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Washington’s Gutless Approach to Our Addiction Crisis

Just before the New Year, Norway’s parliament voted [1] to decriminalize the possession of all illegal drugs, including marijuana, cocaine, and heroin. Drug trafficking and possession will remain illegal. Essentially, drug users will now have the option of going to rehab—instead of jail—if they are arrested with a small amount of drugs.

This concept is rapidly gaining support worldwide, particularly in Europe, and several countries have taken steps toward this new direction in the war on drugs. However, Portugal would be the most direct comparison to Norway’s recent policy change.

The Portuguese government implemented this model of decriminalization in 2001. If someone is arrested with a small quantity of any illegal drug, they are not placed in handcuffs or sent to jail. Instead, that person receives a summons to appear at a panel with a lawyer, social worker, and psychiatrist. The panelists gives their opinions on the best plan for government-assisted treatment for the individual. However, the drug user is ultimately in control and can choose to decline any form of rehabilitation without legal penalties.

This “soft” approach to the war on drugs has been an unquestionable success. Portugal put this model in place at a time when the country had some of the worst addiction statistics in Europe. There were 78 drug overdose deaths [2] per every million people. Albeit, that was only a fraction of the problem America currently faces. Last year, there were 64,000 drug overdose deaths in the U.S, a rate of 185 [3] per million people. Portugal, on the other hand, had only six drug-induced deaths per million people last year, now one of the lowest rates in Europe.

Overall drug use has steadily decreased in Portugal over the last 16 years. Most importantly, this policy change has been a resounding success as a public health initiative. For example, drug-related HIV infections have dropped 95 percent.

Given these results, one would assume that the concept of decriminalization would not be controversial. Indeed, Americans for the most part support the underlying principles of decriminalization. An ABC News poll [4] from last summer found that 69 percent of Americans support a law requiring rehabilitation, as opposed to jail, for first-time and even second-time drug offenders.

Likewise, a Rasmussen poll [5] from a couple years ago found that only 10 percent of Americans believe the country is winning the war on drugs. However, the term “decriminalization” elicits a very different response from the vast majority of Americans, particularly when it involves harder drugs. Only 13 to 16 percent of Americans support decriminalizing heroin, cocaine, or meth, according to a Vox/Morning Consult poll [6].

Despite the stigma associated with decriminalization, the Global Commission on Drug Policy recommends the policy. This organization is headed by a number of business leaders, several former heads of state, along with many former high-level government officials, including George P. Schultz, who served as secretary of state under Republican Presidents Reagan and George H.W. Bush.

The last report [7] by the Global Commission on Drug Policy also recommended several “harm reduction” practices proven to reduce drug addiction levels, along with addiction’s negative impact on society. The report supported political hot-buttons, such as needle-exchange programs, naloxone (a medication that immediately reverses opioid overdoses), heroin-assisted treatment, supervised injection facilities, among others.

Support for supervised injection facilities is growing throughout the country, particularly in Seattle [8], New York [9], and Delaware [10]. The Massachusetts Medical Society also supports [11] this policy. In fact, a study [12] found that the city of San Francisco would save several lives with such a facility, along with $3.5 million.

These facilities allow medical professionals to recommend rehab options, provide clean needles, and prevent deaths in multiple ways. They administer naloxone in case of an overdose, which is roughly 99 percent effective with reversing an overdose death. Also, the drugs can be tested for deadly additives, such as fentanyl. For instance, 88 percent of the drugs tested [13] at the safe injection site in Vancouver contained fentanyl.

Obviously, these are revolutionary concepts. However, while there is overwhelmingly positive evidence in support of harm reduction practices, most politicians are unwilling to risk their careers to make the necessary changes. In fact, one of the top Republican leaders once adamantly supported a groundbreaking approach to the drug war. He said [14], “We’re losing badly the war on drugs. You have to legalize drugs to win that war.”

Those words came from Donald Trump 27 years ago at luncheon hosted by the Miami Herald. He also blamed our politicians who “don’t have any guts.” However, now that he is in the ultimate position of political power, he has not demonstrated the courage to make the positive reforms he once publicly advocated.

