What Can We Do?
A 5-step plan to save lives
Clockwise from top left: A PCR drug checking machine; a shipment of illegal drugs; a safe consumption site; harm reduction supplies. Photo creds: Genetic Engineering & Biotechnology News; USA Today; Seattle Met; Route Fifty. See links below.
The following is an excerpt from p. 243-249 of “Conclusion: Undoing Drugism” from my new book, Drugism (2022):
So, what can we do to save lives? What are some proven measures to reduce or eliminate the issues associated with illegal drugs? There are five things we can implement to save lives, reduce crime, and foster a more sensible approach to drugs in our society. They are:
1. Drug checking facilities
2. Safe consumption sites
3. Decriminalize all drugs and paraphernalia
4. Allow for legal and well-regulated production, prescription and/or sale of all drugs
5. Universal healthcare
1. Drug checking facilities
The first step is quite simple. Allow people to test the purity of their drugs. Carl Hart put it best: “Drug-safety testing has been empirically demonstrated to reduce the number of users exposed to harmful effects of adulterated substances.”[i] The fentanyl test strips mentioned above are a very basic version of this. More comprehensive services are available in some places which test for a wider array of substances with various degrees of precision. Such services also appear from time to time at festivals, concerts, and other public events. The more people have access to drug checking, the less drug-related deaths and hospitalizations we will suffer.[ii]
2. Safe consumption sites
The next step is also fairly simple but has not yet been widely implemented in the US. Safe consumption sites (SCSs), also known as overdose prevention centers or drug consumption rooms, are places where people who use illegal drugs can go to do so safely, attended to by medical professionals who can reverse an overdose, should one arise. Such sites typically also offer access to clean paraphernalia, basic health services, and optional referral to drug treatment programs. Like drug checking, SCSs have been empirically proven to reduce negative outcomes associated with drug use. Most importantly, not a single death has occurred at any SCS.[iii]
The first safe consumption site was established in Switzerland in 1986. The country has since opened several more, as have Canada, Australia, Spain, France, Germany, the Netherlands, Denmark, Norway, and Luxembourg.[iv] For years, the only legally authorized SCS in the western hemisphere was InSite, located in Vancouver, Canada. In 2012 the Canadian Supreme Court ruled SCSs to be legally permissible, and several more have since opened throughout Canada.[v]
The fight for SCSs in the US has been a long and challenging one. Unofficial and clandestine SCSs have existed in New York City and presumably elsewhere since at least 2010.[vi] In 2018, a nonprofit in Philadelphia, Pennsylvania named Safehouse announced plans to open a SCS there after the city’s government announced it would support such a move. However, the following year, Safehouse was sued by the federal government. US Attorney William McSwain led the case, which claims that SCSs violate an arcane, Reagan-era drug law.[vii] The case has been stalled in the courts ever since, and Safehouse has, as of this writing, not yet opened an SCS in Philadelphia.
In Seattle, Washington plans were also made to open an SCS and funds were allocated to create and run it. However, this has also stalled due to the Safehouse case.[viii] California, Massachusetts, and Rhode Island have all introduced or passed legislation which permits the creation of SCSs in those states, and several years ago, the mayor of Ithaca, New York called for the creation of an SCS there.[ix] None have yet materialized in any of these places, unfortunately.
Finally, in November 2021, after years of stalling, the first officially authorized SCSs opened in the US, in New York City. The two facilities are run by a group called OnPoint NYC.[x] In their first six weeks open, the two OnPoint SCSs reversed 124 overdoses. That is roughly three lives per day that are saved at just two facilities in one city.
The opening of OnPoint NYC came amid encouraging signs from the Biden administration. Just a month earlier, in October 2021, Health and Human Services Secretary Xavier Becerra signaled that his agency would not oppose but instead likely support efforts to establish SCSs.[xi] And in February 2022 the Justice Department said in a statement that they are “evaluating supervised consumption sites,” and holding “discussions with state and local regulators” on the topic. Their evaluation of SCSs, the agency said, is “part of an overall approach to harm reduction and public safety.”[xii]
Imagine how many lives could be saved if there were SCSs in every city, and anywhere else illegal drug use is concentrated. More SCSs would also mean more access to naloxone and clean supplies and disposal of needles. Safe consumption sites are an integral part of any strategy to reverse the harms of the War on Drugs, and to undo drugism. At the present moment, many, many more are sorely needed in the US and throughout the world.
