Decarcerating America
Page 15
For drug policy advocates, it is important to consider what decriminalization means beyond the question of drugs. The drug policy reform movement has won significant success by promoting a narrative of the “nonviolent offender,” distinguishing drug offenses—most of which are nonviolent—from other offenses including, and especially, violent offenses. The public and lawmakers are more sympathetic to a person detained on a drug possession charge than one detained on, say, assault. But as this distinction continues to be made by the drug policy reform movement, it increasingly puts that effort at odds with the movement to end mass incarceration, because to win, we must not allow violence to become an all-encompassing justification for incarceration, nor can we allow for the continued use of language like “offender” which serves to dehumanize and “other” people.52
Nowhere is this dynamic more vivid than in efforts to reform cannabis laws, most of which have used this distinction to assure the public and lawmakers that a particular reform measure wouldn’t benefit “those people”—people with violent offenses on their records—but would benefit only those who committed nonviolent offenses. Not only do we need health-based approaches to drug policy, but in order to meaningfully decarcerate—to substantially reduce jail and prison populations overall—we need to develop new ways to address violence. We must actually respond to the needs of those harmed by crime (victims), meaningfully hold accountable those who commit violence, protect public safety, and find ways to accomplish these goals that do not require locking people in cages and dehumanizing them for interminable amounts of time.53 To meaningfully contribute to decarceration, decriminalization must form the basis for how drug policy reform initiatives and communications strategies are developed and deployed.
Using Facts, Not Propaganda
Basic knowledge about drugs is important for advocates working on drug policy and criminal justice reform; understanding differences between drugs and being aware of the relative harm versus benefit of drugs will aid reformers in all movements. Most urgently, however, reformers must understand that people take drugs for a variety of reasons, including for pleasure; that the vast majority of people who take drugs don’t have a problem; and that most who do experience a problem find a way to course-correct without formal treatment.
Compulsive, problematic drug use (addiction) is the exception and not the norm for most individuals’ use of drugs. Most adults who use psychoactive substances do so without it leading to serious problems in their lives, and they successfully carry out their responsibilities, from jobs to kids to community roles.54 This is true for familiar substances, such as tobacco, alcohol, caffeine, and cannabis, and it is also true for less familiar substances, such as cocaine, MDMA, opiates, and what are now called novel psychoactive substances.55
The potential for abuse of drugs, or harm caused by drug use, is real. But over the course of the drug war there has been deliberate, sustained misrepresentation of the scientific evidence about drugs to serve a political purpose of executing a drug war. Media too often report on fiction as fact, and policy makers are quick to use those accounts to formulate policies that serve a political purpose.
Promoting propaganda about drugs and drug use for political purposes is quite old, and nearly all of us have experience with it. In the 1980s, Nancy Reagan’s Just Say No campaign was launched, ostensibly to teach young people about the harms of drugs, but really it was the centerpiece of the Reagan administration’s effort to normalize their expanded drug war and recruit citizens to serve in it. I was in elementary school when the Just Say No program was launched; my school, like many around the country, adopted the program. Police officers came to our school to tell us that if we tried drugs, especially cannabis, even once, we’d become addicted, and that people who used drugs were bad people who should be reported to the police. Many kids in my school had parents who were participants in the countercultural drug scenes of the 1960s and early 1970s and regularly used cannabis (and sometimes other drugs). We were being asked to turn in our parents to the authorities.
When I tried cannabis myself in my early teens, I did not immediately crave heroin or other drugs, as I had been told I would. The authorities, in their zeal to keep kids off drugs, succeeded only in lying to my generation and undermining the relationship between kids and adults. Once I realized they were lying about drugs, I never again trusted what school authorities told me about much of anything else.
The misinformation and lies about drugs permeate science as well. Today this is seen frequently with regard to methamphetamine, which is practically the same, chemically speaking, as the pharmaceutical drug, Adderall.56 Yet that hasn’t stopped some scientists in the United States from concluding that methamphetamine use will “ruin your brain,” frequently showing electronic images that compare the brains of people who have used methamphetamine with the brains of those who haven’t. The differences are then presented as abnormalities that “prove” methamphetamine use irreparably harms the brain.57
One scientist decided to test this claim. Dr. Carl Hart, chair of the psychology department at Columbia University and the author of the acclaimed book High Price, reviewed the studies that had been conducted of methamphetamine use in humans and found that for people who used methamphetamine,
cognitive functioning overwhelmingly falls within the normal range when compared against normative data. In spite of these observations, there seems to be a propensity to interpret any cognitive and/or brain difference(s) as a clinically significant abnormality. The implications of this situation are multiple, with consequences for scientific research, substance-abuse treatment, and public policy.58
Drug war propaganda, left unchecked, finds its way into healthcare as well, particularly drug treatment. For instance, there is increasing evidence that cannabis can play a very useful role in reducing harms from other drug use, like opioids, yet many treatment and healthcare providers still won’t recommend cannabis because it is, well, cannabis.59 This is a kind of modern “reefer madness” that spurs otherwise smart people to cling to propaganda because the evidence contradicts their worldview.
