Response to the heroin epidemic: 5. The argument for decriminalization

…by Gina Murillo (comments by “Gina”)…  

So much of what we’re trying to hash out about drug courts here wouldn’t be an issue but for poor drug policy (the War on Drugs — as discussed in the comment section following the last post). The War on Drugs causes far more harm than good. I agree with Marc that Johann Hari makes that case more compellingly than just about anyone else, with the possible exception of Ethan Nadelmann, executive director of the Drug Policy Alliance. (I’m not a huge fan of TED talks, but highly recommend his powerful talk on why we need to end the War on Drugs.)

This really all comes down to how society has been conditioned to view different substances and behaviors. Alcohol and tobacco are far from harmless, but are not only socially acceptable, they’ve both been glamorized cigIDto one extent or another. They both kill many times more people each year than all illegal substances combined, even in the midst of the opiate “epidemic”. Yet, we manage to find under21(admittedly imperfect) ways to deal with the harms they cause as best we can. We do this because we recognize that the harms of prohibiting these substances would likely be significantly greater than simply finding more effective ways to live with them.

Imagine people being arrested for possessing cigarettes (one of the toughest addictions to quit and the #1 cause of preventable death in the U.S.) and facing a drug court judge with the threat of jail or a longer prison sentence for failing to quit smoking. Sure, probably fewer people would smoke and fewer would suffer debilitating disease as a result. But at what (and whose) cost? After all, if legal consequences are so effective at changing negative behaviors, why don’t we criminalize all behaviors we’d like to extinguish for society’s benefit? For another example, how about obesity courts? Health care costs attributed to obesity in the U.S. alone are staggering, with the number of deaths increasing obesekidsteadily each year — making it the #2 cause of preventable death (behind good ole’ tobacco). And the data strongly suggest that households with just one obese parent are at least twice as likely to raise obese children who are doomed to a shorter life expectancy than their parents. Using drug war logic, this ought to be as good a reason as any to criminalize obesity or the behaviors (and foods) that “cause” it.

heroingirlSound crazy? That’s how crazy drug criminalization and drug courts seem to me now. Having dealt with my daughter’s heroin addiction for the past five years, it really hit me, after her most recent “relapse” (for lack of a better term) a little over a year ago, that it wasn’t so much her arrestaddiction that was causing the pain and trauma we were both experiencing as it was dealing with the woefully ineffective — and often counterproductive and EXPENSIVE — U.S. legal and treatment systems.

Whether to decriminalize or even legalize powerfully addictive drugs like heroin is a topic of ongoing heated debate. Decriminalization of the use and possession of all drugs is a no-brainer to me. Legalization is more tricky, but still requires an honest and intelligent discussion about the inherent risks and potential benefits. drugstacksBecause while we labor under the delusion that prohibiting a given substance outright is the ultimate form of control, it is in fact the mechanism by which we relinquish all control to criminals, who have in turn been empowered by such policies to build massive global organizations. The only way to undercut that power is to minimize the enormous profits that are generated by prohibitionist policies.

Those who have considered the idea of legalization in any serious way are quick to couple it with proposals for control, which should address, at the very least, protection of minors (who are, incidentally, not protected from heroin availability at present), and, especially in idcheckthe case of opioids, prevention of leakage or diversion to others, policies for supervision and safety, and strict constraints on who might be eligible for prescriptions. One model of a successful quasi-legalization policy comes from Switzerland, which implemented heroin-assisted treatment (HAT) with great success to stem the tide of its own heroin epidemic in the late 1980s and early 1990s. Here is a brief description of the outcome from an article by Johann Hari in Huffington Post:

Switzerland also had a huge heroin crisis. Under a visionary president — Ruth Dreifuss — they decided to try an experiment. If you are a heroin addict, you are assigned to a clinic, and you are clinicgiven your heroin there, for free, where you use it supervised by a doctor or nurse. You are given support to turn your life around, and find a job, and housing.

The result? Nobody has died of an overdose on legal heroin — literally nobody. Street crime fell significantly. The heroin epidemic ended. Most legal heroin users choose to reduce their dose and come off the program over time, because as they find work, and no longer feel stigmatized, they want to be present in their lives again.

