Decriminalizing drugs doesn't stop addiction

Decriminalizing drugs doesn't stop addiction

All the noise we keep hearing about “ending the failed war on drugs” and decriminalizing drugs as the solution to the addiction epidemic is just that – so much noise. In fact, decriminalization doesn’t guarantee less drug use and addiction to illicit drugs like heroin and cocaine and methamphetamine, or to prescription opioids like OxyContin and Percocet. But when legalization is combined with widely-available free treatment and social assistance programs, it can offer reductions in overdose deaths and the spread of needle-sharing diseases such as HIV and Hepatitis C. A recent column in the New York Times by Tina Rosenberg, a Pulitzer Prize-winning author and former Times editorial writer, describes the experiences in at least 25 countries that have legalized formerly illegal addictive drugs, mostly marijuana but in a few, all illegal drugs. Most notable among those countries has been Portugal, where heroin and other drugs were legalized before most, if not all, other countries. Most countries which have decided to experiment with legalization have simply followed Portugal’s model. In fact, Rosenberg’s article points out, legalization can have some positive effects on overdose and deaths. But it results in little or no reduction in current drug use, addictions and on the rate of new addictions as well. And it has no effect on the supply-side – importers, distributors and local dealers and pushers. This is where we must continue the “war on drugs.”

Portugal’s experience is followed in many countries

Among all the countries embracing some form of legalization, Portugal has gone the furthest, Rosenberg writes. In 2001, Portugal decriminalized possession of less than 10 days’ supply of any drug. Personal use of drugs is still illegal, but the penalties are administrative, not criminal. Meanwhile, dealing and trafficking are still crimes and are treated as severely as ever. “At the turn of the century, Portugal was drowning in heroin and had the worst HIV rates among injecting drug users in Europe,” Rosenberg says. “The country had responded with harsh drug laws, which had not helped. Indeed, the laws drove many users underground.” Today, when police catch people using or possessing drugs, the drug is seized. Within 3 days the user meets with a ‘dissuasion commission’ – usually a social worker and a psychologist who assess the user and his needs. Next comes a ‘dissuasion panel,’ typically a sociologist, lawyer and psychologist. They can take various actions, ranging from a simple warning to mandatory social or health services including treatment if the user is an addict. Users are only punished if they refuse to go or are repeat offenders. And punishments can be fines, community service or ongoing supervision by a local agency.

It sounds good, but it isn’t a slam dunk

Nuno Capaz, the sociologist on Lisbon’s dissuasion panel, said that decriminalization is easy, but it’s only part of the program. “You write down that if people are caught doing illegal things, the sanctions are administrative and not criminal,” Capaz said. “The hard part is making treatment available. It works for us because it works with our health care system — drug users who want treatment can get it for free.” Portugal is also big on “harm reduction” – needle exchanges and follow-up public health response. And although drug free addiction treatment is available, they’re also big on methadone and other substitution therapy to wean addicts off opioids. And pushing drug replacement programs like methadone means that fewer addicts are encouraged to get on the road to recovery right away. And as we said at the outset, the program is not slowing down the rates of use and addiction, but does have a beneficial effect on overdose and needle-sharing diseases.

The Portugal results are in – your results might vary

Here’s the results of what happened in Portugal:

Overdose deaths — down by 72 percent. In 2012 Portugal had 3 overdose deaths per million while the European average was 17.2 per million. In the US, there were 200 overdose deaths per million in 2013 and that number has risen since then, Rosenberg said.

Spread of HIV — down by 94 percent. In 2001, there were 1,016 new HIV infections in Portugal, and in 2012 only 56 – one of the largest drops in Europe.

Drug crime and imprisonment — down, by definition. In 2000, drug offenders comprised 43 percent of those sent to prison. Today its 24 percent, and primarily “the ones you want in jail: dealers and traffickers, not users,” Rosenberg said. Drug-related crime is also down, she said.

Drug use — mixed Two recent British studies looked at drug policies in different countries. The NGO Release looked at 21 countries following decriminalization and found no statistically relevant increase in levels of drug use. But Britain’s Home Office studied the results of drug policies in many countries around the world and observed no obvious relationship between the toughness (or lack of toughness) of a country’s drug laws and the levels of actual drug use in the country. For all its advantages, Rosenberg pointed out, decriminalization fails to alleviate many harms that come from drugs, and the lack of impact on usage is just one example. And Niamh Eastwood, executive director of the British organization Release, said: “[Decriminalization] doesn’t really undermine all the negative consequences from the illicit market. It doesn’t reduce violence. It doesn’t affect drug purity.” Rosenberg summed up: “Indeed, the inconsistent purity of heroin is a big contributor to overdose deaths. In short, decriminalization is not a good solution to the drug problem. It’s just a better solution than the one we’ve got.”

Bottom line – getting your life back is what counts

Regardless of whether drugs are legal or illegal, we’re dedicated to the effective detoxification of drugs and alcohol here at Novus. We set our patients up for the best possible outcome in their journey of recovery. If you or someone you care about needs help with addiction or dependence, don’t hesitate to call us.

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