My Paper: Lessons from Around the World on Drug Decriminalization and Legalization

After decades of tremendous financial and social costs, the punitive drug model is being steadily eroded at home and abroad. Even the conservative law-and-order types who oppose the use of illicit drugs are increasingly accepting that the war on drugs has failed both in its objective (undercutting drug use) and its efficiency (accomplishing little yet reaping a huge economic and human toll).

Even Mexico, which has suffered more than most nations from our appetite for illegal drugs, has gone forward with legalizing marijuana in an effort to undercut a major source of funding for its powerful and vicious cartels. (So now both of America’s only neighbors have fully done away with punitive attitudes towards one of the weaker and comparatively less harmful illicit substances.)

All that being said, I do feel validated in having proposed and written a paper exploring the alternative methods, policies, and cultural attitudes of various countries when it comes to illegal drugs. As the U.S. and other countries question the wisdom of the status quo, it may help to look abroad at those places that were ahead of the curve in dispensing with the punitive approach in favor of more constructive methods. I focus especially on Portugal, which twenty years ago blazed the trail towards decriminalizing all illegal drugs and framing their use as a public health matter rather than a criminal one.

See the source image

As you will hopefully read, many of these strategies are unique to the time, place, or sociopolitical context of the nations that implemented them; nevertheless, there are still useful lessons to glean, and at the very least we can see proof that there are other ways to address the scourge of drug addiction, trafficking, and other associated ills, besides the blunt instrument of police and prisons.

Feel free to leave your thoughts, reactions, and feedback. Thanks again for your time.

The Problem With How We Treat Drug Addicts

The United States is facing an opioid and heroin epidemic that is killing and harming record numbers of people; more people died of overdoses in 2014 than in any other year on record.

One of the latest and most troubling images of this problem was a widely circulated photo of a couple passed out in their car with their four year old left watching from the back city. The City of East Liverpool, Ohio saw fit to share the photo on its Facebook profile to “show the other side of this horrible drug”. Continue reading

Medical Commission Calls For End Of Global Drug War

An international team of medical experts, among them members of The Lancet, one of the world’s leading medical journals, and John Hopkins University’s esteemed Bloomberg School of Public Health, has published a report urging governments worldwide to end policies that criminalize drug use. The statement was timed for the United Nations’ upcoming special session on illegal narcotics. Continue reading

The Countries That Love Marijuana The Most

Using data from the newly-published 2014 World Drug Report conducted by the U.N., put together a graph of the world’s most marijuana-indulgent countries, based on the estimated per capita population of smokes. As expected, the results are interesting:

With an estimated 18.3 percent of the population smoking cannabis, Iceland tops the list by a comfortable margin, followed by Nigeria, Zambia, the U.S. and New Zealand. 

Meanwhile, marijuana is least popular in Ukraine, Finland, Suriname, Guatemala, and Germany — a rather random group of countries, much like the top five. 

Despite being world-renowned for its tolerant drug laws, The Netherlands is somewhere in the middle, with a little less than eight percent of the population lighting up. Perhaps that speaks to popular notion that drugs are only as popular as the strength of their taboo, at least in some societies?

Well, like most European countries (not to mention high-ranking Canada, Australia, and New Zealand), marijuana is technically illegal in Iceland but socially and politically tolerated — possessing a small amount or smoking in public results in a fine, with repeat offenders technically liable for jail time (although this is apparently uncommon).

Moreover, marijuana is expensive in Iceland, with one-eighth of an ounce of high-quality cultivars often costing $175 (compared to $30 to $50 in the U.S.). It is unknown why the island nation ranks so high, but the article postulated that the prohibition of beer until just 25 years ago made marijuana a popular substitute to unwind (since it was comparatively more accepted and easier to access, apparently).

In common with many other countries, Iceland is considering relaxing its drug laws to coincide with its already de facto acceptance of marijuana. Given the mixed bag of countries in which the drug is popular, it seems clear that what’s on the books doesn’t necessarily influence either the popularity or usage rate of a particular drug (although one would need to see data on other drugs to determine that relationship).

Anyway, what are your thoughts?

Inside the Mind of a Heroin Addict

Given the intense stigma of drug addiction, which is often met vicious condemnation and even disregard, the perspectives and mentalities of addicts themselves are rarely ever heard, much less sympathized with. This is arguably most true of heroin addicts, who are considered especially heinous given the intensity of that drug. Too many people see substance abusers as deserving of whatever horrible fate befalls them — after all, they put themselves in that situation, right?

