Eroding Hopes for a Kinder, Gentler Drug Policy

By Ethan A. Nadelmann, AlterNet
Posted on July 29, 2002, Printed on February 13, 2012
http://www.alternet.org/story/13700/eroding_hopes_for_a_kinder%2C_gentler_drug_policy

Until a few months ago, it seemed possible -- unlikely but possible -- that the Bush administration might take a chance in the right direction on drug policy. The president had expressed seemingly heartfelt empathy for people struggling with addiction. Both he as well as the new DEA administrator, Asa Hutchinson, and the new drug czar, John Walters, had expressed a willingness to revisit and perhaps revise the harsh federal mandatory minimum drug sentencing laws, particularly those with such a disparate impact on African Americans. Mr. Bush had even said on the campaign trail that he thought medical marijuana policy should be left to the states.

However, I no longer hope for progress toward a more tolerant and decent federal drug policy during the next few years. In March I sat in the courtroom at the U.S. Supreme Court and listened to the Bush administration's deputy solicitor general argue that every American public school student should be urine tested for drugs. The same afternoon, Justice Department officials testified before the U.S. Sentencing Commission that they no longer saw any need to revise the 100:1 ratio on penalties for powder and crack cocaine. So much for the commitments by the president and his drug policy advisors.

What's really at issue here are fundamental questions over which principles, objectives and criteria should guide our nation's efforts to deal with drug use and abuse.

The prevailing approach in the United States is the war on drugs, which essentially is based on two presumptions: that the criminal justice system and other punitive mechanisms must play a central role in U.S. drug policy, and that the only permissible approach to drug use itself is zero tolerance. Drug policies are evaluated principally in terms of increases or decreases in the numbers of citizens who admit to using drugs illegally; the ultimate aim is a "drug-free" society.

The contending approach -- advocated by the Drug Policy Alliance, the nation's leading drug policy reform organization, and by a growing drug policy reform movement in this country and abroad -- is harm reduction. We believe that criminal justice measures to control drug use are mostly ineffective, counterproductive and unethical, and should generally be used as last, not first, resorts. We regard abstinence as a desirable way to avoid drug problems, but also insist that responsible users of psychoactive drugs should not be punished. We see the fantasy of a drug free society as foolish and potentially dangerous in its absolutism. Our ideal drug policy is one that most effectively reduces the death, disease, crime and suffering associated with both drug use and our largely failed drug control policies. And we insist on the need for fallback strategies, such as needle exchange or measures to stem fatal overdoses, to reduce the harms of drug use by and among those who cannot or will not stop using drugs today.

I have long assumed that drug abuse counselors -- because they deal with drug abusers as human beings, and because so many once struggled with addiction themselves -- must naturally be drawn to drug policy reform. But I also know that the trauma of drug addiction can distort clear analysis, that the constant search for government funding can compromise one's principles, and that relying on the criminal justice system to force people into treatment can prove highly seductive in dealing with people who can't or won't stop using drugs.

I listen to the Bush administration's statements and the response among many leaders in the treatment field, and fear that people who should know better are being co-opted by hollow rhetoric and a few more dollars thrown their direction. There was much applause among treatment professionals when the administration announced its new drug control budget because it included $224 million (6.2%) more for drug treatment than the previous year. It seemed almost impolite to note that expenditures on prevention and research had dropped by $75 million (3%), spending on interdiction had increased by $215 million (10.4%), and that the basic ratio of federal expenditures on drug control remained essentially the same; twice as much for law enforcement and interdiction as for treatment and education. Behind the self-congratulation, the punitive priorities remain unchanged.

It's not enough, however, to focus just on the dollars allocated for drug treatment. Even more important are the policies that determine how these dollars are spent and how drug users, past and present, are treated. Drug treatment in the United States is mostly trapped inside an ideologically confined box that ill serves millions of people struggling with drug addiction. It's time to recognize the need for genuine diversity in addressing the infinite number of variables that determine why some people get in trouble with drugs and others do not. No single treatment approach - no matter how successful for some - can work for all.