[Note: In August 2022, California governor Gavin Newsom vetoed a bill that would have authorized the creation of SCSs in his state. In response, San Francisco City Attorney David Chiu indicated that his city would move ahead with plans to open an SCS anyway, with the support of San Francisco mayor London Breed. See Sjostedt, “San Francisco Plans…”]
3. Decriminalize all drugs and paraphernalia
The next step, drug decriminalization, may seem more politically ambitious, but, to date, far more nations have introduced some form of it than have allowed for SCSs, so in this sense at least it is even more in line with global practice. Policies which decriminalize the use or possession of drugs have been passed and implemented in more than two dozen different nations, including Armenia, Chile, Colombia, the Czech Republic, Estonia, Germany, Italy, the Netherlands, Paraguay, Poland, Portugal, Spain, Uruguay, and more. Such policies have been passed but not properly implemented in Argentina, Brazil, Mexico, Peru, and Russia.[xiii]
The US, as you can see, is a bit behind the curve.
The argument for drug decriminalization has been made many times by plenty of politicians and scholars.[xiv] Decriminalization has also been endorsed by a variety of organizations including the World Health Organization, Human Rights Watch, the NAACP, the Organization of American States, the United Nations Office on Drugs and Crime, and more.[xv] In a nutshell, the argument is as follows.
While individual people may stop using particular drugs, drug use as a whole is not going away.[xvi] Decriminalization conserves the resources (money, personnel, equipment, time, etc.) spent locking people up for drugs. Those resources can then instead be used to address more urgent crimes, of which there is no shortage. Decriminalization has itself been shown to reduce violent crime and burglary. It also improves rates and outcomes of drug treatment and rehabilitation.[xvii]
And, contrary to common fears, decriminalization does not automatically produce an increase in drug use. Instead, in many cases, it has resulted in a reduction of drug use.[xviii] It also allows for greater honesty in public discussion about drugs and improves relations between law enforcement personnel and the people they police.[xix] Finally, and perhaps most importantly, decriminalization will allow us to proceed with the next step: regulation of the production and sale or prescription of all drugs.
4. Legalize & regulate prescription and/or sale of all drugs
For some, the idea of legally dispensing drugs such as heroin may incite anxiety, confusion, or even outright anger. This is understandable, given the general tone of drug education and discourse in the US. However, those who are concerned about the outcome of legalized sale or prescription of currently-illegal drugs can rest assured that the strategy is not a new one—it has been done before, and the outcomes have been overwhelmingly positive.
Even after opioids were federally restricted in the US in the early twentieth century, doctors could still, by law, prescribe them to habitual users for the purpose of maintenance.[xx] For years, with the blessing of the Supreme Court, clinics across the US dispensed heroin and other drugs in this fashion. People who obtained their drugs from such clinics were generally able to maintain steady employment, healthy social relationships, and overall higher quality of life than people who obtained their drugs from illegal sources.
Comparable clinics and prescription practices existed in the UK and elsewhere. The patients of those clinics enjoyed similar benefits. In the US, drug war politics soon overtook public health concerns, and all such clinics were eventually shut down.
In recent years, however, scientists and public health officials around the world have taken a similar approach. As of this writing, ten countries[1] have adopted a practice known as heroin-assisted treatment, or HAT, in which longtime chronic users of heroin are provided with fixed doses of pharmaceutical grade heroin. Without fail, every single study of HAT has shown that it provides immense benefits not only for the recipients but also for their surrounding communities.[xxi]
Heroin-assisted therapy prevents overdose deaths and improves the health and quality of life of its recipients. Because its recipients enjoy generally improved health and little or no risk of overdose, HAT saves money spent on healthcare. And because HAT provides reliable, clean drugs, it greatly reduces the use of street drugs among its recipients. That means less money for illegal drug trafficking organizations. Studies have shown that HAT also reduces rates of crime in areas where it is implemented. As a result, law enforcement agencies save money too.[xxii]
To see what the legal, regulated production and distribution of currently illegal drugs might look like, we can look to HAT. A similar model should be utilized with all drugs that are potentially lethal or that are known to produce serious, adverse health effects.