I would clarify Hari’s description further by pointing out that (1) while Switzerland didn’t legalize heroin, per se, it did make it de facto legal for a very specific subset of the heroin-using population; (2) HAT is a treatment of last resort offered only to those for whom all other methods of treatment have failed; and (3) most HAT patients actually become re-engaged in their lives once stabilized on HAT, regardless of whether they ultimately choose to taper off.

HAT has been so effective in Switzerland that it’s no longer even controversial there, and HAT trials have been implemented in a growing number of European countries and Canada. Very recently, a couple of forward-thinking lawmakers have even made attempts to introduce legislation that would authorize HAT trials in Nevada and Maryland.

I dream of the day our society can, in the inimitable words of Ethan Nadelmann, learn how to live with drugs sensibly, so that they cause the least possible harm and produce the greatest possible benefit to all. Because if there’s one thing we need to recognize, it’s that drugs aren’t ever going to go away, no matter how many laws we pass or how many people we put in jail.


21 thoughts on “Response to the heroin epidemic: 5. The argument for decriminalization

  1. Nicolas Ruf June 7, 2016 at 8:39 am #

    Here’s the basic point about the War on Drugs: prohibition doesn’t work. Drugs are more readily available, cheaper, and better quality than ever. Plus the underground chemists are churning out variations, to avoid legal classifications, that in many cases are more dangerous than their illegal cousins.
    Legalization, or at least decriminalization, regulation, and taxation would gut the illegal drug trade and provide funds for treatment for those who need it. Just interdiction and local enforcement are costing 35 billion a year, about what we’re currently spending on treatment. We could double the capacity and have money left over.
    It’s a tough pill to swallow, so to speak, but check out Peter Christ of LEAP’s argument. And obviously we need to rein in the pain meds.

    • Gina June 7, 2016 at 12:15 pm #

      LEAP is a great organization, Nicolas. I am forming a legal aid organization and hope to work with some local LEAP members. Also, you raise another good point about prohibitionist policies that’s often underdiscussed—they incentivize the development of ever stronger and more dangerous substances (synthetic marijuana is just one example). I am hopeful that as marijuana is legalized for both medical and recreational use in more and more states, it may help reduce the use of stronger or more dangerous drugs. So far, there is evidence to suggest that may be happening in Washington and Colorado, where painkiller deaths have dropped by 25-30%.

  2. Terry June 7, 2016 at 6:41 pm #

    its a no brainer – too many in the industry – that drugs should be legalised and manufactured and distributed in a way that provides quality and less harm. Most working with drug users know the Laws cause as much harm as the drugs themselves. people will use drugs despite what is done to try and eliminate certain drugs. the hypocrisy is seen by the young who see a society drink, smoke and gamble to their hearts content while condemning those who choose illicit drugs as there way of dealing with stress or having fun, which by the way are generally less harmful than licit ones. In Australia the current issue is Ice and much is being said about epidemics (a word that relates to infectious disease, as though drug use is contagious because the drug is infective) but the issue really is that there is no less harmful alternative. what if the only alcohol sold in pubs was Overproof Rum ?? would we not see a lot of trouble and harm ?? but beer is available and most use that. today the Australian press reports that 13 people have OD’d in the last month from a bad batch of heroin. it raises little comment, as though the deaths of drug users matters little. we are doing harm by not challenging the war on drugs and in my view a change of attitude towards drug use would reduce the problem by half overnight.

    • Marc June 9, 2016 at 2:20 am #

      It seems that we are mostly in agreement about the damaging effects of the War on Drugs. I hope we hear from others who may have alternative views.

  3. William Abbott June 9, 2016 at 9:14 am #

    Not from me. This seems the most compassionate approach and has data to support its effectiveness.

    Problem with us Americans is we never seem to learn from out mistakes- and this is only one of them

    • Paul Mattern June 11, 2016 at 2:35 pm #

      A huge problem for those in treatment and recovery is that there is a massive disparity in the criminal justice system regarding how we treat people who suffer from addiction. I watch the people who have funds obtain very different sentences if they are facing criminal prosecution than those who are indigent, and often homeless and broke.

      Sometimes an arrest, or even a subsequent arrest can be rock-bottom and a chance to help them start to realize there is a problem, and make this the start of a new beginning.

