A Vision for the Post-War on Drugs World
“Who lives longer? The man who takes heroin for two years and dies, or a man who lives on roast beef, water and potatoes ’till 95? One passes his 24 months in eternity. All the years of the beefeater are lived only in time.”
Recently, many media outlets and medical professionals have come to refer to the current opioid problem as an epidemic. At the same time alcohol continues to be an even greater threat to public health, as it can be mixed with other drugs thus increasing the chance of death and overdose (Pollack, 2014). Although this information is widely available, it is unlikely prohibition of alcohol will come back into effect. No one is saying alcohol should be a Schedule 1 Drug. To a certain degree people realize that the prohibition of alcohol only exacerbated the problem it was causing. During the era of alcohol prohibition people switched from mostly low-alcohol content beer to a stronger mixture of cocktails and spirits. What we are seeing today with rising heroin and opioid use is this same pattern. New and more dangerous substances continue to surface and are being sold unregulated.
Other opiates, methamphetamines, synthetics, and anything that can produce a kick, are becoming more prevalent on the black market, despite our law enforcement agencies’ most extensive (and expensive) efforts. It begs the question; why refer to the heroin problem as an epidemic when clearly it is capable of moving between multiple populations and between geographically separated people across the globe? Should this not be considered a global problem and be treated accordingly? A look at the United Nation’s report on the global opiate trade should be enough to convince governments around the world to look at this problem for what it really is; a pandemic (UNODC, 2010). After half a century of efforts to combat the trade directly, we have only seen an increase in drug use. It is time to start looking at the situation differently, and hopefully, time to adopt a healthier approach to fighting the trade of opiates.
First, let’s examine the claim that the war on drugs has been a failure. According to an article by The Economist, even when law enforcement has been successful in rooting out the supply line of one source, another quickly emerges elsewhere to satisfy the increase in demand (The Economist, 2011). The Obama administration also touts a change should be made to deal with the demand of these drugs as a health issue. However, this “change” has not been seen in any budgets or policies from the administration. Any efforts to move toward treatment have been overstated and are not sufficient enough (DPA, 2015). The CDC has found that since 1999 the rate of overdose deaths involving opioids has quadrupled, and half of those deaths involved a prescription for things like oxycodone, hydrocodone, and methadone (CDC, 2016). They also discovered that not only have heroin related deaths tripled between 2010-2014, but that the largest increase in overdose deaths from 2013-2014 involved illegally made synthetic opioids, often without the knowledge of the user (CDC, 2016). An article by the Huffington Post pointed out, using graphics from 1999 to 2010, almost every state saw an increase in overdose mortality rates (Short, 2014). “The number of these deaths reached a new peak in 2014: 47,055 people, or the equivalent of about 125 Americans every day” (Park & Bloch, 2016). After decades of harsh policies on drugs and over $1 trillion invested in curbing the supply we have seen nothing in return in terms of overall citizen health (DPA, 2015). The Cato Institute found that ending current drug policies that attempt to stem the supply of drugs would save roughly $41.3 billion in law enforcement and government expenditure (CATO, 2010). Not only do the policies not work, as we have had a substantial increase in overdoses and use, but also they seem to be making the problem worse.
Although the current United States administration has continued with a harsh stance on the issue, the President has recently pushed to open up access to treatment. Part of this better access to treatment includes many solutions that lean towards fighting the demand of substances. They include; a Mental Health and Substance Use Disorder Parity Task Force, better access to Medicaid for substance use disorder, expanse of public health-public safety partnerships to combat the spread of heroin, syringe service programs, private sector commitments, community heroin specific policing, and a focus on solutions for rural communities (whitehouse.gov, 2016). With this declaration by the Obama administration, the US government has essentially admitted that it has not been doing enough. However, it has not yet acted to change the policies in place which do nothing, if not help sustain a global black market for opiates and narcotics.