Trump has even taken steps to reverse the tepid moves toward progress made by the Obama administration. The most damaging decision was choosing Jeff Sessions as the attorney general. Sessions ordered [15] all federal prosecutors to pursue the most serious charges (including ones with mandatory minimums) in all drug cases. It was a reversal of Eric Holder’s 2013 instructions [16] to federal prosecutors to consider a variety of factors before charging a non-violent, low-level drug offender with a crime that has a mandatory minimum sentence.

However, the coup de grâce was the decision by Trump last month to appoint Kellyanne Conway as the head of his opioid commission. One could easily describe this as a “gutless” political decision to appoint the ambassador of “alternative facts” who has violated ethics rules [17] to tout the products of the president’s daughter. After all, Trump himself has declared the opioid crisis a “health emergency [18].” However, he has not dedicated any resources to fight the problem or issued a clear policy direction.

Trump has not embraced modern approaches to treating addiction. During his first White House meeting [19] with the opioid commission that covered many of the aforementioned harm reduction practices, he focused more on his own obsession—a border wall. This aversion to progressive ideas was highlighted by a decision last week by the Trump administration to ban the CDC from using seven specific words [20], including “evidence-based” and “science-based.”

This flies in the face of the recommendations from our country’s top health officials. Last year, the surgeon general of the United States released a first-of-its-kind report [21] on drug addiction that called for an “evidence-based public health approach” to drug addiction. This is of the utmost importance because our government does not prioritize prevention and treatment. Case in point: A study [22] found that 65 percent of America’s prisoners need substance abuse therapy, but only 11 percent actually get it. Likewise, less than five percent of court-ordered drug rehab appointments meet the appropriate medical standard [23].

In fairness, Trump picked Chris Christie, who is fairly moderate on this issue, to lead a research team on the opioid epidemic. Christie’s committee came to several conclusions [24] in favor of harm reduction practices, such as removing the legal barriers to naloxone and more funding for treatment.

However, it seems unlikely that Trump will follow through with these initiatives based on his choices in top leadership positions. His first choice for drug czar was Rep. Tom Marino (R-PA) who felt that drug users belonged [25] in a “hospital-slash-prison.” Marino has enacted an absurd level of hypocrisy on the issue of drugs. He is an adamant supporter of harsh prison sentences for illegal drugs, yet he has acted as a gatekeeper for the legal drug pushers that have flooded this country with prescription opiates.

The Washington Post published several articles showing how Congress protected the drug companies that were complicit in the opioid crisis, including one [26] that pointed to Marino’s role in the “Ensuring Patient Access and Effective Drug Enforcement Act,” which reduced the legal culpability of prescription opioid distributors.

America’s problem with drug addiction has ebbed and flowed over the last two centuries. However, there has been an unprecedented increase in the last two decades. The cause of this spike has been a fraud unleashed upon society by Big Pharma.

Purdue Pharma, the manufacturer of Oxycontin, was able to convince many Americans that their product was “non-addictive” with junk science and aggressive advertising. The pharmaceutical company was able to avoid any severe consequences by enlisting the services of various revolving public officials, such as Rudy Giuliani, whose consulting firm helped negotiate [27] favorable terms with the DEA. 

It is the corrupt revolving door between government and the private sector that has enabled the drug industry to exacerbate the opioid epidemic. It starts at the DEA, which establishes the production limits for the overall opioid market. Unfortunately, the money from Big Pharma has entirely too much influence over the agency. Last year, the DEA set a production limit that was 1,300 percent higher than the level 20 years earlier. [28]

Again, the Washington Post has done a tremendous job reporting [29] on the root cause of this problem. Since 2005, there have been 42 former DEA officials who have taken jobs working in the pharmaceutical industry or for law firms representing the industry. Thankfully, Sen. Tammy Baldwin (D-WI) proposed S. 2057 [30]: Pharmaceutical Regulation Conflict of Interest Act, which would directly address this. However, this is unlikely to pass because the pharmaceutical industry is one of the top contributors to Congress.

We are witnessing other countries improve their drug policy while Congress and the Trump administration seem unwilling to display the political courage to change the status quo, or disentangle themselves from the special interests that are keeping Americans mired in addiction.