      I am a criminal lawyer and my hands are so often tied. If I have a client who has good insurance and s/he is arrested, that is often enough incentive for them to let me check them into an expensive and supportive rehabilitation center. I realize it isn’t for everyone, but in the criminal justice system this changes things. By the time my clients are facing sentencing, they have had months of inpatient treatment, outpatient treatment and groups. At sentencing I have a huge number of letters from psychiatrists, psychologists, social workers, etc.

      I am often able to resolve these cases very favorably. I can argue they are in recovery, have evaluations showing they are not likely to re-offend and even witnesses from their treatment centers.

      However if I have a client who is indigent, the only “treatment” our state health care is normally a 3-day program. My clients get out, they relapse, and by the time we get to sentencing they are going away for years.

      A very different outcome based not on the cost of an attorney, but the cost of proper treatment. My clients with good insurance or funds allow me to get them a better result.

      The poorest of my clients get their treatment in prison. There is none. It breaks my heart and I do what I can. Change starts with single people sharing with one another and working towards change.

  4. Mark June 10, 2016 at 6:11 am #

    Marc, your message seems to be getting out there … at least in China!



    • Marc June 13, 2016 at 8:35 am #

      Thanks, Mark. This is certainly interesting. And I really do see grey areas — areas of overlap — between the disease model and the learning model. This could well be one of them.

  5. matt June 10, 2016 at 4:45 pm #

    I know this discussion is about legalization and decriminalization. There needs to be a concerted effort to rehabilitate the woefully inadequate treatment system, its modalities and scant availability. At least in the US. The only thing I really learned from rehab was that I needed to learn to do it myself (which is a lesson in itself, but not one my wife and I needed to pay tens of thousands of dollars to learn). Whether or not drugs get legalized, there will still be the need for effective treatment. Community-based centers that can respond to the needs of a particular area and be clearing houses for treatment, education and prevention may be what’s most effective.

    • Marc June 10, 2016 at 5:31 pm #

      We know that without question. Alcohol, a legal drug, has damaged many lives. So it’s not the legal/illegal dimension that matters. It’s the tendency to seek immediate relief vs. the capacity to hold in mind the horizon of possibilities…that people need help with.

      Life sometimes feels like outer space might feel to an astronaut running out of oxygen. People need help conserving the oxygen in their tanks, learning to survive with the thinnest of mixtures…and they also need enough oxygen to keep them alive during that process of learning.

      • matt June 10, 2016 at 5:52 pm #

        … and learning where to find more oxygen. 🙂

      • Carlton June 11, 2016 at 10:22 am #

        For many people, the addiction can eventually seem to be as essential to living as Water, Food and Air is.

        A pivotal realization of a persons recovery, or even life, can be when they realize that how they think, believe and feel about the addiction, is changing.

        And as the parade of extreme things in life occurs, both tragic and exhilarating, a person may notice that their knee-jerk thoughts, feelings beliefs and actions, are no longer hinging, or even relating to the addiction anymore.

        It can become a major revelation and landmark about the addiction and about themselves, because the addiction no longer seems as essential to living as Water, Food and Air anymore.

        As life goes on and the parade of extremes continues, a persons self-trust may become what it was before the addiction, and that first, pivotal realization, had been an indication that a change had begun

        This Blog, UNDERSTANDING ADDICTION is a rare place where stories of addiction and recovery can be shared outside of recovery programs where accounts like this may not be understood ..or even possibly misconstrued.

        I hope the stories posted here help shed light, and possibly initiate more research of Recovery from Addiction.

        • Marc June 13, 2016 at 8:43 am #

          I hope so too, Carlton. I like what you say about the dawning realization that something is changing, realizing that you don’t really need this “oxygen” so much anymore (like a fish might say: hey, I must have gills!). Indeed, the change often starts to happen without our awareness, and then the cycle of changing habits, changing needs, self-awareness and growing self-trust has a chance to get started. In fact it may not be a question of returning to one’s previous level of self-trust but rather recognizing an entirely new capacity for coping with needs and impulses.