There is a word in German, Verschlimmbessern; to make something worse in the very act of trying to improve it. I think it appropriately describes what has happened internationally since the United States went to war with drugs. According to a SIGAR report, 85 percent the worldwide market consists of Afghan opium years after the US led invasion (McCleary, 2015). Southeast Asian countries are also getting in on the trade of controlled substances. In Central and Latin America drug trade activity has led to violence, from 2007 to 2014 Mexico alone estimates 164,000 people were victims of cartel crime (Glenza, 2016). These cartels now operate not only inside of Mexico as their own little countries, but they also act internationally without regard to borders or any kind of law. The countries plagued by this sort of violence eventually called for the UN to hold a special session on drugs.
Back in 2014 former heads of state from Brazil, Chile, Colombia, Mexico, Poland, Portugal, and Switzerland joined with other UN members to push for a new paradigm in Global Drug Policy. It was called Taking Control: Pathways to Drug Policies that Work (drugpolicy.org, 2014). They called for a move toward public health and social investment and away from criminalization. This comes with the understanding that to stop addiction and demand, users need treatment not punishment. Death and prison sentences for minor drug abuse in this perspective are essentially human rights violations.
The government, not criminals, should control drugs with a more sophisticated regulation system. This can reduce the power that black market organizations have. The solution calls for regulation and responsible institutions. While many claimed this is an unrealistic plan, the Commission maintains that an evidence and fact based policy is feasible and necessary. The Commission also pointed out that society and culture tend to change faster than institutions. That being said it is the grassroots movements we should be looking toward and not a decades old destructive drug policy. The Global Commission on Drug Policy hoped to take advantage of the 2016 UN General Assembly Special Session to implement this new policy. However, these bold and new actions were not accepted during the session. A ban on capital punishment for users was left out and there was no mention of “harm reduction” strategies (Glenza, 2016). Over 20 countries in the world have capital punishment for drug offences (drugabuse.com, 2015). “We are not expecting a lot from UNgass,” said former president of Switzerland Ruth Dreifuss. “In this sense, our provision is what the reality is: that the world community is not ready, is not willing, to have the change of politic that is absolutely necessary.” (Glenza, 2016).
It is unfortunate that another solid chance at changing policy and attitude toward the issue was lost. While some say a drug free world is impossible, and they may be right, we can still have a world with better treatment. We decide if we consider this epidemic turned global pandemic a question of health or a question of crime. Some supporters of treating this problem as a health concern are the American Public Health Association, the World Health Organization, the Global Commission on Drug Policy, the Organization of American States, the National Latino Congreso, the NAACP, the International Red Cross, and Human Rights Watch (Miller, 2016). However, it is not enough to say the war on drugs has failed. It does not solve anything but it is a step in the right direction. What we need now is actual policy change.
The call for a switch to treatment versus punishment is gaining ground. But proponents of keeping it a crime persist. They point out the dangers in turning criminals into victims. The argument is that at the end of the day every individual is responsible for their own choices. It is not untrue. More has to be done than just handing out help. The language used here is very important. We will not be able to get desperate people the help they need unless we can make a difference between criminal and patient.
Take for example accidental Governor Paul LePage of Maine. Recently, he vetoed a bill that would have made naloxone, an effective antidote for heroin and opioid overdoses, more readily available at pharmacies and for emergency medical staff. This veto came after Maine saw a spike in overdoses the previous year. The governor argued that “Naloxone does not truly save lives; it merely extends them until the next overdose” (Tesfaye, 2016). Many may feel this way about the problem but more still don’t see turning the blind eye as a solution. People who abuse should not be seen as inhuman or not worth saving. Saving lives will not inevitably continue the drug problem if we can use the billions of dollars lost from enforcement to create better healthier treatment and offer safer preventative measures. In fact, it seems that when we let people slip through the cracks the cracks just get left open. The argument that abusers are patients of drug addiction instead of criminals has been argued before. An article by A.R. Lindesmith from the Journal of Criminal Law and Criminology was written in 1941 about how addicts without treatment become more dangerous criminals (Journal of Criminal Law and Cimonology, 1941). And somehow US prisons in the 21st century continue to be filled with mandatory minimum abusers as well as the substances they abuse.