Brian Saady is a freelance writer and the author of four books, including Dealing From the Bottom of the Deck: Hypocritical Gambling Laws Enrich Crooked Politicians, a Select-Few Casinos, and the Mob [31]. You can follow him on Twitter @briansaady [32]

 

15 Comments (Open | Close)

15 Comments To "Washington’s Gutless Approach to Our Addiction Crisis"

#1 Comment By John_M On January 3, 2018 @ 12:34 am

I would not decriminalize all drugs. Some of the Cathinone derivatives (bath salts) have been documented to cause recurring psychotic symptoms for long periods (> 1 year) after a single substantial dose. But you might want to decriminalize some of the less destructive variants. The small scale cost of Carfentanyl was < $10/gm before criminalization. (Both data points came from a Science article in 2017.) With a potency ~ 10,000 X that of Heroin, this drug could put the Taliban out of business. It is not that Fentanyl is inherently dangerous – but that it and its derivatives are much more powerful (the absolute toxicity seems to be comparable to VX). Properly diluted and in single use micro-injectors, supervised injection sites should be able to safely use it and at the same time wipe out the commercial market for opium products.

Note that we were unable to significantly impact the smuggling of Cocaine and Heroin (estimated intercept rates were ~ 30%) over the last few decades. With synthetic drugs that are 100 to 10,000 times more potent, the shipments would be correspondingly smaller and interception far more difficult – ignoring the threat of home market synthesis.

I do not approve of any of these poisons. I actually don't even drink alcohol. But I don't believe in fighting doomed battles. We lost the last one – and against the synthetics, we have no hope of success.

Go for damage mitigation.

#2 Comment By Paul Zerzan On January 3, 2018 @ 6:09 am

“Safe Injection Sites” do not work. In Vancouver, B.C. the number of overdose deaths has skyrocketed as more and more SIFs open. True people don’t die at the SIF but the die in increasing numbers in the community. SIFs increase drug use, addiction and the death rate by providing a “safe” place for first timers to try drugs. Once hooked they don’t care about safety only about their next fix. The free needles handed out also encourages drug use. If you don’t believe me check out the statistics on how much overdose deaths have increased in B.C. since the first FIS opened.

#3 Comment By Andy Myatt On January 3, 2018 @ 8:47 am

Stop calling Trump/the Trump Administration “Washington”. Washington voted to decriminalize marijuana 18 years ago, for Christ sakes.

#4 Comment By Jeff On January 3, 2018 @ 12:01 pm

Quit yer whinging, Andy–Washington (the city) predates Washington (the state) by nearly a hundred years. Even Washington (the territory) didn’t come along till almost sixty years after the city.

#5 Comment By Andy Myatt On January 3, 2018 @ 12:33 pm

I was talking about Washington DC, Jeff. Washington DC, which voted to decriminalize marijuana well before Washington State, is NOT Trump/The Trump Administration.

#6 Comment By Professor Nerd On January 3, 2018 @ 12:36 pm

Trump voter apologists such as J.D. Vance claimed they went for His Orangeness because he made the opioid crisis an issue.
Yeah, he said “build a wall,” which anyone who thought about the issue for longer than 5 minutes knew to be nonsense in terms of easing this scourge.
Vance’s own book is hypocritical on drugs.
He lauds his grandfather, even though he is a nasty alcoholic and a worthless father and husband, while bashing his mother for following in grandpa’s footsteps.

#7 Comment By Peter Bargmann On January 3, 2018 @ 1:42 pm

Legalize production & sale of pot; tax it similarly to alcoholic beverages. Regarding possession of small amounts of other drugs (i.e., heroin, cocaine, opioids) for personal consumption, sentence administratively to rehab. 2nd & later offenses, prosecution & imprisonment with rehab available. Manufacture, importation, distribution, sale, prosecution & imprisonment.

#8 Comment By E Kent On January 3, 2018 @ 4:00 pm

I remain unconvinced about legalization, just look at the problem of prescription opioids.

That said, the only way out of this problem is treatment treatment treatment. Clinical care, therapeutic care, harm reduction, replacement therapy like methadone, decriminalization as far as steering addicts into treatment instead of prisons.

This is a problem that requires leadership willing to follow best practices and make moves motivated by compassion. Leaders willing to enact policies based on what has been PROVEN time after time to work. And it’s not going to get better until that’s what we have.