  6. Percy Menzies June 11, 2016 at 12:31 pm #

    There is general agreement that decriminalization should be the state policy. The possession of small quantities of drugs should not lead to arrest and harsh punishment. There is a lot of overlap and at times confusion with legalization. No country including Switzerland and Portugal have legalized heroin as pointed out by Gina.

    Historically, the drug ‘treatment’ policies for heroin have focused primarily on the reduction of criminal activity and less on getting the patient well. I have talked about this in my earlier article on Marc’s website. This has to change. We have to put strong focus on patients regaining a semblance of normality. This is not always the case, as Marc wrote after his visit to the center in Belgium.

    Any disorder or condition that affects the biological instincts of survival is difficult to treat and may requires several episodes of treatments. Sadly, some will succumb before they quit. Alcohol, tobacco, processed foods are just a few of the culprits on the legal side and legal and illegal drugs are the other culprits. Restrictions and education are two powerful measures to either get people to quit or not start in the first place.

    Heroin Assisted Treatment (HAT) may work for a very small subset of highly refractory patients, but is not feasible for more widespread use. Let’s focus on effectively using the existing medications – methadone, buprenorphine and naltrexone. My heartfelt support for what your daughter has to suffer. May be we should talk offline on the ‘treatment’ she is receiving.

    Treatment of addictive disorder does not have to expensive. Many writers including Marc and Maia Szalavitz have criticized the treatment industry. We have to focus on outcomes, especially relapse prevention and this is best achieved through a combination of appropriate anticraving medications and behavioral therapies offered in the patient’s ‘home’ environment.

    Our treatment strategies have to operate on the assumption that the patient is going to be exposed to a myriad of legal and illegal drugs and other addicting addicting substances both during and after recovery. But these environmental factors are not going to undermine the cure. Is this not the way we treat most maladies ranging from pneumonia to diabetes to smoking cessation?

    • Marc June 13, 2016 at 8:47 am #

      Thanks for carefully outlining your position here, Percy. For readers who want to think more about Percy’s perspective (both the pro and the con), please do see his guest post on this blog, three posts back, as linked above.

  7. Paul Mattern June 11, 2016 at 3:16 pm #

    The problem I see in the US is that there is a massive disparity between what treatment is available. For the poor, there really is little or no treatment, and what I would call minimal case is cost-prohibitive for many.

    As an American, I am jealous of many of the treatment options that are discussed in this group. The United States has more people incarcerated than any developed country in the world. Many of those are addicts who are serving prison terms as an alleged form of substance abuse treatment.–attorney–addiction-is-not-a-crime.html.

    Even minimal treatment is expensive to the American.

    • Marc June 13, 2016 at 8:56 am #

      Paul, though we may disagree about labelling addiction a disease, I am fully convinced of what you’re saying about imprisonment. Johann Hari’s book, Chasing the Scream, is particularly compelling in its portrayal of the horrors of imprisonment for addicts, its utter failure as a system of control, and its lopsided application re minorities. His description of “tent city” in Arizona is truly heart breaking. So voices like yours are badly needed. Thanks for sharing your website with us.

  8. Paul Mattern June 13, 2016 at 3:34 pm #

    Thanks Marc. As for whether addiction is a disease, I realize there is a disagreement about that. I find that sadly, many of my clients’ families are not supportive when they hear their loved one has become an addict, and when I call it a disease the family is more receptive, as opposed to taking the “you made the bed, you lay in it – tough love” that I do see from some of my clients’ families. Some families abandon my clients once they suffer from addiction and are in the criminal justice system.

    I see Tent City about once a month and I will find and read Chasing the Scream. In Arizona, if we rehabilitated those who suffer from addiction and properly treated those who suffer from severe mental illness but don’t have access to medical treatment, or are too impaired medically to seek it, I bet we would find a huge majority of our prison population. Proper treatment of these people would put me out of business, but it would be a happy day for me. Thank you for your site. It reminds me I am not alone with my beliefs.

    • Marc June 14, 2016 at 5:20 am #

      Paul, what I often try to emphasize is that rejection and stigmatization are not the logical opposite of the disease attribution. If your kid was being bullied routinely, or your friend was raised with self-destructive religious beliefs and suffering as a result, you would never think of turning your back on them, but you would never call what they are suffering a disease. I know this argument is perhaps too abstract or too “precious” for people going through hell. And if some people need to call addiction a disease to mitigate blame and stigmatization, it’s okay with me.