Whatever specific special interests are in the way of healthy drug policy change are of no real interest to us if we can educate ourselves and use democracy in a positive way. Treatment is a rational plan that must stop being ignored. Portugal became a contemporary model when they decriminalized drugs in 2001. Since then, the country has been able to free up resources to help people and addicts have been able to reach sobriety through their programs. The overall results after 14 years have shown that treating drug addiction as a health problem rather than a moral problem is effective (Aleem, 2015). Another example is Switzerland. In the 1980s they switched to a harm reduction plan by providing more clinics and social workers. The overall result was a decrease in syringe spread disease, overdoses, and a 60 percent drop in felony crimes by patients, 82 percent of which stopped selling heroin and spreading the drug (COP, 2016).
The threat of opioid abuse in our society is not just national, rather it has become entrenched worldwide. It has no regard for borders, and is more than capable of passing through no matter how tall we build our walls. It is true we must all tackle this problem individually but that does not mean we have to leave people behind. It doesn’t mean people have to face it completely alone. The FDA understands this need to help people, even if the administration won’t make drastic change. The FDA last year pushed to approve easy-to-use nasal spray to treat opioid overdose, with acting commissioner Stephen Ostroff, M.D. saying: “Combating the opioid abuse epidemic is a top priority for the FDA” (FDA, 2015).
Author Johann Hari’s recent book Chasing the Scream goes into his three-year long journey into the war on drugs. He talks about how humans look for relief in many ways. When they are cast out that relief becomes extremely rare and we look for things that have the best hooks; from pornography to methadone. We make it even harder for these people to find socially acceptable relief, like grabbing a beer (a deadlier drug) or meeting with friends, because of how society treats them. Users get their benefits, jobs, and support taken away with no way of returning to normalcy (Hari, 2015). Hari also points out that individual recovery is necessary but society also has to change how it treats ‘junkies’ and get rid of the negative stereotype.
In 2016 it does not look like the UN will be able to change the current international drug policy. But that does not mean the general international community needs to keep playing along with the idea that this is a problem that can be tackled directly. While this is truly an enormous global issue we can still make progress locally. Opening up clinics and providing better access to preventative treatment is something that can be done without widespread national and international support. Today with access to the internet and information around the world we can understand that what we are experiencing on Main St. USA is happening in India, Russia, and countless other places. This is no mere epidemic easily solved with a few more armored police cars. This is a pandemic and a health issue. Addiction is global concern.
It is also quite possibly a breadcrumb clue to a much bigger problem. It may be the red flag that alludes to a bigger dilemma of over-consumption. According to Clarissa Estés: “Addiction is anything that depletes life while making it ‘appear’ better” (Estés and Estés, 1992). In this light economic consumption tends to act like a drug itself. We see western social culture bent on consumption with casualties rising from the over-consumption of readily available, addictive, more potent, and legal product. We should not act so surprised. In other words, this is not the ‘Oh No!’ moment, rather it is the ‘Oh…right’ moment. And were it not for the too few systems in place to help victims of addiction the problem would surely be significantly worse. It becomes increasingly hard to ignore economic factors when you consider that a majority of users could not grow opium in their own back yards and these abusers and suppliers will go to great lengths to fill in that market for people looking to escape from reality. Here, ignorance is the real criminal.
The rhetoric so far has not matched what the data is clearly telling us. La aritmetica non è opinione (Italian proverb; arithmetic is not an opinion). We do not need more broken doors we need more conscious healthy citizens. Your average patient receiving morphine in a hospital does not immediately become an addict. The road to addiction and overdose is much longer, much scarier, and more desperate. It takes an environment of poor living conditions, depressed social life, and a psychology of unhealthy consumption to bring a person to the door of their supplier. Addiction is both a social and a health problem and it needs to be addressed as such. At the beginning of this article I left a quote by Aldous Huxley. We need to seriously understand the perspective he brings up. Who led the better life? The 21-year-old dead junkie or the 95-year-old potato eater? While each of us sits back and ponders this, and many may come up with the same answer, we have to realize that there are people who are looking at the world today and what they are saying through their actions is clear; that life in America is now better lived short for some. We need to understand why or we will continue to lose citizens and loved ones to opiate and substance abuse.
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