Already, the HAT model and at least one variation of it have been applied to fentanyl in Canada.[xxiii] The model would certainly be useful for opioids more generally, amphetamines, and cocaine. It may also be an appropriate option for people who habitually use ketamine, tryptamines, phenethylamines, or benzodiazepines. Ultimately, medical professionals should be allowed to legally provide all drugs currently available on the street—even when the recipient is a known habitual user of the drug.
If implemented effectively, such a strategy would see overdose rates plummet. The money made by illegal drug trafficking organizations would also fall drastically, as would the money spent on drug-related issues by law enforcement and healthcare institutions.
We have already created relatively sensible policy which governs the production and sale of numerous drugs, including alcohol, coffee, and tobacco, all of which have been prohibited in the past. There are also a plethora of different approaches to cannabis legalization being implemented as you read this, all of which we can study as potential models for more widespread legalization. Between the variety of well-established markets for drugs which are already legal (alcohol, tobacco, coffee), the array of approaches to incremental legalization that we have seen with cannabis, and the model offered by HAT, we have numerous options as we collectively decide how best to regulate newly-legal drug markets.
The question, therefore, is not whether we should legalize drugs. It is quite apparent that we should. Instead, the question is, how do we regulate them? The answer will vary not only from drug to drug but also from place to place, as different cities, states, and nations decide which approach is best for them.
5. Universal healthcare
If drugs are offered through official medical channels—for example, at clinics and via prescription—the success of such strategies will correlate strongly with access to healthcare. Universal healthcare will ensure that the entirety of a given drug-using population has access to the above-mentioned services and, in so doing, go a long way toward the goal of resolving problems associated with drug use.
Universal healthcare, or UHC, is based on the simple premise that healthcare is a human right. Like other human rights, this one should not be granted conditionally—for example, depending on which drugs one uses. Instead, if one is willing to accept that everyone deserves healthcare, it should mean everyone deserves healthcare, regardless of what drugs they use. The idea that people should not be denied healthcare merely because of their drug use is not a new one. It has been expressed in some form or fashion since the early days of prohibition.[xxiv]
Universal healthcare already exists in more than thirty countries across the globe.[xxv] Not surprisingly, many of the countries with the most progressive drug policies also offer UHC. Of the more than two dozen nations that have decriminalized drugs, one in five offer UHC. Of the ten nations besides the US that have authorized SCSs, all of them provide UHC. Likewise, of the ten nations that offer HAT, all of them have UHC.
The US is the world’s only large, wealthy nation that does not provide UHC to its citizens.[xxvi] We pay significantly more for healthcare than the rest of the world does, largely because healthcare here is heavily privatized.[xxvii] There is also, accordingly, a greater disparity in the prices we pay for healthcare than in other nations. Unfortunately, our most powerful politicians and the tycoons that back them are bent on preventing UHC from taking root here. For this reason, UHC is, of the five steps listed above, probably the least likely to be implemented in the US. It is included in the list anyway because of the great potential it holds for public health and, specifically, for efforts to resolve problems associated with drug use.
These five steps—drug checking facilities, safe consumption sites, drug decriminalization, legal and regulated production and sale or prescription of all drugs, and universal healthcare—are the best, most effective things we can do if we wish to end the War on Drugs and resolve the problems associated with illegal drug use. And while it may seem idealistic, each one of these components has already been done, to varying degrees, in different places across the world.
These strategies have been shown to save lives, save money, reduce crime, and generally improve the quality of life not only for people who use illegal drugs but for entire populations. If we are genuine in our desire to resolve the problems associated with illegal drug use, we should do our best to implement all of these as soon as possible.
Many are reasonably concerned with how much these strategies will cost. Money is an undeniably important factor in the decision to do move forward with the above-mentioned steps (or any political decision for that matter).[xxviii] Based on real-world examples that are already in effect, it is possible—in fact, quite likely—that all of these measures will actually save us money.[xxix] Not only that—they will make us money.
