Public health experts have long decried the United States’ drug war — a law-and-order approach to reducing the drug trade by punishing sellers and users — for impeding the development of a public health model that views drug addiction as a disease that is preventable and treatable. Now, a new policy paper from Rice University’s Baker Institute for Public Policy has analyzed trends in drug policy and use, and is calling for a transition to a harm-reduction approach, which research suggests would more effectively reduce the negative individual and societal consequences of drug use.
According to the paper’s author, Dr. Katharine Neill, the rate of federal inmates incarcerated for drug offenses hovered at just under 50 percent in 2011, and in 2013 the federal government budgeted $25.6 billion to fight the drug war, $15 billion of which was directed toward law enforcement. In addition, by some estimates, state and local governments spend a combined total of $51 billion per year on drug-related law enforcement efforts, which suggests they have a lot to gain by investing in treatment options, said Dr. Neill.
“That law enforcement efforts continue to dominate drug policy highlights the need to reframe the discourse on drug use and addiction,” said Dr. Neill, the Baker Institute’s Alfred C. Glassell III Postdoctoral Fellow in Drug Policy. “While emphasizing the cost-saving benefits of treatment is important, this should be coupled with more public conversations focusing on drug addiction as a disease requiring medical treatment, not politically based solutions. Reframing the issue in this way should increase the likelihood that a public health approach to drug policy will be adopted for the long term.”
The policy paper, “Tough on Drugs: Law and Order Dominance and the Neglect of Public Health in U.S. Drug Policy,” is published in the journal World Medical and Health Policy.
Harm reduction is a public health philosophy and intervention that, quite simply, seeks to reduce the harms associated with drug use and ineffective drug policies. A basic tenet of harm reduction is that there has never been, and will never be, a drug-free society. “A harm-reduction approach recognizes the permanence of drugs in society and, instead of trying to eradicate drug use, focuses on minimizing harm associated with drug use for the individual and society,” said Dr. Neill.
This approach encompasses several objectives, including:
- preventing individuals from using drugs;
- treating individuals who want to stop using drug;
- preventing drug use where it increases the chances of negative outcomes such as driving while on drugs; and
- helping individuals who want to continue using drugs do so in a way that does not further compromise their health or the health of others.
This last objective is often achieved through needle-exchange programs intended to prevent the spread of HIV and hepatitis C and is more controversial than other policies, noted Dr. Neill. More recently, as opioid overdoses have spiked in the U.S., harm-reduction proponents have also encouraged policymakers to expand the availability of naloxone, a prescription drug that can reverse an opioid or heroin overdose if administered in time. The World Health Organization estimates that expanding access to naloxone outside of emergency rooms in the U.S. could save as many as 20,000 lives every year.
As a broad approach to drug use, harm reduction is multidimensional and can even include contradictory objectives, she said. For example, some proponents wish to decriminalize drug use and focus on helping drug users get the resources they need for treatment or to continue to use drugs safely, while others accept the illegality of drug use so long as treatment is more available. Others argue that distinctions should be made between drugs according to the risks they pose to the user and society and that policy should be based on these distinctions.
Still, said Dr. Neill, most advocates of harm reduction agree on some basic tenets, including the view that addiction is a disease requiring medical assistance, the desire to minimize risky behavior without requiring abstinence and the need to protect the public from the consequences of drug use, which includes punishing individuals who commit acts that harm others.
“Despite some debate within the public health community about how to deal with drug use, it seems clear that a multifaceted approach is necessary,” Neill said. “This includes educating the public on risks associated with drugs via schools, parents, the media and public policy; addressing structural deficiencies that dispose people to drug use, including poverty, lack of education and poor housing conditions; facilitating community involvement in addressing drug addiction; providing services for diverse needs, including prevention, treatment, addiction maintenance and harm-reduction techniques; and funding research that examines the effectiveness of different types of programs and the interactions between individual and environmental factors that affect patterns of drug use.”