History shows we can't arrest our way out of the drug war

America's opioid abuse epidemic seems unstoppable. In 2015, the American Society of Addiction Medicine...

Posted: Feb. 28, 2018 6:36 AM
Updated: Feb. 28, 2018 12:51 PM

America's opioid abuse epidemic seems unstoppable. In 2015, the American Society of Addiction Medicine reported that there were 20.5 million Americans living with a substance abuse disorder, including 2 million involving prescription pain relievers, and 591,000 involving heroin. With 64,000 deaths reported from overdoses in 2016, and over 50,000 of those deaths specifically from opioids, the number of Americans struggling with addiction has continued to rise.

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But response from the federal government has been moderate at best. In October 2017, President Donald Trump declared the opioid crisis a public health emergency. This launched a 90-day federal mobilization against the problem, but it didn't allocate additional funds or outline how, specifically, the battle was going to be waged.

The most recent federal budget wasn't much better. The Department of Health and Human Services reported that, for 2018, $3 billion was available to address issues ranging from the opioid crisis to "serious mental illness." But where this money will go remains unclear. Beyond discussions of an anti-drug ad campaign and vague promises to advance better practices for pain management, there have been few policy clarifications since Trump declared the emergency over four months ago.

Attorney General Jeff Sessions has done little to help, either. This month, Sessions unveiled a new task force that would target the epidemic. But Sessions' new group, led by Mary Daly, a former US attorney who supervised narcotics units in Virginia and New York, is focused almost exclusively on law enforcement, and not on treatment or rehabilitation. Prosecuting opioid crimes, investigating opioid-related health care fraud, and increasing funding to state and local law enforcement are necessary measures, but, as we learned in the 1980s, we can't arrest our way out of the drug war.

With 174 Americans dying of an overdose each day, the opioid crisis seems terrifying, but it doesn't have to be. The thing is, we've been here before. America experienced a major heroin epidemic over four decades ago, between 1967 and 1976. But when the federal government instituted large-scale reforms, including widespread support of methadone maintenance programs, rates of overdose deaths plunged. Studying the lessons of the past could help us battle the drug epidemic today, and it could keep our focus on where it matters most: on the substances that are needlessly killing thousands of Americans every year.

As historian David Courtwright notes, by 1970, there were roughly 634,000 heroin addicts nationwide. User demographics were also shifting. In the late 1960s, most addicts were young, urban African-American and Latino men. But by 1970, white suburbanites and Vietnam veterans had joined their ranks, and overdosing was a problem among active military members as well. In the spring of 1970, officials in Vietnam reported two overdose deaths a month. By that fall, the number had risen to two a day.

1971 was a turning point in the American battle against heroin addiction. Heroin was a problem not only because of the number of people dying - 1,000 New Yorkers died from an overdose in 1970 alone - but also because it caused other problems as well, including a rapid uptick in crime. Concern grew to the point that, by that year, Americans listed heroin as the third largest national problem, after the Vietnam War and the economy.

President Richard Nixon, first elected in 1968, was a well-known hard liner on drugs. He ran on a platform of law and order, and actively tied drug use to criminal behavior. But by 1971, Courtwright said, Nixon was "pragmatic" about heroin. His administration pursued a multitrack series of drug policy efforts, which included new enforcement programs and diplomatic efforts, but also focused extensively on demand reduction and treatment. He started SAODAP (the Special Action Office for Drug Abuse Prevention), a new office to oversee the effort, and asked its director, Jerome Jaffe, to concentrate federal resources on battling heroin.

Between 1970 and 1974, the budget for federal drug prevention efforts rose from $59 million to $462 million, and over 60% of that money went toward demand reduction. This money allowed methadone maintenance clinics - where opioid addicts got methadone, a substance that mimics heroin's effects without the euphoria, allowing them to slowly wean themselves off the drug - to open across the country, and the number of methadone patients increased from 9,000 in 1971 to 73,000 in 1973. By 1976, as Courtwright cites, heroin deaths had been reduced by 80% through a large-scale, multimillion-dollar treatment system. The change was difficult and expensive, but within less than a decade, the heroin epidemic had abated.

Though the rates of addiction and death are similar, we're not seeing the same kind of coordinated federal response today. Instead, the Trump administration is letting the opioid crisis linger as it turns its attention to another drug: marijuana.

Ten weeks after Trump declared the public health emergency, Sessions revoked the Obama administration's Cole memo, which permitted state legalization laws to stand. Sessions' antagonistic feelings toward the drug are well-known: He has repeatedly condemned its use, and suggested that cannabis is "only slightly less awful" than heroin.

This was a surprising claim, since there are no recorded deaths from marijuana overdose, and legalization receives bipartisan support. According to a Gallup Poll, 64% of Americans support recreational legalization, and even more support medical marijuana. Effective medical marijuana programs have also produced a dramatic reduction in opioid deaths: A recent study found that states allowing medical marijuana to treat chronic pain saw opioid mortality rates drop by 20%. It's hard to understand why Sessions would resurrect an unpopular war on pot, even as the nation reels from an ongoing opioid overdose epidemic.

But history provides a lesson here as well. At the same time America was undergoing its last heroin epidemic, marijuana decriminalization laws were passed nationwide. Between 1973 and 1978, a dozen states decriminalized personal possession, reducing marijuana's penalty to a civil fine. This was done with the federal government's tacit support: In 1975, a white paper released by the White House's Drug Abuse Task Force declared that the federal government's primary responsibility was the treatment and rehabilitation of "hard" drug users -- heroin addicts, mostly -- and not "soft" drug users like marijuana smokers.

Though these laws were later overturned during the "Just Say No" 1980s, they proved that the federal government could emphasize a strong anti-drug stance by simultaneously treating the deadliest drug of the moment, while recognizing states' rights to enact their own laws. And though little has come from revoking the Cole memo, Sessions' antagonism toward popular marijuana laws, alongside the Trump administration's reticence to combat overdose deaths, stands in direct contradiction to the way we effectively tackled the heroin epidemic of the past. Their actions suggest that this administration is more interested in waging a rhetorical war against pot and arresting everyone committing an opioid-related crime than treating and rehabilitating the Americans who need help the most.

It doesn't have to be this way. Recent history shows a strong federal commitment to tackling opioid overdose deaths can exist alongside respect for popular, voter-driven cannabis initiatives at the state level. Something can be done to reduce overdose deaths, but only if our government wages the correct fight.

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