      As for Tent City… I found it via Google after reading Hari’s book, and I was amazed to find that Hari was NOT exaggerating its horror. Apparently it’s recently been closed or will close shortly: Which is great, but of course the addicts (most of whom,as you say, have co-occurring mental health issues, will be placed in other jails.

      Yes, you simply must read Chasing the Scream. It puts the whole thing in perspective, and it’s an excellent, exhilarating read.

  9. Gulfstream Diagnostics August 3, 2016 at 10:28 pm #

    Thanks Marc for giving the information. I think families always support the person, if having drug addiction. They help them to remove from the addiction. They always try to find how to remove drug addiction.

  10. Julie October 13, 2016 at 8:32 pm #

    Opiate users need responsible medical attention, not criminal attention. Rehabs and prisons do not work because this is not a behavioral problem, it is a chemically induced traumatic brain injury (TBI) and if done repeatedly, it causes literal brain damage no different than a diabetics pancreas being damaged and requiring insulin to live. Spiritual, medical, and legal ignorance in the United States IS what is causing the silent Spiritual and physical genocide of our fellow Souls. The current War on Drugs is a War on Souls trapped in poisoned, injured, and damaged brains. The true War on Drugs that shall be won is a War on Ignorance with the intelligence and morality of God.

    Education / true prevention programs are key in this Spiritual and physical war. Early intervention by parents with *true moral public service help (not forever criminalization and torture) from the medical and legal community. Parents are being forced to remain silent as to not immorally Spiritually murder their own child. There are tons of constitutional issues of public mug shots of the sick – which is cruel and unusual punishment to punish those without proper medical care who’ve been forced into crime because of their TBI.

    Laws are suppose to be of benefit to public safety and order. The laws in the United States are now wickedly set up to entrap those who ignorantly (unknowingly) harm/ injury their brains into incredible poverty and hell. They have literally turned God’s children into the hands of Satan. May God forgive us all for our ignorance; those who ignorantly fell (with no intent whatsoever to harm themselves or others) and those who have literally tortured them for it.

    It is this idea that addiction is a behavioral problem and/ or psychological problem in which IS killing our fellow Souls. We must spread true education as it shall set us all free from this wickedness.

    These affected Souls need Physicians in the neuroscience speciality that are the true competent moral children of God; not those who are ignorant and foolishly believe they are gods. The injured and/ or damaged need to be rescued by God and their Physician in a most dignified/ respectful manner.

    Ignorance literally kills. Intelligence and the morality of God is the *only answer.

    And if most are unaware, over 90% of those who are incarcerated – are non-violent drug related crimes in which they did not commit the crimes while on the drugs, they committed them to get the drugs. The laws are set up to enslave them into the world of criminality as well.

    It is incredibly immoral/ of Satan himself to throw a Soul trapped in a sick and damaged body into a cruel cage because they have TBI. We can all agree the PETA, the general public, and other groups would go nuts if any sick animal that could be morally/ responsibly medically treated were tossed in cages with hardened criminals 24/7/365/years.

    Last, those in most treatment centers will biochemically lie to get back on the streets to feed those damaged neurons/ receptors/ transmitters.

    God despises cruelty. It is cruel to force a child of God into immorality (to lie, steal, murder, betray) because they are sick. That is of Satan. This wickedness and literal preventable and absolutely Spiritually and medicinally treatable insanity of our fellow beautiful Souls whom damaged their brain – their sanity systems – must end. They do have hope for a absolutely normal, sober, intelligent, successful, and happy lives with replacement opioid therapy alike insulin for diabetics.

    For the deceived drug dealers – if we morally get rid of the demand, we get rid of their poisons. Heroin should forever be illegal, but victims of it must be morally and competently Spiritually and medically rescued from their ignorance and harm to themselves.

    May God forgive us all for this incredible Spiritual, medical, and legal ignorance, harm, and destruction to our ourselves, others, our neighborhoods, towns, cities, states, and ultimately our nation. May all eyes open to true healing and the real strategies to win the War on Drugs.

    And may God be with you and yours always.

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