Editor’s note: This commentary is by Stuart Friedman, a clinical social worker and drug abuse counselor who has spent extensive time in China helping to develop community-based mental health programs. He lives in Middlesex.
[I]t is past time for us to acknowledge that the 45-year War on Drugs has been a failure by any reasonable measure. None of the stated goals for this effort have been reached and in many ways the emphasis on legal measures to counter was is now recognized as a health problem have raised the cost to individuals, their families and society at large. The results of this approach include:
• increased use of drugs (including designer drugs seeking to evade legal prohibitions);
• large increases in the number of people incarcerated;
• the development of sophisticated organizations for the import and manufacture of drugs;
• the life-long immiseration of individuals who had already started the race of life with serious handicaps;
• the inter-generational transmission of social alienation as drug-convicted individuals and their families are marginalized;
• the spread of infectious diseases that pose a danger to the entire population;
• the creation of a near failed state on the southern border of the US, placing the people of Mexico and the US at grave risk for drug lord violence;
• underfunding needed treatment programs while showering money on ineffective law enforcement efforts
We have constructed an approach to drug use that careens from crisis to crisis, from one substance to another, and from one unproven initiative to another. Unfortunately this has led to huge expenditures on things that do not address the serious public health problem posed by drug dependence, while beggaring the approaches that have been demonstrated to be effective. Over 60 percent of the federal budget for drug control is spent on law enforcement, even though every dollar spent on treatment saves $7.46 in other costs. This is made all the more tragic by the millions of lives that have been sacrificed on the altar of self-righteous finger pointing by those interested in garnering headlines for themselves or funding for their ineffective approaches.
The good news is that we know that a community-based, public health program can work and implementation of a successful program can get us started on the road to recovery. The drawback to this approach is that its short-term claims are modest, its activities are, by themselves incremental, and its activities extend into many aspects of society at large.
Despite political rhetoric to the contrary, access to needed treatment and education remains limited, geographically isolated, and often seen as punitive and retributive rather than therapeutic, by participants.
This is precisely how we have had great success in the U.S., including Vermont, in reducing the hazards associated with tobacco use since the 1964 Surgeon General’s report on the hazards of smoking. In Vermont we have reduced the prevalence of smoking by over half, saving tens of thousands of lives. The activities that helped in this effort included:
• ongoing public campaigns underscoring the dangers of smoking;
education/skill building in schools for students before they start smoking;
• limiting places where smoking can legally occur;
•developing easily accessed, low cost, voluntary services for those seeking to quit;
• limiting the access of youth to smoking materials;
• raising the tax on tobacco products.
The benefits of these efforts have been far-reaching; one example is the 50 percent reduction in deaths due to heart attacks in recent years. The example of heart attacks is especially relevant as it has likely been the result of many interventions, medications, education, and social changes that have come about. Smoking cessation was just one of many tactics used to bring about this great public health improvement.
By contrast, our approach to drug abuse and dependence has relied heavily on punishment and victimization of individuals abusers and their families. It is estimated that over 50 percent of the people incarcerated by the State of Vermont are individuals whose non-violent offense was directly related to their use of drugs. Despite political rhetoric to the contrary, access to needed treatment and education remains limited, geographically isolated, and often seen as punitive and retributive rather than therapeutic, by participants.
I recall an interview I did with a young woman in 2013 when I was volunteering at a methadone clinic in Vermont. She was entering treatment after being on a waiting list for over a year. She told me that her daily habit of opiates could easily cost her $50 a day, yet her monthly income was only $850. When I asked how she bridged that financial gap she told me she did whatever was necessary: shoplifting, small scale dealing, trading sex for drugs, stealing pharmaceuticals from family members.
In this instance we had an individual who was ready for treatment (a key factor in the literature) but during the year she was waiting to gain access, committed dozens of criminal acts in order to maintain herself. Under current practice she might have been apprehended, charged, convicted and sentenced and when finally released, less likely to pursue treatment than when she originally sought it. In the meantime her family life was disrupted, her pre-adolescent daughter handed from relative to relative during the incarceration, and the obstacle she faces multiplied.
Had this scenario played out all the responsibility would have been placed on the patient, ignoring the large part our community at large played in her plight. By working to isolate and condemn drug users, by denying them access to immediate treatment for what could be considered a health emergency (imagine if we told a patient that while they needed cardiac bypass surgery and it would likely save their life, there was a waiting list of a year before it could be scheduled!), we only increase their misery, the misery of those near and dear to them, and the social cost of our failure to act on what we know works best.
We know what works, we have the trained professionals who can implement the approach and it is past time to abandon the failed law enforcement approach and implement the proven strategy of a public health initiative.