Because mass incarceration cannot be ended without ending the war on drugs, it is imperative that reform advocates in both movements develop the ability to identify misinformation about drugs and combat it.60 Drug scares are routine in America—and in nearly every drug scare of the last 150 years, misinformation, propaganda, and outright lies have been used by authorities to target select populations for criminalization, most often communities of color. When these lies are repeated by advocates or assumed to be true, it inhibits our ability to advance reforms that roll back criminalization. To use a phrase coined by Dr. Marsha Rosenbaum, a scientist and longtime drug policy advocate, when it comes to drugs, it’s time we “just say know.”61
Promoting Harm Reduction
Many advocates working in drug policy reform have long known of and practiced harm reduction; indeed, the drug policy reform movement over the last thirty years has been profoundly shaped by it. Even so, not everyone in the drug policy reform movement understands what harm reduction is, and it is relatively new (if not entirely new) to many people working in the movement to end mass incarceration. As a conceptual and practical framework, harm reduction may be among the few approaches that can immediately strengthen both movements and foster more effective collaboration between them.
While there are various definitions of harm reduction, the Harm Reduction Coalition defines it this way: “Harm reduction is a set of practical strategies and ideas aimed at reducing negative consequences associated with drug use. Harm Reduction is also a movement for social justice built on a belief in, and respect for, the rights of people who use drugs.”62
Harm reduction has its roots in public health and can be applied beyond the scope of drug use itself. For instance, consider seat belts. Auto accidents are a leading cause of death in the United States; driving in cars can be quite dangerous, even deadly. To reduce the potential for injury or harm of
this dangerous activity, we wear seat belts. That’s a form of harm reduction.
Harm reduction is critical in these reform spaces because it accepts that human beings throughout the world have always used psychoactive substances (drugs) and are going to continue to use them, regardless of moral or legal consequences. Most do so without legal or health problems. There are, relative to the number of people who use drugs, a much smaller number of people whose drug use turns to addiction. By acknowledging the reality that, despite best efforts to discourage or prohibit drug use, many people are going to use anyway, and some will use in ways that may harm themselves, we can craft interventions that reduce drug-related harm, save lives, and improve health and safety.
Take syringe exchange programs, which have been operating legally in many states in the United States for thirty years and much longer underground. Developed by people who inject drugs to reduce transmission of blood-borne diseases, these programs allow people to obtain clean needles to inject drugs while providing proper, safe disposal of used needles. Syringe exchange programs are responsible for dramatic reductions in the transmission of HIV/AIDS among people who inject drugs. In New York City, for example, over the last twenty years there’s been an 80 percent drop in the number of HIV transmissions associated with injection drug use as a result of providing access to clean needles.63 These programs also become a pathway for people to connect with broader services and health care. While syringe exchange is still controversial in some parts of the United States, advocates in every region of the country are convening unusual alliances of health providers, people who use drugs, and local police leaders to launch and expand syringe exchange programs. Notably, syringe exchange programs are already standard practice integrated into healthcare systems in countries throughout the world, on nearly every continent.64
Another harm reduction intervention proven to improve health and save lives is supervised consumption facilities—places where people can consume their drugs in a medically supervised location instead of in an alleyway, a park, the bathroom of a McDonald’s or local coffee shop, or the street in between parked cars. They cannot purchase drugs there—they can only bring their own drugs to consume. Such facilities operate in nearly one hundred cities around the world, including Vancouver, Copenhagen, Berlin, Paris, London, and Sydney. The only such facility in North America operates in Vancouver, Canada; Toronto plans to open an interim site by the end of 2017. In the United States, both Seattle, Washington, and Ithaca, New York, are moving toward opening their own facilities.65 There are no recorded deaths in any of these facilities, but there are thousands of recorded instances of people getting help and often starting on their own paths to recovery.
For those who may recoil at the idea of creating a supervised consumption facility where people would consume their drugs under medical supervision, consider that variations of such places already exist, just for substances that are already culturally accepted. People buy and consume alcohol in bars, without any medical supervision. In major airports across the country, such as Atlanta and Salt Lake City, travelers can find “smoking lounges,” promoted by the airports as an amenity for travelers.66 In these lounges, smoked tobacco—by far a greater killer than heroin—can be consumed.67 Even though these rooms lack medical supervision and generally provide no resources to help users quit (should they wish to do so), they are a form of harm reduction. By congregating smokers in these dedicated smoking rooms, exposure of others to secondhand smoke is reduced, and airport personnel don’t have to deal with travelers who are frustrated by having to exit security to smoke.
