Griffin Dugan, 1629137

LSJ 376, Section AF

5/30/18

The Opiate Task Force’s Response to the Opiate Epidemic

Introduction

Drug use has been ubiquitous throughout human civilizations. However, in the age of

rampant capitalism and a culture of mass consumption, many modern countries are experiencing

crises surrounding the overuse of drugs and drug addiction. In particular, the United States of

America is currently in the midst of the appropriately-labeled “opiate epidemic”. A rich history

of Big Pharma’s promoting of opiate painkillers played a huge role in the development of this

epidemic, and the federal government’s attempts to prohibit drug use have had disastrous effects.

In response, the Opiate Task Force has elected to decriminalize the possession, use and selling of

opiate drugs. Instead, civil restrictions and sanctions will be placed on those seen possessing,

using or selling these drugs, including fines and referrals to treatment when necessary. In turn,

treatment for the opiate epidemic should focus primarily on harm reduction as opposed to

abstinence, as approaches like Law Enforcement Assisted Diversion (LEAD) and safe injection

sites have consistently proven to be more effective at treating problems with drug abuse

compared to abstinence programs like Alcoholics Anonymous or drug court. While this

approach does not come without its own problems, it will still be an improvement over the

current “war on drugs” mentality.

An Overview of Current Problems with the Opiate Epidemic

 The opiate epidemic’s namesake can best be understood by looking at the alarming

statistics of abuse and overdose in the United States. Out of all the countries on Earth, the

United States is responsible for up to 80% of opiate painkiller consumption (Lecture 4/30).

Estimates show that 78 Americans die from opiate overdose every day, and this rate has

quadrupled since 1999 (Hari 2017). Some sociologists predict that by the end of 2018, 650,000

people in total will have overdosed on opiates (Lopez 2017). In more recent years, although the

overdose rates due to prescription opiates has leveled out, these deaths have been overtaken by

overdoses due to the use of illicit opiates like heroin and fentanyl (Lecture 5/2). The economic

burden of this epidemic adds up to more than $78.5 million, with a 1/3 of that coming from

expensive health care and drug treatment costs (Lopez 2017). These numbers demonstrate the

wide-reaching and fatal implications of this drug epidemic, as the US is losing lives everyday

due to its mass consumption of opiates.

In order to best combat this epidemic, it’s important to recognize what factors led to its

creation. The opiate epidemic can be traced back to the upsurge in opiate painkiller prescriptions

in the 80s and the 90s that overlapped with the “pain revolution”. During this time, chronic pain

was increasingly becoming a better recognized problem, and organizations like the American

Pain Association were pushing doctors to prescribe opiates to treat it (Lecture 5/2). When Big

Pharma took notice that painkillers were creating a lucrative market, there was a concentrated

effort on the part of pharmaceutical companies to try and monopolize the market. Most notably,

Purdue Pharma’s creation and subsequent patenting of OxyContin in 1995 drew in massive

profits, particularly because the company falsely advertised the medication as being this panacea

for pain that people could not become addicted to (Sarpatwari 2017). Loose patenting laws

combined with miniscule regulation of such false advertising contributed to the rise in opiate
painkiller prescriptions (Sarpatwari 2017). Once governments started to create some regulations

regarding opiate prescriptions, many people were already addicted. When they were denied

painkillers through the legal market, these people turned to cheaper illicit substances like heroin,

which provided six doses for the price of one OxyContin pill (Lecture 5/2). In this way, the

over-prescription and subsequent deprivation of opiate painkillers directly contributed to the

excess of addictions to illicit opiates.

