During the 2016 presidential primary race, Chris Christie spoke movingly in New Hampshire about the death of a law school classmate who became addicted to drugs after a running injury. The topic resonated among the voters of New Hampshire, which, like many other states in the northeast, has grieved the loss of too many of its people to drugs. That resonance was not enough to drown out the full-throated fantasy offered by Donald Trump as he preyed on that grief, promising a wall that would end the movement of heroin across our border, completely ignoring the fact that most of it comes across at our legal ports of entry.
Instead of building an impossible wall across the thousands of border miles to stop the opioid crisis, Trump has signed an executive order that established a commission (headed by Christie) to study the issue. According to the PBS report on the commission, its goals are to:
- Identify existing federal dollars to combat drug addiction, including opioids;
- Assess availability and access to addiction treatment centers and overdose reversal and identify underserved areas;
- Measure the effectiveness of state prescription drug monitoring programs;
- Evaluate public messaging campaigns about prescription and illegal opioids, and identify best practices for drug prevention.
At the same time, Trump is planning to eliminate the White House Office for National Drug Control Policy. Established during the Reagan administration, the office has spent 30 years supervising the drug control policies and plans of the federal government. As yet, no new drug czar has been named.
As governor of New Jersey, Chris Christie used his position to advocate for a revision in the state’s drug policies. He was successful in signing a law that restricted legal prescriptions for opioids to five days in treating acute pain. As a “small-government” Republican politician moves to put the government between doctors and their patients once again, laws such as this tend to further stigmatize the majority of opioid users, who require the drugs in order to function on a daily basis.
On the other side of the ledger, Christie did expand Medicaid to cover the cost of rehab and drug treatment programs and required private insurers to provide up to six months of inpatient and outpatient addiction treatment. In 2013, when there were more than 70,000 addicts in New Jersey, there were only 6,000 beds available. Hopefully the new rules will encourage the addition of more treatment facilities.
But even this is only nibbling around the edges of our opioid epidemic, which really calls for a revolution—a revolution in our thinking about addiction, and our decision to treat it as a crime instead of the illness that it is.
Ireland is considering the decriminalization of all drugs for personal use. Facing a rising death toll from drug overdoses, the nation is looking at solutions other than incarceration. And the obvious place for both Ireland and the United States to look is Portugal.
On April 25, 1974, Portugal finally overthrew the longest-lasting dictatorship in Europe. For 50 years the nation had been isolated and tightly controlled. After the revolution, the celebrations included experimentation with drugs on a national scale:
By 1999, nearly 1% of the population was addicted to heroin, and drug-related AIDS deaths in the country were the highest in the European Union, according to the New Yorker.
Desperation probably played a major role in the decision to decriminalize the personal use of drugs in Portugal. Too many people were dying and HIV, AIDS, and hepatitis C infections were all increasing among drug users, putting an incredible strain on the health care system. But the results of this 15-year experiment are breathtaking. Two years ago the
Washington Post reported that:
Among Portuguese adults, there are 3 drug overdose deaths for every 1,000,000 citizens. Comparable numbers in other countries range from 10.2 per million in the Netherlands to 44.6 per million in the U.K., all the way up to 126.8 per million in Estonia. The E.U. average is 17.3 per million.
Figures from the Transform Drug Policy Foundation show an increase in use of illicit drugs immediately after decriminalization, followed by a steady decline. Rates of HIV and AIDS infection have fallen by 95 percent.
Dr. João Goulão, a family physician, has been involved with Portugal’s decriminalization program for the past 15 years.
Fueled by the idea that removing the stigma around both addiction and mental illness could help more addicts get the help they needed, Goulão and his team immediately set out to change the way drug addicts were perceived and treated by society. Goulão also knew that he had to improve the public’s trust in the police in order for the program to work. If drug addicts could recognize their problem and present themselves to the police rather than run away from them for fear of punishment, they’d have an easier time getting treatment, he reasoned.
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The system works so that someone caught with drugs in a public place are escorted by police to a police station, where they will confiscate the drugs, weigh them, and determine whether the amount exceeds a certain threshold. If it does, the person might be suspected to be a dealer and sent to the criminal justice system. If not, the person is instead sent to the Ministry of Health.
The critical part of a successful decriminalization program is ensuring that the social and medical support structure is available. In Portugal, 90 percent of the government funds spent on drug policy are spent on the prevention and treatment of addiction, leaving only 10 percent on criminal enforcement. The drug policy is run through the Ministry of Health, with no input from the criminal justice system.
For more than 15 years the solution instituted by the people of Portugal has proved successful because it combined decriminalization with social/medical support systems designed to help addicts recover. It was implemented with the same resolve and determination that any war requires. Today, vans with methadone travel the streets of Lisbon, freely handing out the medicine to those who need it to stay off of heroin, and distributing free needles and condoms to any who ask.
Could such a plan work here?
First, we would have to recognize addiction as a chronic illness on par with diabetes or heart disease. They are conditions that can be managed through different forms of treatment. Sometimes medication is required, as well as lifestyle changes and counseling. No blame should attach to illness. Recognizing and treating addiction must be taught in our medical schools, just as they teach treatment for any other medical condition.
Then we have to move drug policy completely out of the Department of Justice and into Health and Human Services. Our program should be overseen by the surgeon general of the United States, not a man who lies to Congress, or a drug czar. It should include not just treatment and recovery, but a living wage for all Americans and an income for those in recovery.
Funding should be moved from incarceration to rehabilitation. The (now-unavailable) data supplement to the 2015 National Drug Control Strategy reveals that In 1980, there were 478,793 clients in substance abuse treatment facilities, both inpatient and outpatient. In 2013 there were 1,249,629. And while there may be as many as 2 million rehab beds, there are almost 20 million Americans over the age of 12 who need them. Private prison owners would probably be wise to convert prisons to hospitals if they want to continue feeding at the public trough. Pressure must be applied to state governments to ensure they follow federal guidelines on decriminalization and treatment.
Establishing a presidential commission, convicting those who deal deadly drugs, stigmatizing those in chronic pain through limiting prescriptions, building a wall that will not work, and allowing dramatic price increases for naloxone (which is known to reverse opioid overdoses) don’t help us resolve this issue. At best they are nibbling at the edges, and at their worst they can result in a lifetime of pain from lack of access to legal drugs—or even death, due to the high prices of life-saving medication.
We don’t need nibbling at the edges: we need a revolution. And we need it now. Yes, now, even in the face of Republican control of our federal government. During his January State of the State speech, Chris Christie said:
“Our friends are dying. Our neighbors are dying. Our coworkers are dying. Our children are dying, every day, in numbers we can no longer afford to ignore.”