, African American, Hispanic, or "undesirable" whites such as hippies or gay men.
The pursuit of harm reduction measures is saving lives. In order to prevent the spread of HIV, Hepatitis C and other infections, drug warrior resistance to sterile syringe exchange has dissipated. In the spring of 2015, sterile syringe distribution was embraced within two months by conservative Indiana Governor Mike Pence (R) once a heroin-related HIV outbreak was identified in Scott County in southeastern Indiana.
The distribution of naloxone (Narcan (R)) to reverse overdoses has become widespread. States are even changing regulations to permit the purchase of naloxone without a physician's prescription. Thousands of lives are being saved nationwide. Yet in some places, such as Butler County, Ohio, Sheriff Richard K. Jones announced his deputies won't carry naloxone to save lives if a person is found in an overdose condition. In 2017, in Middletown, Ohio, a city council member proposed that if a person has been revived from an overdose twice, they will no longer be provided naloxone by the city EMTs -- it's too expensive.
In many states and jurisdictions, a harm reduction measure is to exempt from prosecution for drug possession those who call 9-1-1 emergency response to persons who are in an overdose. This is known as a "Good Samaritan 9-1-1" law. On the other hand, responding to the increase in overdose deaths, some prosecutors are seeking the death penalty for the distributors of opioids if someone dies from the drugs received directly or indirectly from the distributor. (Most street distributors have no way to know what contaminants, if any, are in the drugs they distributing.) In 2017, Attorney General Jeff Sessions, returned to the decades-old language of enforcement, and revised policies adopted under Attorney General Eric Holder in order to seek longer sentences.
Notwithstanding the rhetoric, when applied, public health measures associated with drugs have been successful: Addiction to tobacco is going down. Driving while intoxicated by alcohol is going down. In states with regulated marijuana markets, teenage use is not increasing.
To repeat, we are at a fork in the road. Is our priority still enforcement, punishment, the language of deterrence (without the effect), and more death and suffering? Or is our top priority to save as many lives as we can and to reduce and minimize the suffering of drug users (remembering that every person who is addicted is someone's beloved child)? Do we resume to ham-fisted approach of enforcement and punishment that has consumed the police, prosecutors and courts for much of the past half century? Waging our war on drugs we now spent in the range of one trillion dollars trying to quell the drug trade, intensify border security, increase arrests, lengthen sentences, and strip the rights of drug users who get caught. To deter drug use we introduced drug testing in our nation's schools and workplaces.
We provided billions of dollars to other nations for a variety of anti-drug police and military operations. With that money, we have seen over the decades the authorities inflict countless human rights abuses against farmers, couriers, distributors, users, and those rumored to be so. These tragedies have played out over and over in Bolivia, the Bahamas, Cuba, Colombia, Mexico, Thailand, Afghanistan, and lately the Philippines. Extrajudicial killing, death squads, extortion, gang violence, and widespread corruption.
Our friends in Europe have reduced overdose, reduced the spread of HIV and Hepatitis, reduced crime, reduced homelessness, and reduced the number of addicts without focusing on imprisonment and punishment. Heroin maintenance has been legalized in Switzerland and is carried out in Britain and the Netherlands. Portugal decriminalized the possession and use of drugs coupled with public health interventions achieving dramatic declines in HIV infection, death and numbers of persons addicted.
Yet in the United States the availability and purity of street drugs have steadily increased, hundreds of thousands of Americans remain ensnared in addiction, additional hundreds of thousands are imprisoned, and too many people wanting help to become sober cannot get appropriate treatment when they are ready.
Increasingly, the American people are recognizing that attempting to control the drug market through force, prohibition and incarceration, our policies have created a more efficient drug trade and a hugely profitable drug market. Every comprehensive conversation about our domestic problems -- gun violence, poverty, racial tension, health, educational achievement and opportunity, community development, civil liberties and terrorism, even the environment -- recognizes the significant aggravation of the problem by the illegal drug market and the consequences of enforcement. Thus, increasing numbers of Americans are rethinking our drug goals and contemplating a new strategy.
To support a well-designed change of direction, we provide specific policy-related information on each of the following drugs: marijuana (including medical marijuana), heroin and other opiates, crack cocaine and alcohol.