A clean needle is cheaper than a hospital bed.
How will they save us money? It turns out a clean needle is cheaper than a hospital bed. In 2019, a White House press release shared that the federal government’s annual budget for drug enforcement was around $35 billion dollars. Projections for 2022 estimate that the figure will be $41 billion.[xxx] But these numbers do not include the billions more spent by institutions and individuals, apart from the government, to treat or mitigate the problems around drugs. A study published in 2021 found that hospital visits resulting from drug use cost the nation $13 billion in one year.[xxxi] We spend another $35 billion on drug rehabilitation each year in the US alone.[xxxii] Taken together, these numbers indicate that the US will spend approximately $89 billion this year to tend to the costs of drug prohibition.
Speaking of money, there will be tons of it—all taxable—when the drugs that are currently prohibited become available for legal sale or prescription. The global market for illegal drugs is worth roughly $700 billion.[xxxiii] Of this, about $150 billion is spent by people in the US.[xxxiv] These figures suggest that if we legalize drugs and collect even just a standard 5% sales tax on them, it would generate $7.5 billion in tax revenue each year in the US. And if we consider the taxes that would be paid by the producers and distributors of newly-legal drugs, the figure multiplies. Perhaps more importantly, that $150 billion we spend on drugs each year would flow into the pockets of legal US businesses rather than illegal drug trafficking organizations.
In the US, people spend $150 billion a year on illegal drugs.
Drug prohibition is a strange creature. An anachronism that has been repeatedly brought back from the dead to wreak havoc upon innocent bystanders, it is, at its core, irrational and misguided. More than half a century ago, a preeminent psychiatrist from Sudan and advisor to the World Health Organization named Tigani el Mahi noted this, in slightly different terms. “Making a drug illegal,” el Mahi explained in a 1962 WHO report, “produces adverse psychic effects.”[xxxv] As we have seen, the adverse effects of drug prohibition are not only “psychic,” or mental. They are quite physical as well, and also social, political, and economic in scope.
More recently, the British journalist Johann Hari wrote that during a visit to Portugal, one of the many countries that have decriminalized drugs, “people described the idea of busting [drug users] with puzzlement, as if it were a strange medieval practice from the distant past.”[xxxvi] Hopefully one day the entire world will view drug prohibition in this manner. However, it may be naïve to think that drugs will ever completely cease to be used for political ends.
[Keep reading here.]
Footnote
[1] Canada, the UK, Spain, Germany, Denmark, the Netherlands, Switzerland, Belgium, Luxembourg, and Norway; see Drug Policy Alliance, “Heroin-Assisted Treatment…”; “Norway to test…”
Endnotes
[i] Hart, Drug Use for…, 135
[ii] Drug Policy Alliance, “Drug Checking.”
[iii] “A visit to…”
[iv] Mendonça, Bento, and Almeida, “The controversy of…”
[v] Hari, 202-203.
[vi] Peltz, “It keeps us…”; Verma, “A Visit to…”; and Drug Policy Alliance, “Research on an…”
[vii] Feldman, “In Philadelphia, Judges…”
[viii] Markovich, “Court ruling blocks…”
[ix] Jaeger, “Biden Administration Open…” On Ithaca, New York proposal, see Peltz.
[x] Peltz and Balsamo, “Justice Dept. signals…”; “America’s First Supervised…”
[xi] Jaeger.
[xii] Peltz and Balsamo.
[xiii] Rosmarin and Eastwood, “A Quiet Revolution…”
[xiv] On the need for decriminalization, see Hari, Ch. 16, throughout; Rosmarin and Eastwood, 11-12; and Drug Policy Alliance, “It’s Time for…,” 17.
[xv] See Appendix I in Drug Policy Alliance, “It’s Time for…”
[xvi] Hari, 248 and 270.
[xvii] Drug Policy Alliance, “It’s Time for…,” 13 and 15.
[xviii] Ibid., 14 and Hari, 249-250.
[xix] Drug Policy Alliance, “It’s Time for…,” 13 and Hari, 248.