#9 Comment By Lerty23 On January 3, 2018 @ 4:58 pm

Legalization of hard and soft stuff may be bad for the users, but it makes life easier for the rest of us.

#10 Comment By Patrick On January 3, 2018 @ 10:07 pm

It seems to me that offering addiction treatment is a good idea, it is more humane and is probably cheaper than incarceration, but lets be realistic about the lack of resources available for addiction treatment.

I live in a rural county where the abuse of illegal and controlled substances is common. Unfortunately the county has no inpatient mental health care and there is only one psychiatrist, with a general outpatient clinic.

Early in civilian practice I tried to help abusers of controlled substances by prescribing a tapering dose of medication over several weeks. Most came back after finishing the taper demanding that I restart the narcotics they were weaned from. Drug seekers are very persistent and will lie, steal and threaten to get what they want; they are also a population at very high risk for suicide. For my safety, and the safety of my staff, I stopped taking any new patients who was taking any controlled substance.

I have had this discussion with hospital administrators who have told me that inpatient mental health care is not profitable and not going to happen. Yet the hospital was in the process of building a same day surgery center.

Those who advocate more arrests and longer incarcerations do so because they don’t understand, or want to understand the complexities of addiction medicine, or how to use local government regulations to insure that hospitals are providing the services that the community needs rather then what generates the most profit.

A Certificate of Need (CON) to build a hospital is claimed to be a method to reduce the number of hospitals so that beds remain full and hospitals are operated more efficiently. This CON is also used by large hospital systems to keep out competitors and control the local market. Requiring a hospital to hire psychiatrists and open an inpatient mental health service should be used as a condition to obtain a CON to build a same day surgery center. Another alternative would be to abolish the requirement for a CON and negotiate for another hospital system to build a hospital that provides a service the community needs.

I don’t see this solution coming from Washington, where were they when Pharmaceutical companies were lobbying to have pain considered a 5th vial sign, implying that a physician was negligent for not controlling any pain or marketing addicting medications as a non-addicting alternative to narcotics?

Local Medical Boards are taking steps to deduce narcotic drug abuse but what do we do with those already addicted? The Federal Government requiring states to incarcerate more for longer time will just require building more prisons and increasing the economic burden for states.

#11 Comment By TD On January 4, 2018 @ 11:29 am

Re: Patrick: Probably one of the most informed and reasonable comments concerning our “gutless approach to our addiction problem” in the US. In addition, I would like to add that while it was just announced that Attorney General, Jeff Sessions would be cracking down on legal marijuana, NOTHING at all is being done to address the opioid addiction problem in this country which began, not with illegal street drugs, but with legal prescriptions of opioids obtained through physicians and pharmaceutical companies. Trump’s appointment of Kelly Anne Conway as some sort of “opioid expert” should tell you all that you need to know, regardless of your political persuasions that our interest in solving our serious and growing opioid addiction problems are not being seriously addressed.

#12 Comment By Brian On January 9, 2018 @ 9:24 am

So decriminalizing all drugs is the clear, moral policy that must be effected immediately. Also, any scumbag politician who pimps themselves as an intermediary between Big Pharma and the DEA must be punished, before they… decriminalize any drugs.

I’m more than happy to listen to any new approach. I don’t know what the right answer is, but – as someone who has the same faith in prison as Eugene Debs – I’m generally inclined against locking people up.

One thing, though: I’ve read lots of on the ground reporting about the opioid crisis. But I’ve never read an interview with anyone who lives in the communities being destroyed who said “you know what we need here? More meth.” The issue is a lot more complicated that you’re laying out here.

#13 Comment By Autumn Bennett On January 9, 2018 @ 11:13 am

As a recovering heroin addict/opiate addict I can attest to the fact that safe-injections sites are a malfeasance. They do not work. They simply enable. People want to “feel” like they are helping but by giving a junkie a safe place to shoot up, they are merely exacerbating the problem. Why quit if everything is so easy? Why stop if you don’t experience any negative consequences.

The only reason I stopped is because my life got so hard, so unbearable, I was brought so low that the only way I had to go was up. If that “up” had been a safe-injection site, I would probably be dead now. It is just allowing people to kill themselves more slowly, all for the sake of virtue-signaling.

