The Opioid Crisis is an Opportunity for Re-Calibrating Drug Policy

The opioid crisis is killing over 140 Americans every day. It is devastating communities, many in rural areas that have few resources for dealing with it.  Emergency department visits for opioid-related problems increased by over 100% between 2005 and 2014. The annual economic impact of opioid addiction and abuse alone is nearly $79 billion.

Opioid addiction and abuse is also affecting the economy.  Regina Mitchell, the co-owner of a steel fabricating business in Hubbard Ohio, an area hard hit by opioid addiction, is struggling to fill job vacancies in her factory.  She observed in a recent interview with the CBS affiliate WTVR “There are good paying jobs and the opportunity in our area.  We just can’t find people to show up and pass a drug test.”

On Tuesday August 8th President Trump was briefed on the opioid crisis by health officials and members of his administration.  After the briefing, he offered the following advice.  The “best way to prevent drug addiction and overdose is to prevent people from abusing drugs in the first place. If they don’t start, they won’t have a problem… So if we can keep them from going on — and maybe by talking to youth and telling them: ‘No good, really bad for you in every way.’ But if they don’t start, it will never be a problem.”

It is obvious that Trump has no understanding of addiction or abuse. First, his words are shockingly reminiscent of Nancy Reagan and “Just say no” and drug education programs like the DARE program.  The evidence is clear that “Just say no” and DARE were and are naïve and ineffective.

So, don’t start, but for those who do, the Trump Administration has a second prong to their approach, which is the criminal justice system and punishment.

Jeff Sessions, the Attorney General in the Trump Administration recently announced the requirement that federal prosecutors must charge drug offenders with the most severe offenses possible.  Sessions words in a speech on August 2nd send a pretty clear message. "In recent years some of the government officials in our country I think have mistakenly sent mixed messages about the harmfulness of drugs…" We cannot capitulate intellectually or morally unto this kind of rampant drug abuse. We must create a culture that's hostile to drug abuse."

For the past fifty years, we have been waging a war on drugs that has relied nearly exclusively on supply control and tough punishment. 

Despite the logic of limiting the availability of drugs and threatening and punishing those who are involved in the drug trade and using drugs, the report card for tough on drug crime is bleak.  We have invested over $1 trillion over the past forty-five years on the war on drugs.  There is essentially no evidence in support of the success of that effort and one would be hard pressed to find many with knowledge of the war on drugs who would claim it has worked. 

Why has it failed?

The medical community declared nearly seven decades ago that drug and alcohol addiction and dependence are medical disorders.  We can’t punish diabetes or cancer away.  Why do we think getting tough on addiction would work?

To complicate the landscape, approximately 40 percent of opioid dependent individuals have comorbid or co-occurring psychiatric disorders.  Common comorbid conditions include depression, anxiety and bipolar disorder.  Post-traumatic stress disorder and personality disorders are also present, though less frequently. Punishment is not only ineffective, it often exacerbates mental health disorders.

Punishment also does not deter those with substance use disorders. Today, the vast majority of individuals who enter the U.S. criminal justice system have a substance use disorder, meaning addiction, dependence or abuse.  The recidivism rate for those with such disorders is nearly 80 percent. The reason is simple – punishment does nothing to address drug abuse, dependence or addiction.

It’s time to stop disregarding the scientific and clinical evidence. It’s time to get realistic about how we should address the drug problem.  The evidence is unequivocal – we cannot effectively control supply.  There is simply too much money to be made.  We should recalibrate drug policy by dramatically ramping up evidence-based strategies of demand reduction.  The only way to reduce the incidence of substance use disorders is effective treatment.  Ideally, that should occur outside the confines of the justice system with community-based treatment.  Those who end up in the justice system should be diverted to treatment, not simply locked up. 

Drug abuse is a public health problem.  It is time we treat it that way.