[xx] Hari, 37 and Acker, Creating the American…, 34-35.
[xxi] Drug Policy Alliance, “Heroin-Assisted Treatment...,” 1.
[xxii] Ibid., 2.
[xxiii] Krishnan, “Doctors Are Prescribing…” and Krishnan, “Drug Users Can…”
[xxiv] Acker, 216 and Hari, 34-35 and 41.
[xxv] The New York State Department of Health, “Foreign Countries with…”
[xxvi] “America is a…”
[xxvii] Hankin, “How U.S. Healthcare…”
[xxviii] Hart, 170-171, 248.
[xxix] Hari, 222.
[xxx] Lee, “America has spent…”
[xxxi] Peterson, Li, and Xu, “Assessment of Annual…”
[xxxii] Schneider and Quartaro, “Addiction in America…”
[xxxiii] “Can the global…”
[xxxiv] “Americans’ Spending on…”
[xxxv] El Mahi quote taken from Young, “The Police as Amplifiers of Deviancy” in Rock, ed., Drugs and Politics, 127.
[xxxvi] Hari, 252.
Sources
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“Can the global…”“Can the global criminal network be destroyed? | DW Documentary.” Deutsche Welle, Apr 24, 2022. https://www.youtube.com/ watch?v=gYo-icA2848
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Krishnan, Manisha. “Doctors Are Prescribing Fentanyl to Help People Addicted to Opioids.” Vice, Jan 28, 2022.
Krishnan, Manisha. “Drug Users Can Now Legally Buy Pure Fentanyl for Dirt Cheap in Vancouver.” Vice, Apr 11, 2022.
Lee, Nathaniel. “America has spent over a trillion dollars fighting the war on drugs. 50 years later, drug use in the U.S. is climbing again.” CNBC, Jun 17, 2021.
Markovich, Matt. “Court ruling blocks Seattle’s efforts to create supervised heroin injection sites.” KOMO News, Jan 13, 2021.
Mendonça, Natália Heringer. Nárgila Mara da Silva Bento, and Dulce Maria Filgueira de Almeida. “The controversy of a public debate: the drug use rooms in France.” Revista Científica Multidisciplinar Núcleo do Conhecimento, (6)1:61-79, November 2021.
Peltz, Jennifer. “‘It keeps us safe’: An NYC bathroom set up to stem overdoses.” The Associated Press, Jul 13, 2018.
Peltz, Jennifer and Michael Balsamo. “Justice Dept. signals it may allow safe injection sites.” The Associated Press, Feb 8, 2022.
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Rosmarin, Ari and Niamh Eastwood. “A Quiet Revolution: Drug Decriminalisation Policies in Practice Across the Globe.” Release, 2012.
Schneider, Jeff and Emily Quartaro. “Addiction in America: By the Numbers.” ABC News, Jun 17, 2016.
Sjostedt, David. “San Francisco Plans To Back a Safe Consumption Site, Despite Newsom’s Veto.” The San Francisco Standard, Aug 22, 2022.
The New York State Department of Health. “Foreign Countries with Universal Health Care.” Apr, 2011. https://www.health.ny.gov/regulations/hcra/univ_hlth_care.htm
Verma, Jeevika. “A Visit to VOCAL, a Vital Hub of New York Harm Reduction.” Filter, Sep 12, 2019.
Photo credits
PCR machine photo from Genetic Engineering & Biotechnology News, via Philippe Psaila/Science Source : https://www.genengnews.com/magazine/200/development-and-evolution-of-pcr/
Illegal drug shipment photo from USA Today: https://www.gannett-cdn.com/presto/2019/06/21/USAT/00558a0b-de75-48b2-98e1-8d597517bb43-AP19172525733530.jpg?crop=5471,3063,x0,y0&width=3200&height=1792&format=pjpg&auto=webp
Safe consumption site photo from Seattle Met: https://www.seattlemet.com/news-and-city-life/2017/10/superior-court-judge-throws-out-initiative-to-ban-injection-sites
Harm reduction supplies photo from Route Fifty, via Eric Risberg/AP Photo: https://www.route-fifty.com/health-human-services/2020/01/mailed-needles-drug-use/162369/
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