The punitive practices that the federal government used in an attempt to fight this drug

epidemic have only made matters worse. To date, the US government has spent over one trillion

dollars on the war on drugs, and currently it is spending fifty billion dollars annually to maintain

the fight (Lecture 5/14). Despite the government’s goal to drive up the price of opiates in order

to decrease the availability of these drugs, the price of heroin has dropped 85% since 1981

(Lopez 2017). This has only served to make the drugs more available to the public, increasing

the rates of addiction. The main visible impact of the war on drugs has been mass incarceration,

which has made the US the largest jailer in the world. This large prison population

disproportionately affects minority groups, especially black men (Forman 2011). Outside of

prison, the criminal justice system’s label continues to have an impact on prosecuted and

incarcerated individuals. Having the label of “drug criminal” on a person’s record comes with a

variety of additional disadvantages, including employment discrimination and the loss of rights

to voting, jury service, certain health and welfare programs, food stamps, public housing, and

student loans. Beyond that, the racial disparity in which certain groups are targeted and

imprisoned contributes to harmful stereotypes about members of said groups, and these

stereotypes have lasting and debilitating impacts on drug users as well as non-users (Forman

2011). Considering the lowering of drug prices and the heightened levels of mass incarceration,
it is easy to conclude that the US government has failed to combat drugs in America, including

opiates.

Policy Reform: Why Decriminalization Works

Given this epidemic’s history, decriminalizing these opiates while maintaining civil

sanctions for their public use, possession and selling is the best way to combat this issue. The

goal of doing so would be to decrease the costs associated with law enforcement and the criminal

justice system, while also providing treatment for addicts and withholding stigmatic judgement

of drug use in general (Lecture 5/30). The model for this policy would primarily come from

Portugal, where in 2001 the country decided to decriminalize all drugs and instead place civil

sanctions and restrictions on use and possession for up to 10 days’ worth of the drug. In doing

so, Portugal created regional Commissions for the Dissuasion of Drug Addiction (CDTs) that

decided on a case-by-case basis whether the person caught using or possessing drugs was simply

doing so experimentally/recreationally, or if there was actually drug addiction present. For the

recreational users, fines and mandatory educational services would be placed on the individual.

However, in cases of drug dependence, the CDT would instead recommend drug treatment and

education services for the individual (Hughes 2010). The US should adopt an identical model

for opiate use, with the fines of the recreational user going towards payment of the treatment

programs needed by addicts. Additionally, the US should include sellers under

decriminalization’s protections, as many sellers are addicted themselves and are selling drugs to

maintain this lifestyle. In this way, the US can adopt a policy of decriminalization that reduces

legal costs and helps drug addicts recover most effectively.

This model of decriminalization has been shown to be effective at confronting

problematic drug use and abuse. In the case of Portugal, decriminalization proved itself to
reduce problematic use, overdose and opiate-related deaths, drug-related harms, criminal justice

overcrowding, mortality rates, and HIV transmission rates. There was also a visible increase in

the uptake of drug treatment, primarily by the older population (Hughes 2010). Additionally,

data has been gathered from various US states that have already voted to decriminalize marijuana

in favor of civil sanctions. In these states, there was absolutely no impact on drug use (Lecture

5/30). These data help dispel the myth that decriminalization would encourage drug use and

increase addiction and overdose rates. As these examples show, decriminalization does not

actually foster more drug use, and lends itself to reducing problematic drug use behaviors and

consequences.

Drug Treatment with a Focus on Harm Reduction

Even when these drugs are decriminalized, it is essential that drug treatment policies are

put in place. Currently, there is a lot of unmet need for drug treatment: in 2015, 22 million

Americans needed treatment in a specialized facility, and only 10% of these people ended up

getting access to treatment (Lecture 5/21). This unmet need can be attributed to many things,

such as the 30 million Americans who still lack health insurance, as well as long waiting lists and

inadequate funding (Lecture 5/21). In order to eliminate some of this unmet need for treatment,

the civil fines collected from non-addicted opiate users can be used to fund more treatment.

Although this will not cover the large deficit in care, it will certainly contribute to a more

equitable playing field.

Outside of funding, there is the issue of what drug treatment programs focus on.

Research has made it clear that punitive programs that focus on abstinence from drugs have a

terribly low success rate. For example, although the abstinence-based Alcoholics Anonymous

holds the title for the most popular treatment option for alcohol addiction, it actually is effective
only between five and eight percent of the time (Glaser 2015). On the other hand, while people

who participate in drug court’s complete abstinence from drugs do report lower recidivism rates

and better life outcomes than those who go to prison, their results are as effective as in-

community treatment facilities (McCoy 2009). These data suggest that while these abstinence-

based treatment programs are effective in some circumstances, they are not the best option for a

large portion of the drug-using population.