Harm reduction interventions have dramatically improved treatment options for people struggling with addiction, especially heroin addiction. The most successful interventions for heroin addiction are maintenance therapies—methadone and burprenorphine.68 Americans may be surprised to learn that many countries, including Britain, Germany, Australia, and Denmark, allow doctors to prescribe heroin to people when methadone and buprenorphine have proven ineffective maintenance therapies.69 These interventions have proven to be incredibly effective in treating people with serious heroin addictions.70
As the opioid crisis in the United States continues to expand, and the response by some law enforcement leaders and Attorney General Jeff Sessions is so hyper-focused on criminalization, it is imperative for reformers to look for interventions that are not rooted in criminalization. Interventions like syringe exchanges, supervised consumptions facilities, heroin maintenance, and other harm reduction approaches may prove enormously valuable in addressing the crisis.
Finally, harm reduction can help advocates shape more effective public health communication strategies to address drug crises. Many politicians and law enforcement agents tell people that heroin is dangerous, and frequently say that even one-time use of heroin could lead to death. What if authorities took a harm-reduction-oriented approach? With heroin, for example, rather than rely solely on a message discouraging people from using it, what if authorities were to discourage use while acknowledging that some people will use it anyway? If we acknowledged this fact in policy and practice, it might lead to public health intervention messages like this:
Don’t do heroin. But if you do, make sure you’re as safe as possible. Don’t use alone. Have the overdose reversal drug naloxone on hand. Call 911 in an emergency. Don’t mix your heroin with other drugs—especially alcohol and benzos; the combination with depressants increases the likelihood you may overdose and die. And if you want treatment, call 555-555-5555 and you’ll be connected to help.
Harm reduction, as a practice and philosophy, has been shaped by people who use drugs—those who have been marginalized, stigmatized, criminalized—and has been remarkably successful in improving public health and safety. The wisdom, experience, and insight found in the networks of people who use drugs and harm reduction service providers who work with them have strengthened the foundation of the drug policy reform movement for years and can be engaged and utilized by advocates working toward decarceration. Reform efforts in both movements should, wherever possible, be oriented around harm reduction.
Strengthening the Safety Net
To realize a health based approach, we must strengthen the social safety net in the United States and improve access to that safety net—particularly access to health care.
The drug war is a systemic response to a perceived problem (or manufactured one, depending on your perspective). In his 2011 book Drugs, Crime and Public Health, Dr. Alex Stevens, a professor of criminology at the University of Kent, sought to understand the differences among Western industrialized nations in health outcomes related to illicit drug use. Why, he asked, did the United States have remarkably different outcomes from other industrialized Western nations, with higher rates of overdose death, drug addiction, and incarceration? While the Netherlands and Portugal have comparatively more liberal drug policies than the United States, Sweden’s drug policies are similar to the punitive approach in the United States. But even with this approach, Sweden demonstrated outcomes much more like those of the Netherlands and Portugal. What was happening to account for these differences?
The evidence, Stevens concluded, “indicates that the provision of social support is more important in affecting the levels of problematic drug use than is the stringency of drug policy . . . The levels of drug use and drug problems do not depend on the level of prohibition. They are more closely associated with the level of social equality and support.”71
Stevens is making a transformative point. To reduce the harms associated both with problematic drug use and with our enforcement of drug laws, we must not focus exclusively on drug policy but rather need to take account of the social inequalities that shape people’s lives. Sweden’s outcomes look more like those of the Netherlands because both countries have, in comparison to the United States, strong social safety nets and far less economic inequality. The drug war in the United States has expanded simultaneously with a constant and steady erosion of th
e social safety net. And the United States has some of the highest rates of economic inequality among developed countries.72
To end the drug war and mass incarceration, we need a social safety net prepared and resourced to respond both to addiction and to the real harms and issues that give rise to problematic drug use and the development of addiction. Services must be available regardless of geography, race, class status, gender, or any other factor, and all people must be able to access those services. Stevens noted:
Long-term solutions to drug problems require change to be effected outside the realm of drug policy. If governments do have the drug problems they deserve it is not because they have neglected to enforce their drug laws, but because they have failed to protect their citizens from the malign effects of inequality.73
In 2014, shortly after the implementation of the Affordable Care Act, which expanded health care access to millions of Americans, I co-authored a paper about how advocates could leverage the health care reform to end the drug war and mass incarceration. We wrote:
At a conceptual level, the [Affordable Care Act] represents an opportunity to recast substance use disorders and drug use as a matter for public health rather than criminal justice. Second, the dramatic expansion of healthcare coverage, enabling participation in community-based care and treatment, is likely to substantially improve the quality of life for millions of people, and particularly for low-income populations and communities of color, by expanding the social safety net through access to healthcare. In turn, this expansion may serve to reduce both criminal justice system involvement and the social exclusion so familiar under the structures that have developed through the far-reaching War on Drugs.74