#14 Comment By The Dean On January 10, 2018 @ 10:09 am

Interesting. The Wall Street Journal as well as other major publications are running full page ads paid by tobacco companies who are forced to admit that nicotine is addictive and that they are responsible for the addiction. In Ohio the state is running television ads paid by the state, educating its citizens that if you are addicted to state sponsored lottery games, that it is a brain condition and not a lack of will power.

Regarding the Colorado experiment of legalizing marijuana for recreational use: there will be many Ohio initiatives coming along in the next several years for us to vote on. One of these may be for the legalization of the recreational use of marijuana. I hope the citizens of this state show some prudence and think this through. I cannot imagine an earlier generation even dignifying the question of legalization, let alone permitting its use.

Remember Coloradans did not legalize marijuana; they legalized tetrahydrocannabinol or THC, the active ingredient in marijuana. Legalizing this drug poses quite a problem. According to the University of Mississippi’s Potency Monitoring Project, the THC level in marijuana in 1978 was 1.37 percent; today it is 8.52 percent. In researching for this article I found the following: THC is stronger in hash and finally hash oil which has been distilled to over 90 percent purity. I discovered that drug abusers – not satisfied with this stronger form of dope – now gravitate to what is called dabbing. Dabbing is smoking the distilled form of THC. Does anyone believe this is good for society?

Issue 1: Legalizing marijuana will put drug pushers out of business

Let us dispel this myth right now, that by legalizing marijuana we will reduce crime because it will take the profit out of this drug. I disagree; legalizing this drug will just broaden its market share. The price will drop and the amount consumed will increase with a larger customer base. Street pushers will move to other drugs.

Issue 2: How will this drug be sold?

Head shops catering to marijuana smokers will spring up like they have in Colorado. Under aged children will get an older sibling or friends to buy for them. Unlike alcohol, the abuser pollutes the very air around him/her. What about children in the same room? What about people who are anti-drug and do not wish to be impaired? At bars where there is open-air tobacco smoking, do we allow customers to smoke dope? Poor families, dysfunctional families and one-parent families will suffer the most; they always do.

Issue 3: Popularizing the use of another intoxicant

Business owners in the marijuana trade, like all businesses, will want to expand market share and increase consumption of their product. Are we going to allow advertising? Do we allow TV advertising? What about magazines? The Center for Disease Control and Prevention estimates that 75,000 Americans die from alcohol every year but our government allows TV advertising for beer and wine. Hard liquor manufacturers under pressure to turn bigger profits broke their self-imposed ban on television advertising in 1996. What did Congress do about these changes? Nothing, because the tax revenue generated on alcohol is significant. When it comes to a moral compass, do not look to Washington, D.C. for direction.

Issue 4: THC-infused food

In Colorado there are companies that are making soda pop such as cherry, grape, etc., infused with THC. They also make various candies, chocolates and desserts infused with THC. Although they will not admit it, the target markets here are children, teens and curious adults. One owner was honest enough to admit that he wants to grow his business as big as possible to position himself for a buy-out by a larger company. Another stated that he wants the casual user to be the habitual user so he can make more money. He is honest, I will give him that. These are irresponsible, self-serving people that have only one goal: getting rich and society be damned. We used to call them pushers and put them in jail.

Issue 5: The effect on society

Absences from work and school will rise. For those who are susceptible to addictive behavior, this will be another gateway drug destroying lives and families. Who picks up the bill? We the tax payers will. If you have a drug or alcohol problem that leads to one of the qualifying defined impaired conditions for disability, Uncle Sam (i.e. the taxpayer) will pay. After all, you are disabled.

What is the answer? Part of the answer is a cultural change. Like our attitude toward smoking cigarettes, stop glorifying pot. Stop making movies that depict drug use as socially acceptable, even desirable for a party or a good time. Call out these pseudo-businesses that are exploiting vulnerable people. Call out celebrities that act irresponsibly. Finally, demand moral leadership from the person occupying the White House, now and in the future.

#15 Comment By Kip W On January 21, 2018 @ 11:48 am

I’d like to have seen more about for-profit prisons and their very active lobbying in DC. I can’t help but feel that having a profit motive for continuing excessive sentences might have something to do with the problem.