Nationwide, communities face an unprecedented rise in substance misuse fatalities. A record 63,600 overdose deaths were recorded in 2016, two-thirds of which involved opioids. To stem the tide of this crisis, some communities are doubling down on the war on drugs, despite clear evidence that increasing arrests and incarceration does not lower drug use. But an increasing number of cities are bucking the trend and adopting models that treat substance misuse as a disease, not a crime. Instead of criminalizing substance use disorders, communities are focusing on saving lives and reducing the harmful effects of drug use.
The idea of “harm reduction” may seem like common sense today, but it signifies a radical departure from traditional U.S. responses to drug use, which relied heavily on the criminal justice system. More and more cities are expanding access to clean syringes, launching safe-injection facilities, and decriminalizing possession of controlled substances. Public acceptance of these approaches was unthinkable just a few years ago. Today, however, they are filtering into the mainstream. In fact, support for harm reduction spans the ideological spectrum. These strategies are underway in red and blue states alike, representing promising steps toward dismantling the country’s failed drug policy agenda.
The war on drugs in the United States has been a failure that has ruined lives, filled prisons and cost a fortune. It started during the administration of former president Richard Nixon with the idea that because drugs are bad for people, they should be difficult to obtain. As a result, it became a war on supply.
As first lady during the crack epidemic, Nancy Reagan tried to change this approach in the 1980s. But her “Just Say No” campaign to reduce demand received limited support.
Studies show that the US has among the highest rates of drug use in the world. But even as restricting supply has failed to curb abuse, aggressive policing has led to thousands of young drug users filling American prisons, where they learn how to become real criminals.
The prohibitions on drugs have also created perverse economic incentives that make combating drug producers and distributors extremely difficult. The high black-market price for illegal drugs has generated huge profits for the groups that produce and sell them, income that is invested in buying state-of-the-art weapons, hiring gangs to defend their trade, paying off public officials and making drugs easily available to children, to get them addicted.
Drug gangs, armed with money and guns from the US, are causing bloody mayhem in Mexico, El Salvador and other Central American countries. In Mexico alone, drug-related violence has resulted in over 100,000 deaths since 2006. This violence is one of the reasons people leave these countries to come to the US.
Add it all up and one can see that focusing on supply has done little to curtail drug abuse while causing a host of terrible side effects.
What Can Be Done?
First the US and Mexican governments must acknowledge the failure of this strategy. Only then can we engage in rigorous and countrywide education campaigns to persuade people not to use drugs.
The current opioid crisis underlines the importance of curbing demand. This approach, with sufficient resources and the right message, could have a major effect similar to the campaign to reduce tobacco use.
We should also decriminalise the small-scale possession of drugs for personal use, to end the flow of nonviolent drug addicts into the criminal justice system. Several states have taken a step in this direction by decriminalising possession of certain amounts of marijuana. Mexico’s Supreme Court has also declared that individuals should have the right to grow and distribute marijuana for their personal use. At the same time, we should continue to make it illegal to possess large quantities of drugs so that pushers can be prosecuted and some control over supply maintained.
Finally, we must create well-staffed and first-class treatment centers where people are willing to go without fear of being prosecuted and with the confidence that they will receive effective care. The experience of Portugal suggests that younger people who use drugs but are not yet addicted can very often be turned around. Even though it is difficult to get older addicted people off drugs, treatment programs can still offer them helpful services.
With such a complicated problem, we should be willing to experiment with solutions. Which advertising messages are most effective? How can treatment be made effective for different kinds of drugs and different degrees of addiction? We should have the patience to evaluate what works and what doesn’t. But we must get started now.
Sentencing policies of the War on Drugs era resulted in dramatic growth in incarceration for drug offenses. Since its official beginning in the 1980s, the number of Americans incarcerated for drug offenses has skyrocketed from 40,900 in 1980 to 452,900 in 2017. Furthermore, harsh sentencing laws such as mandatory minimums keep many people convicted of drug offenses in prison for longer periods of time: in 1986, people released after serving time for a federal drug offense had spent an average of 22 months in prison. By 2004, people convicted on federal drug offenses were expected to serve almost three
times that length: 62 months in prison. At the federal level, people incarcerated on a drug conviction make up nearly half the prison population. At the state level, the number of people in prison for drug offenses has increased ninefold since 1980, although it has begun declining in recent years. Most are not high-level actors in the drug trade, and most have no prior criminal record for a violent offense.
We need new metrics for measuring the success of our nation's drug policies. Rather than measuring success based on slight fluctuations in drug use, the primary measure of effectiveness should be the reduction of drug-related harm – such as overdose deaths, drug addiction, and the transmission of diseases such as HIV/AIDS and hepatitis C.
Critically, though, our drug policies should also be evaluated based on the harms caused by the policies themselves. We need to drastically reduce the enormous numbers of people behind bars for drug law violations.
We also need to end the corruption, public distrust of law enforcement, environmental damage, breakup of families, loss of civil liberties, collateral sanctions like removal of financial aid for students, and racial disparities in drug law enforcement, prosecution and sentencing. Our drug policies should be judged – and funded – according to their ability to meet these goals.
Voters and state lawmakers are moving forward even while their federal counterparts remain paralyzed by decades of inertia and drug war rhetoric. The number and scope of state-level reforms provide evidence of diminishing public confidence in the reflexive “get-tough” mentality, and a growing commitment to approaches rooted in science, compassion, health and human rights.
Both Republicans and Democrats – in states from Maine to Montana, and from Mississippi to Michigan – have led successful efforts to use marijuana for medical purposes, to reduce long and costly prison sentences for people who commit nonviolent drug law offenses, to increase access to sterile syringes to reduce the spread of HIV/AIDS, and to prevent fatal drug overdose.
The United States has almost single-handedly exported the prohibitionist model to every country in the world. The U.S. Drug Enforcement Administration alone maintains more than 80 foreign offices in over 60 countries.
In many parts of the world, however – from South America to Europe – health-centered drug policies are being implemented that are proving to be remarkably more effective at improving public safety and health than outright criminalization.
Portugal presents the most significant and successful example of a post-criminalization, health-centered drug policy. In 2001, Portuguese legislators decriminalized low-level drug possession and reclassified it as an administrative violation. The explicit aim of the policy shift was to adopt an approach to drugs based not on dogmatic moralism and prejudice but on science and evidence.
At the heart of this policy change was the recognition that the criminalization of drug use was not justifiable and that it was actually a barrier to more effective responses to drug use. Every objective analysis has clearly demonstrated that Portugal has drastically decreased its rates of violent crime, addiction, and disease transmission since reforming its drug laws.
Harm reduction is a set of practical strategies and ideas aimed at reducing negative consequences associated with drug use. Harm Reduction is also a movement for social justice built on a belief in, and respect for, the rights of people who use drugs.
Harm reduction incorporates a spectrum of strategies from safer use, to managed use to abstinence to meet drug users “where they’re at,” addressing conditions of use along with the use itself. Because harm reduction demands that interventions and policies designed to serve drug users reflect specific individual and community needs, there is no universal definition of or formula for implementing harm reduction.
However, HRC considers the following principles central to harm reduction practice.