Whatever motivations or triggers lead an individual to first try heroin — and more often than not, the habit is precipitated by an intersection of very complex psychological, social, and economic factors — the point is, they’re suffering immensely and don’t want to be where they are. The mind of an addict is a scary and hopeless place, as these series of accounts gathered by The Guardian attest. I urge everyone to read through them and try to get a little perspective on this neglected and misunderstood world of drug addiction.

As always, please feel free to weigh in.



The Double Standard of Drug Addiction

Yesterday, Phillip Seymour Hoffman — like sadly many other talented actors — died of an accidental drug overdose after years of struggles and relapses. His death has universally been mourned, including by yours truly. But like most high-profile deaths related to drugs, it exposes an even bigger tragedy: the unusual and ultimately counter-productive way in which society treats the subject of drug use. As Simon Jenkins of The Guardian succinctly observes:

Does the law also mourn? It lumps Hoffman together with thousands found dead and friendless in urban backstreets, also with needles in their arms. It treats them all as outlaws. Such is the double standard that now governs the regulation of addictive substances that we have had to develop separate universes of condemnation.

We cannot jail or otherwise hurl beyond the pale all who use drugs. We therefore treat some as “responsible users” and when something goes wrong mourn the tragedy. Offices, schools, hospitals, prisons, even parliament, are awash in illegal drug use. Their illegality is no deterrent. The courts could not handle proper enforcement, the prisons could not house the “criminals”. In Hoffman’s case his friends clearly knew that he was a drug addict. The police would have done nothing had they known.

So what do we do? We turn a blind eye to an unworkable law and assume it does not apply to people like us. We then relieve the implied guilt by taking draconian vengeance on those who supply drugs to those who need them, but who lack the friends and resources either to combat them or to avoid the law. Hospitals and police stations are littered each night with the wretched results.

There are no winners in the illegality of drugs, except the lucky ones who make money from it without getting caught. The only hope is that high-profile casualties such as Hoffman’s might lead a few legislators to see the damage done by these laws and correct their ways. At least in some American states the door of legalisation is now ajar. Not so in Britain, where the most raging addiction is inertia.

What do you think? Are drug-related deaths like Hoffman’s (among so many less visible ones) at least partly the result of a legal culture that criminalizes drugs, and by extension its victims? Would legalizing or decriminalizing once-illicit substances help turn drug abuse into a public health problem to be addressed, rather than a crime to be unequally and ineffectively enforced? Evidence from some U.S. states, as well countries around the world, suggests these steps would help to some extent. But what do you think?

The Rationality of Addiction

Drug addicts and substance abusers would hardly come to mind as rational or reasonable individuals. Yet an interesting new study discussed in the New York Times sheds light on the very complex nature of addiction, one that challenges the popular caricature of drug abusers as voracious consumers enslaved at all costs to a particular high.

Dr. Hart recruited addicts by advertising in The Village Voice, offering them a chance to make $950 while smoking crack made from pharmaceutical-grade cocaine. Most of the respondents, like the addicts he knew growing up in Miami, were black men from low-income neighborhoods. To participate, they had to live in a hospital ward for several weeks during the experiment.

At the start of each day, as researchers watched behind a one-way mirror, a nurse would place a certain amount of crack in a pipe — the dose varied daily — and light it. While smoking, the participant was blindfolded so he couldn’t see the size of that day’s dose.

Then, after that sample of crack to start the day, each participant would be offered more opportunities during the day to smoke the same dose of crack. But each time the offer was made, the participants could also opt for a different reward that they could collect when they eventually left the hospital. Sometimes the reward was $5 in cash, and sometimes it was a $5 voucher for merchandise at a store.

When the dose of crack was fairly high, the subject would typically choose to keep smoking crack during the day. But when the dose was smaller, he was more likely to pass it up for the $5 in cash or voucher.

“They didn’t fit the caricature of the drug addict who can’t stop once he gets a taste,” Dr. Hart said. “When they were given an alternative to crack, they made rational economic decisions.”

When methamphetamine replaced crack as the great drug scourge in the United States, Dr. Hart brought meth addicts into his laboratory for similar experiments — and the results showed similarly rational decisions. He also found that when he raised the alternative reward to $20, every single addict, of meth and crack alike, chose the cash. They knew they wouldn’t receive it until the experiment ended weeks later, but they were still willing to pass up an immediate high.

So if biological and psychological addiction aren’t as potent as it seems to be…what accounts for all the addicts? As with most social and public health issues, the origins are multidimensional:

“There seemed to be at least as many — if not more — cases in which illicit drugs played little or no role than were there situations in which their pharmacological effects seemed to matter,” writes Dr. Hart, now 46. Crack and meth may be especially troublesome in some poor neighborhoods and rural areas, but not because the drugs themselves are so potent.

