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December 9, 2015

"Decriminalizing Drugs: When Treatment Replaces Prison"

The title of this post is the headline of this lengthy New York Times commentary piece authored by Tina Rosenberg, which gives extended attention to Portugal's experience with drug decriminalization. Here are extended excerpts:

If one of my children were a drug addict, what would I want for him?

I would want what any parent would: for his addiction to be treated as a health problem, not a criminal matter, and for him to have every kind of help possible to get him off drugs. Until that happened, I would want him to be able to manage his addiction and live a normal life by taking methadone or another substitute opioid. And until that happened, for him to stay as safe as possible from overdosing, developing H.I.V., or going to prison, which would irrevocably alter the course of his post-addiction life.

What’s significant about the question is not how I would answer, but the probability that I might be asked it at all. Because I am white and middle class, society would view my addict child as a sick person who needed help. If I were African-American and poor, he would most likely be seen as a criminal to be locked up. And no one would be interested in what I wanted, or what was best for him....

New England and Appalachia have been hit particularly hard by the heroin and opioid epidemic in the United States, but all across the country, policies are emerging that treat drugs as a health problem instead of a crime. Conservative politicians who once called needle exchange the devil’s work are now establishing them in their cities. Police officers now carry naloxone, a drug that instantly reverses overdoses, and are saving lives on a daily basis. Cities all over the country are copying Seattle’s Law Enforcement Assisted Diversion program, in which police officers put low-level drug offenders into treatment and social services instead of jail. It is hard to imagine Congress decriminalizing drugs, but easy to imagine that soon, any debate at the national level may be irrelevant.

Where will that take us? We can look at what happened in various countries that have decriminalized drugs. Portugal has gone the furthest. It decriminalized the personal use of all drugs (dealing and trafficking are still crimes and use remains illegal) in 2001. Its program is the most comprehensive and the best-studied. At the turn of the century, Portugal was drowning in heroin and had the worst H.I.V. rates among injecting drug users in Europe. The country had responded with harsh drug laws, which had not helped. Indeed, the laws drove many users underground.

On July 1, 2001, Portugal reversed course, decriminalizing possession of less than 10 days’ supply of any drug. That’s not legalization. But the penalties have been made administrative, not criminal. When the police catch people using or possessing drugs, the drug is seized. Within 72 hours, the user meets with what is called a dissuasion commission. The commission has social workers and psychologists who use the police report and assess the drug user and his needs. Then the user comes before a dissuasion panel; Lisbon’s, for example, has a sociologist, a lawyer and a psychologist.

The panel can simply warn a user, or send him to appropriate social or health services — including drug treatment if the user is an addict.  Nuno Capaz, the sociologist on Lisbon’s panel, said that users were punished only if they refused to go or they were repeat offenders.  The punishment can be a fine, community service, or supervision by a local agency.

Decriminalization doesn’t work alone. “You need to invest heavily in public health response,” said Niamh Eastwood, executive director of Release, a British organization. “The success of Portugal is not just a model of law reform, but also significant harm reduction and a public health response. The whole package should be deployed.” “Decriminalization is easy,” said Capaz. “You write down that if people are caught doing illegal things, the sanctions are administrative and not criminal. 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.”

As it changed its laws, Portugal set up prevention campaigns, harm-reduction measures such as needle exchange that make drug use safer, and treatment services. Although drug-free treatment is available, Portugal relies heavily on methadone and other opioid substitution therapy to gradually wean users away from drugs. Hyper-controversial when it first started, Portugal’s program is now widely accepted.  When global recession hit in 2008, the country’s health, housing and employment programs were severely cut. That may have affected its drug policies, but when drug programs themselves were cut — mostly outside of Lisbon — the losses were less than in other programs, Capaz said. Their success largely protected them, and politicians knew that cutting treatment or prevention services would only cost more later.

With those caveats, here’s what’s happened in Portugal:

Overdose deaths — down by 72 percent....

Spread of H.I.V. — down by 94 percent....

Drug crime and imprisonment — down, by definition....

Drug use — mixed....

Portugal is far from alone. At least 25 countries have decriminalized some drugs, mostly cannabis. A few countries in Europe did so in the 1970s — or had never criminalized drugs at all. But in the last 10 years more have joined in Europe and Latin America, and other countries that have not decriminalized have nevertheless softened their policies to emphasize public health and harm reduction.... The tragic exception to the trend is Russia, where even methadone is still illegal. Russia’s cruelty towards drug users is the main reason the country’s epidemic incidence of H.I.V. has doubled in the last five years....

The most surprising endorsement of decriminalization came last month from the United Nations Office on Drugs and Crime, which had always taken a hard-line approach to drugs. At a harm-reduction conference in Malaysia, the agency released a paper that began: “This document clarifies the position of UNODC to inform country responses to promote a health and human rights based approach to drug policy.” It lays out the case for decriminalization and harm reduction. (Branson put the paper on his website.)

As soon as the paper came out, the agency drew back. The author was supposed to speak at the conference, but didn’t. A spokesperson for the agency said the paper was “neither a final nor a formal document….and cannot be read as a statement of UNODC policy.” It’s not clear why the agency retreated, but in the past, the United States has pressured international organizations to retract documents that propose a softer line.

Other countries that have decriminalized have largely echoed Portugal’s results, seeing big improvements in avoiding deaths, disease and imprisonment, but very little effect on usage. Two recent British studies examined the effects of drug policy on drug use in different countries. The nongovernmental organization Release looked at decriminalization’s effects in 21 countries, and found no statistically significant increase in levels of drug consumption. Britain’s Home Office published a study last year of drug policies and their effects in countries around the world. “We did not in our fact-finding observe any obvious relationship between the toughness of a country’s enforcement against drug possession, and levels of drug use in that country,” the report concluded.

For all its advantages, decriminalization fails to alleviate many harms that come from drugs — its lack of impact on usage is one example. “Decriminalization doesn’t deal with the supply-side issues,” said Eastwood. “It doesn’t really undermine all the negative consequences from the illicit market. It doesn’t reduce violence. It doesn’t affect drug purity.” 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. 

December 9, 2015 at 02:22 PM | Permalink

Comments

Outlaw the poisons which kill. Number one is tobacco. The judges who send humans off to prison for smoking pot or snorting coke or pepsi are mostly all tobacco smokers. Those judges do not care that they are committing suicide so why put others in jail for less onerous drug use?

Posted by: Liberty1st | Dec 9, 2015 6:43:16 PM

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