In comparison, harm reduction programs have consistently shown to be more effective at

treating drug abuse and addiction. For example, LEAD is a program started in Seattle that

matches drug users on the streets with case managers that work with them to secure housing and

food, without requiring the client to stop using drugs (Lecture 5/21). Not only has LEAD created

a much more connected and cooperative framework for the different branches of Seattle law

enforcement, but it has also resulted in clients being 60% less likely to be rearrested, and 87%

less likely to be sentenced to prison within the first year of their enrollment. Furthermore, LEAD

clients ended up spending 39 fewer days in jail on average, and as a result the city saw a 30%

decrease in criminal and legal systems costs (Beckett 2016). These data suggest that a more

interconnected, public health approach to the opiate epidemic lends itself to positive results.

Additionally, there are harm reduction programs outside of LEAD that show promising

results. Also located in Seattle is 1811 Eastlake, a housing project for alcoholic people to live

that results in less time in the ER and jail, and consequently less money being wasted (Lecture

5/21). Although this project is specifically for alcoholics, there’s no reason to suggest similar

results wouldn’t occur if a site was made for opiate addicts. Methadone maintenance programs

that are used to treat narcotic drug addictions usually keep 1/3 of their clients, and have been

shown to reduce the total volume of heroin in the clinic’s area (Lecture 5/21). Syringe exchange
programs have been effective at reducing HIV/AIDS transmission rates, and there is currently no

evidence to suggest that the creation of a syringe exchange site encourages more drug use or new

drug users (Lecture 5/21). Finally, safe consumption sites are locations where people are able to

go to safely use their drug of choice without being subject to law enforcement and the civil

sanctions of decriminalization (Lecture 5/21). All of these harm reduction programs represent

the possibility for evidence-based, effective treatment for drug addicts that take a public health

focus.

The Newness of Decriminalization

There will be a few things to be wary of when decriminalizing these opiate drugs.

Firstly, the results of decriminalization on drug abuse in the US will be difficult to research and

ascertain in terms of causality, as it is impossible to control every confounding variable when

enacting new policy (Lecture 5/30). This means that changes to opiate use and abuse that are

directly attributable to decriminalization will take a lot longer to determine. In the same vein,

although there are real life examples of drug decriminalization seen in instances such as

Portugal’s decriminalization of all illicit drugs or certain US states’ decriminalization of

marijuana, for the most part decriminalization is a recently evolving policy idea (Lecture 5/30).

The reality is that the war on drugs has been waged in the US for nearly half a century, so a lot of

the knowledge surrounding drug policy is inherently engrained in this prohibitionist mentality

(Lecture 5/14). In addition, because of strict conventions for its members, countries that are a

part of of the UN have found it nearly impossible to experiment with alternatives to such a

prohibitionist response to drug use (Hari 2016). While the data aforementioned does strongly

suggest decriminalization will be more effective than criminalization, the sheer newness of these
kinds of policies makes it difficult to predict its success and outcomes with one-hundred percent

certainty.

Conclusion

The reality to accept is that the war on drugs has ultimately failed to combat America’s

opiate epidemic, and in many ways its prohibitionist and punitive practices have caused more

public harm than good. The opiate epidemic started with the pharmaceutical companies being

irresponsible with their advertising and distribution, and this neglect has lent itself to the harm

and fatalities we see today. The continued rates of opiate overdose deaths, combined with the

flooding of prisons by disproportionate numbers of people of color, exist in spite of criminal law.

This clearly demonstrates that drug criminalization is a harmful and ultimately futile practice. In

response, it is in the country’s best interest to decriminalize opiate drugs while maintaining civil

sanctions that will help deter drug use and fund treatment programs. These treatment programs

must take on a realistic harm reduction philosophy; drug use has proven itself to be inevitable, so

the most responsible and pragmatic action would be to help reduce the harms associated with

drug use. Should the US choose to decriminalize these drugs, it will serve as an example for

other countries going through similar drug problems. It is because of its position as a role model

that the US has a national duty to be at the global forefront of drug policy reform and treatment.
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