“If you’re living in a poor neighborhood deprived of options, there’s a certain rationality to keep taking a drug that will give you some temporary pleasure,” Dr. Hart said in an interview, arguing that the caricature of enslaved crack addicts comes from a misinterpretation of the famous rat experiments.

“The key factor is the environment, whether you’re talking about humans or rats,” Dr. Hart said. “The rats that keep pressing the lever for cocaine are the ones who are stressed out because they’ve been raised in solitary conditions and have no other options. But when you enrich their environment, and give them access to sweets and let them play with other rats, they stop pressing the lever.”

So once again, we find evidence that negative material conditions — poverty and inequality — play a major role in yet another social ill. It seems so deceptively easy: reduce poverty and improve social environment (usually through the former), and everything else falls into place for the most part. In that case…

…why do we keep focusing so much on specific drugs? One reason is convenience: It’s much simpler for politicians and journalists to focus on the evils of a drug than to grapple with the underlying social problems. But Dr. Hart also puts some of the blame on scientists.

“Eighty to 90 percent of people are not negatively affected by drugs, but in the scientific literature nearly 100 percent of the reports are negative,” Dr. Hart said. “There’s a skewed focus on pathology. We scientists know that we get more money if we keep telling Congress that we’re solving this terrible problem. We’ve played a less than honorable role in the war on drugs.”

Indeed, there are too many entrenched interests that have a lot to gain from the ever-more costly crusade on drugs — from the private prison industry, to moralizing religious fundamentalists, among others. As studies like these continue to mount, and as the social and economic liabilities of this hamfisted approach build up as well, I can only hope we take a more humane and sensible approach to what is ultimately a socioeconomic and public health problem.

Four Successful Ways Other Countries Are Dealing With Drug Abuse


Let’s start with an easy one – sterile syringe access programs. We know from decades of research and implementation the world over that these programs prevent the spread of HIV/AIDS and hepatitis C among people who inject drugs. And yet our federal government still prohibits the use of federal HIV prevention funding for syringe access programs, citing erroneous drug war rhetoric about “encouraging drug use.” While we could consider all of the data from around the world, in the case of syringe access, we have plenty of evidence from locally funded programs here in the U.S. that have proven this scare-mongering to be untrue. Syringe access programs prevent the spread of HIV/AIDS and do not encourage or increase rates of drug use. Period. This has been proven from Bangkok to Bakersfield – so why is Washington dragging its feet?

Next up is another proven method of preventing HIV and other diseases. Safe injection facilities (SIFs) are places where people who inject drugs can do so under medical supervision. These facilities reduce overdose deaths and the spread of diseases such as HIV/AIDS and hepatitis C, and also to draw hard-to-reach users into treatment and rehabilitation. While the idea of facilitating intravenous drug use might raise eyebrows as syringe access once did, the results are incontrovertible. More than 90 facilities are serving clients — and saving lives — as we speak, in countries including Canada, Australia, the Netherlands, Spain and Switzerland. It’s time we started raising our eyebrows at a government willing to ignore the evidence in favor of drug war rhetoric.

This next innovative idea saves lives and is successfully treating opiate addiction in a number of European countries including Denmark, Germany, Switzerland and the U.K: heroin-assisted treatment. This treatment involves strictly regulated and controlled prescription of pharmaceutical heroin to help severely dependent heroin users who have not succeeded with other treatment options. The programs have been shown to significantly improve participants’ health, their housing and employment situations, and to dramatically decrease criminal behavior. Impressive results like these should have this idea on the tip of every legislator’s tongue.

And, finally, the success story that has dramatic implications for drug policy the world over: decriminalization. Ten years ago Portugal shifted its method of dealing with drug use and misuse from a punitive approach to a health-centered one by rapidly expanding access to treatment and decriminalizing drugs – all of them. Rates of overdose and HIV infection have dropped precipitously and none of the hysterical predictions of Lisbon becoming a drug tourism capital have materialized.  In fact, following the introduction of decriminalization, Portugal has maintained drug use rates well below the European average – and far lower than the United States. Most importantly, youth drug use rates have dropped – a goal we can all agree on. It’s a bold experiment – but didn’t the U.S. used to be a place known for its bold experiments?

In light of forty years of failure, would it hurt to at least try some of these options, perhaps beginning at the local or state level? How much more money and life must be wasted in these fruitless efforts?