The Problem With a Drug Free America
What we want is a country where people have what they need to flourish. For some people, that means better access to high quality health care and the drugs that come with it...
Let justice roll down like waters.
Amos 5:24
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Dear Friends and Colleagues,
I grew up hearing the goal of a “Drug Free America” stated over and over. It needed no explanation, it was just assumed to be a good and righteous cause. This meant that every drug bust was a cause for celebration, another battle won. It is a clear and simple framework with stark dividing lines between right and wrong.
The non-profit that used to bear that name changed it long ago and for good reason. But this email isn’t about the organization, but the moral framework “Drug Free America” invokes and why it is so problematic. Put simply, it's a bad goal.
Drugs are a technology that we use to achieve certain ends. When they are used well, they help us achieve health and wellbeing. Other times, they erode our health and can end lives. A “Drug Free America” isn’t necessarily a good thing.
What we want is a country where people have what they need to flourish. For some people, that means better access to high quality health care and the drugs that come with it, for others that means access to addiction treatment and still others ensuring that they won’t die suddenly from a contaminated drug supply.
Is this all just semantics? No.
Imagine for a moment if a cancer treatment center put out a press release celebrating a reduction in the amount of chemotherapy they offered this year. We would scratch our heads.
What we want to know are things like, have we done a better job at prevention? Are more people going into remission and cancer free? Are people who do have terminal cancer living longer and better lives?
But every day in the United States in local and national media we see reports from law enforcement about drug busts. There are celebratory news stories about all of the drugs taken off the streets. The more drugs seized, the more good being done.
But is it?
New research out this week shows a significant spike in overdoses after law-enforcement drug seizures. Within seven days, the number of fatal overdoses is an estimated twice what it would have been otherwise.
This has been a phenomenon long observed by the folks at Law Enforcement Action Partnership. Drug busts temporarily disrupt the drug supply in a way that introduces uncertainty for drug users. Differences in potency and increased chances of contamination in the drug supply leads to more overdoses.
This is the same phenomenon we saw with prescription opioids. We successfully reduced opioid prescribing by 44% over the last decade. The result? A massive increase in overdose deaths as people shift from prescription opioids to the illicit market.
Our goal should be to maximize public health and safety. When we start with that framework, a whole host of other f policy approaches begin to make sense. We begin to think in terms of harm reduction, and measure our successes against that standard. And, when we learn that a commonly accepted policy approach is associated with increased death rates, it makes sense to rethink it.
We know that reducing access to licit and illicit drugs for teens is one very important way of reducing addiction and contributes to public health and safety. But it is a means to an end, not the end itself.
Prohibition as a primary goal does not work. We should design policies that put health and safety at the forefront given the reality of drugs in our midst and measure success against those goals. To paraphrase Jesus, we aren’t made to serve the law, the law is made to serve us.
Making this distinction matters. Lives are at stake.
Keep the faith,
Timothy McMahan King
Senior Fellow, CNDP
Research compiled by Cassidy Willard, Research Associate
Spatiotemporal Analysis Exploring the Effect of Law Enforcement Drug Market Disruptions on Overdose
A study published earlier this month found that fatal overdoses doubled “within 7 days and 500 meters following opioid-related seizures.” The study focused on data involving police seizures of opioids and stimulants and the overdose events that followed. The relationship between drug seizures and overdoses is not novel. Instead, “efforts to disrupt the illicit drug supply have historically incentivized potency to minimize volume and maximize profit.” This phenomenon is not limited to opioids, we see the effect of “the harder the enforcement, the harder the drugs” in other contexts including the transition from beer to moonshine during prohibition. Ultimately, as police continue to seize drugs, the drug supply will become less predictable, and overdose fatalities will increase.
The relationship between police contacts for drug use-related crime and future arrests, incarceration, and overdoses: a retrospective observational study highlighting the need to break the vicious cycle
One year ago researchers published results from a retrospective observational study highlighting the negative effects associated with the traditional policing approach to drug use-related crime. The study highlights two big problems following “a police contact with probable cause to arrest for a drug use-related crime.” First, higher rates of recidivism and incarceration. The study found that the mast majority (84%) of people experienced incarceration in the year following “a police contact with probable cause to arrest for a drug use-related crime.” Second, “in the six years following “a police contact with probable cause to arrest for a drug use-related crime”, 9.6% of people sustained a fatal opioid-related overdose.
The study hypothesized that a different policing approach at the time of the police contact could have prevented fatal overdoses. The results as a whole indicate “an individual’s increasing struggles with addiction as we observed increasing trends with arrest, incarceration, and overdose events following an overdose-related police contact under the criminal justice-based policing method.” The potential solution? Police change their thinking from a criminal justice-based approach to an approach based on harm reduction.
Overdosing on Regulation: How Government Caused the Opioid Epidemic
“The ‘more restrictions, more deaths’ view posits that opioid overdoses result mainly from restrictions on opioid access, which push consumers to higher‐potency products and hamper their ability to determine the potency or quality of the drugs they consume. This view is supported by evidence that restrictions on opioid prescribing over the past decade may have pushed opioid users to the underground market, increasing the harms associated with illicit drug use. At a minimum, increasing regulation of opioid prescribing has failed to decrease opioid overdose mortality over the past several years, weakening the case for additional regulations. We suggest that deregulation of opioid prescribing may decrease the harms of illicit drug use and promote other benefits to public health and safety.”
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