A Public Health Approach to Drug Policy

 

If your neighbor told you she had cancer, what would you do? You’d probably say, “I’m sorry,” maybe you’d offer to drive her to treatment, offer to watch her kids or do something else to help her out in a difficult time. But what would you do if you heard police stopped your neighbor and discovered that she had heroin in her pocket? Avoid her? Think she should have known better?

 

While all evidence suggests that addiction is a disease, a disease that affects the brain and body, a disease, like cancer, that some people are more likely to get than others, and a disease that can respond well to treatment, it’s the one disease that we punish and incarcerate people for. For over thirty years now, more and more Americans with addictions have ended up behind bars as a result of sentencing policies. Starting in 1973 with the Rockefeller Drug Laws that created the first mandatory minimum sentences for drug crimes, states and the federal government have prioritized locking people up over treating them even though treatment reduces crime, creates safe communities and costs much less than prison.

 

A 2008 Justice Policy Institute report showed that increasing admissions to drug treatment is connected to a decrease in crime rates, reduced incarceration rates, and helps people be more successful reentering the community after prison.[1] A range of national research has shown that for every dollar spent on drug treatment in the community, the public receives $6 to $7 in benefits from decreased crime, decrease cost of incarceration, stable employment, and more.

 

Slowly, some states and the federal government are realizing their public safety priorities have been in the wrong place. Some of New York’s Rockefeller Laws were rolled back this year, and the Obama administration and U.S. Attorney General are voicing support for a reform to the crack cocaine laws. What’s going on? Groups around the country are educating people that drug use and abuse is a public health problem, not a criminal justice problem.

 

What does that mean – public health problem? The Drug Policy Alliance and New York Academy of Medicine define a public health approach to drug policy as: a coordinated, comprehensive effort that balances public health and safety in order to create safer, healthier communities, measuring success by the impact of both drug use and drug policies on the public’s health.

 

What does that look like in practice? For anybody thinking about how to get a handle on thinking about drug policies that create healthier communities rather than more incarceration, the City of Vancouver, B.C., has created a framework for developing coordinated and comprehensive policies targeting public health. They call it the four pillars approach, and the four pillars are prevention, treatment, harm reduction, and public safety.

 

Prevention is about education and activities that help people make healthy decisions about using substances like drugs, tobacco and alcohol. Often we think about prevention as being focused on youth with hopes of reaching them before they begin to use addictive substances. Prevention programs should be realistic, age-appropriate, and culturally appropriate. Prevention can also include activities like youth after school programs that give young people information and choices about safe and healthy ways to spend their time.

 

While we might think of prevention programs as something that happen in the classroom or community, they are connected to policy decisions at federal, state and local levels. Funding is needed to implement prevention programs, and often decisions about what programs are appropriate are made by elected bodies or government agencies. Successful prevention programs are probably the least expensive way to treat drugs as a public health problem. By helping change behavior early on, communities avoid the associated costs of increased need for medical care, crime, incarceration, missed work days, and more.

 

Addiction is treatable, but treatment services are lacking in Oregon and across the country. About one out of every eight Oregonians, around 258,045 people, needs some kind of assistance for a substance abuse problem. Only 25% received publicly supported treatment.[2] In Oregon’s prisons, over 10,000 people have a moderate to severe addiction.[3] The need is there, and it’s huge, but investing in treatment saves money and creates more public safety in the long run.

 

So if treatment is so great, why don’t we have more of it? Simply put – money. If you want more treatment you need more infrastructure, more counselors, more offices, more beds in residential treatment and none of that happens without a dedicated source of money. The State of Oregon does not put enough resources into treatment to allow treatment to expand to meet the needs of the state’s residents. Instead, we ignore the need, and send some to prison for addiction-driven crimes like identity theft that could have been prevented.

 

For several legislative sessions, groups such as the Oregon Partnership and Oregon Prevention, Education, and Recovery Association have mobilized to raise revenue for prevention and treatment by increasing the tax on beer. Even though Oregon has one of the lowest beer taxes in the country, increasing the beer tax has not yet been successful.

 

Some programs combine both treatment and enforcement parts of the four pillar approach. Drug courts connect people arrested for possession with a treatment program. A judge monitors an individual’s progress. If a person completes the treatment requirements, the drug charge is dropped. The judge can also impose a range of sanctions if a person is not complying with treatment. Multnomah County, Oregon, has the second oldest drug court in the country. In its first ten years of operation, the drug court saved an estimated $79 million due to the decrease in recidivism of participants. The drug court also cost $1,392 less per person than the standard court/jail approach.[4]  Along with the challenges of just meeting the needs of treatment, are meeting the needs of people in recovery. More clean and sober housing is needed in Oregon, and treatment should also include assistance with getting jobs and other life skills when appropriate.

 

Harm reduction is the idea that we should work to reduce the harms associated with addiction regardless of whether a person is in treatment or not. Harm reduction programs can create safety for both individuals and communities.

 

Needle exchange programs are fairly well known harm reduction projects. At their most basic level, the programs try to keep people with addictions safe by making sure they have clean needles and don’t contract or spread disease. At the community level they slow the spread of diseases like HIV or Hepatitis C and make neighborhoods safer by decreasing the number of abandoned syringes. They can also be entry points for healthcare and treatment programs.

 

With a public health approach, law enforcement actions should focus more on mid- to high-level dealers, trafficking, and organized crime, not on small-time dealers who are supporting their addiction.

 

In another place where treatment and public safety come together, a public health approach also suggests that people on parole, probation, or post-prison supervision should have access to treatment rather than jail or prison sanctions for a dirty UA (urinalysis). Like community-based treatment in general, addiction services for people coming out of the criminal justice system need more resources.

 

This article is just a starting place for a longer discussion about how we handle addiction and crimes connected with addiction in the community. In moving forward, we must remember that the criminalization of addiction impacts some parts of our community more than others. Racial profiling and other examples of structural racism mean that people of color with addictions are more likely to end up in the criminal justice system. African Americans in particular make up the vast majority of people serving long sentences for crack, even though crack is used by whites, Latinos, and African Americans about equally. Treatment services are not distributed equally, however. With so few state resources allocated to treatment, under-resourced communities of color often have less access to treatment or treatment that is culturally appropriate.

 

Women and children are also disproportionately affected by the criminalization of addiction. Few residential treatment programs allow children to live with their mothers. Greater access to community-based and residential treatment could save the state money by keeping more children out of the foster care system.

 

 

We want safe communities and effective uses of our ever dwindling tax dollars. We want people to be healthy, families to stay together, and people to know that recovery is possible. We know that right now thousands of people are locked up in Oregon’s prisons that have a moderate to severe problem with alcohol or drugs. Certainly not all of those people are in prison for drugs; but how many could have been kept out of prison in the first place, how much harm might have been prevented if people who needed treatment had access to it? If those people still need and don’t get treatment when they get out, then we haven’t done our work to create public safety. We know that treatment works and that it’s a better place than prisons to put our money. So let’s come up with a public health approach for Oregon so we’re treating the disease of addiction, saving lives, and saving resources.

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