Methadone maintenance, for example, remains stigmatized and ostracized in many parts of the country, a victim of misguided abstinence-only ideologies that disparage medical evidence. While Europe, Australia, Canada and other nations make this treatment available in pharmacies and doctors' offices and public health clinics, in the United States all but a few patients can obtain their medication only in heavily regulated clinics that may be far from their homes, poorly run, and staffed by personnel who are often hostile to methadone treatment. The former drug czar, Barry McCaffrey, at least gave lip service to making this treatment more readily available to those in need. The current drug czar so far has been silent.

If the planned expansion of buprenorphine maintenance ultimately leads to a diversification of opioid maintenance prescribing options -- so that addiction treatment begins to resemble good pain management -- then buprenorphine will have performed an important service. If buprenorphine instead provides an excuse for curtailing access to methadone and other maintenance options such as are now proliferating outside this country, it will result in more harm than good.

Perhaps the greatest contradiction in U.S. drug policy is that between the official rhetoric of helping people with drug problems and those in recovery, and the litany of legal discriminations that exacerbate drug problems and impede recovery. More than ten million Americans -- maybe double that -- have been convicted of drug offenses ranging from marijuana possession to sale of one illicit drug or another. The 1996 welfare reform act revokes welfare benefits for anyone convicted of a felony drug offense -- for life. Under federal law, innocent family members of people who have used drugs can be evicted from public housing - even if the family members do not even know about the drug use. Otherwise law-abiding students are targeted as well: The federal Higher Education Act delays or denies eligibility for federal financial aid to any student convicted of any drug offense, no matter how minor. And in the wake of September 11, as private companies step up their background checks of current and potential employees, more and more people with minor drug offenses in their (often distant) past are finding themselves without a job.

None of these policies is consistent with good drug treatment -- yet this administration, like its predecessor, has done nothing to repeal them; indeed, the perpetual search seems to focus on new and more onerous penalties. The single greatest challenge facing addiction counselors today concerns their relationship to the criminal justice system, and particularly to drug courts. The alternatives-to-incarceration movement has made important strides in diverting many drug offenders from courts and jails to treatment programs.

California's Proposition 36, for one, achieves this diversion while seeking to minimize the corruptions inherent in authorizing court supervision of an individual's drug treatment program. Citizens in Ohio, Michigan and possibly Washington, D.C. will vote on similar ballot initiatives this fall, and state legislatures around the country are debating similar sorts of bills -- all of which seek to improve and expand drug treatment options while reducing the use of incarceration in dealing with drug use and addiction.

But the popularity of drug courts and the increasing entanglement of criminal justice with treatment can come at a high price -- the sacrifice of confidentiality between patient and caregiver; the diversion of government funding from voluntary and community-based treatment into coerced treatment programs, often behind bars; the propagation of a myth that treatment doesn't work unless it's backed by the state's coercive powers; the de facto criminalization of relapse; the need to treat non-problematic marijuana use as a basis for revocation of probation or parole; and so on.

I fear that much of the treatment community has developed its own co- dependence -- on the criminal justice system. That's where the money is, that's where the "market" is, and that's where one can turn when treatment "fails." Some drug court judges, I believe, are doing the Lord's work, but the institutionalization of the drug court model -- where judges obsessed with dirty urines substitute their judgments for those of treatment professionals -- may well corrupt drug treatment to the point that it becomes little more than a synonym for state-coerced abstinence.

The federal government's support for drug treatment does not extend far beyond its coercive aspects. Read closely the testimony of drug czar Walters and DEA chief Hutchinson. Listen to their speeches. And most especially watch their actions. This administration's bottom line on drug policy ultimately has little to do with helping people who struggle with drugs, much less those who have been arrested for a drug offense. Like the temperance warriors who shaped alcohol policy during the first decades of this century, their policies are really about punishing people for the sin of drug use.

Addiction counselors ultimately have to decide how much, and on what conditions, they are willing to ally with and subordinate themselves to the criminal justice system in dealing with their clientele. This is an issue that goes to the heart of the profession. I only hope that this debate has begun in earnest, for it concerns the core values, the soul and the future of addiction counseling in America.

Ethan Nadelmann is Executive Director of Drug Policy Alliance.

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