Rethinking our war on drugs is imperative to promote treatment, minimize the incarceration of victims, minimize the disparate incarceration of minorities in our criminal justice system and create a more uniform policy on how we deal with substances with addictive potential. Howard Koh MD, public health policy expert, has just published "A Smarter War on Drugs" JAMA. 2018;320(22):2301-2302.
We have explored various approaches to dealing with substances with the potential for addiction and lethal consequences including the two most deadly, cigarettes which kill 400,000 per year and alcohol which kills 80,000 per year. These two legal substances kill five times more people than the opioid epidemic kills. Nicotine is more addictive than heroin yet it still remains legal. Alcohol destroys lives and causes untold suffering. Is there a ground swell of opinion to make alcohol and tobacco products illegal or jail those with addiction to nicotine or ethanol?
We are all aware of the lack of success of prohibition on dealing with alcohol addiction and while deaths from cirrhosis decreased during prohibition, a huge criminal enterprise to supply alcohol was created. It is no surprise with our current penal code that the US has the highest incarceration rate in the world. Tragically the for profit nature of the prison system creates huge incentives for that industry to promote penal policies. There is strong support for local police departments that did not punish drug users for voluntarily surrendering their drugs and being sent for treatment rather than to jail. Compassion and treatment should guide our policies, not punishment.
Whether we label addiction a disease or condition, few experts endorse a philosophy that substance use disorder (SUD) is a moral failing. The topic is complex and multiple etiologies and risk factors exist. Many environmental, social and genetic factors are associated with SUD. The world health organization and others have resources for school based programs. Prudent educational and treatment based policies are available to mitigate the epidemic of SUD
Worldwide other countries have taken a non punitive approach such as the Nederlands and Portugal and there has been no spike in SUD. Portugal has the second lowest rate of drug related deaths, 3 per million as compared to the EU average of 17.3 per million
Use compassion and treatment as our approach to addressing SUD
Promote school based education and use societal resources to help minimize the devastating impact of SUD. Tax substances with abuse potential like cigarettes and alcohol and direct those funds for minimizing SUD.
Explore and test different non penal approaches to dealing with SUD following the experience of other successful systems
How many times have we heard that we have lost the war on drugs? We need to rethink our a penal approach to drugs and adopt a prevention based and treatment based approach to address SUD. We need a strategy which treats those addicted to illicit drugs no differently than alcohol and tobacco, recognizing we can dramatically improve our overall impact on SUD.