What I Told Congress About the War On Drugs

Ethan Nadelmann is part of Change.org's Changemakers network, comprised of leading voices for social change. Mr Nadelmann is the founder and executive director of the Drug Policy Alliance.

The following piece is excerpted from testimony I gave yesterday about the White House's drug war budget and forthcoming 2010 National Drug Control Strategy, during a hearing called by the U.S. House Domestic Policy Subcommittee, chaired by Rep. Dennis Kucinich (D-OH). To read the full text of my testimony, click here.

The predominant role that criminalization plays in dealing with drugs in this country is unsustainable in both fiscal and human terms. Police made 1.7 million drug arrests in 2008 alone, including 750,000 for nothing more than possession of marijuana for personal use. Those arrested were separated from their loved ones, branded criminals, denied jobs, and in many cases prohibited from voting and accessing public assistance for life.

The United States now ranks first in the world in per capita incarceration rates, with less than 5% of the world's population but nearly 25% of the world's prison population. Roughly 500,000 people are behind bars tonight for a drug law violation. That's ten times the total in 1980, and more than all of western Europe (with a much larger population) incarcerates for all offenses. More than half of federal prisoners are there for drug law violations; relatively few are kingpins and virtually none are queenpins.

Yet despite spending hundreds of billions of dollars and arresting millions of Americans, illegal drugs remain cheap, potent and widely available, and the harms associated with them continue to mount. Meanwhile, the war on drugs is creating problems of its own — broken families, racial disparities, and the erosion of civil liberties. Few government policies have failed for so long without any serious effort to question or revise them.

U.S. Senator Jim Webb (D-VA) said recently, speaking about our country's uniquely high incarceration rate, "either we have the most evil people in the world or we are doing something wrong with the way we approach the issue of criminal justice." He went on to say "the central role of drug policy in filling our nation's prisons makes clear that our approach to curbing illegal drug use is broken." Unfortunately, the Office of National Drug Control Policy seems unwilling to reassess this role in any meaningful way.

When it comes to performance measures, ONDCP historically has cited increases or decreases in the total number of Americans who admit to using an illegal drug within the last year as the most important criteria for judging the success or failure of U.S. drug policy.

But drug use rates tell us surprisingly little about our nation's progress toward reducing the actual harms associated with drugs. If the number of Americans using illegal drugs decreases, but overdose fatalities, new HIV/AIDS infections, racial disparities and addiction increases, I would consider that failure. In contrast, if the number of Americans using illegal drugs increases, but overdose fatalities, new HIV/AIDS infections, racial disparities and addiction declines, that's success. We should be focusing on the death, disease, crime and suffering associated with drugs — not drug use per se.

What's more, ONDCP's proposed FY11 drug war budget is largely a continuation of the failed drug policies of the last three decades. Most of the money goes to ineffective supply-side programs, relatively little goes to treatment and prevention, and almost none to harm reduction. Director Kerlikowske told the Wall Street Journal last year that he doesn't like to use the term "war on drugs" because "[w]e're not at war with people in this country." Yet 64% of their budget — virtually the same as under the Bush Administration — focuses on largely futile interdiction efforts as well as arresting, prosecuting and incarcerating extraordinary numbers of people.

Experts have known for years that increasing funding for treatment is the most cost-effective way to undermine illicit drug markets and reduce substance misuse. A 1994 RAND study commissioned by the U.S. Army and ONDCP found treatment to be 10 times more effective at reducing drug abuse than drug interdiction, 15 times more effective than domestic law enforcement, and 23 times more effective than trying to eradicate drugs at their source. More recent studies have reached similar conclusions.

More funding for treatment is needed — though those expenditures will prove most beneficial if they are no longer hobbled by drug war politics and ideology.

Director Kerlikowske says that U.S. drug policy should be "evidence-based" and "balanced." But there is little reason to believe that ONDCP's 2010 Strategy will be either.

Congress's recent repeal of the ban on federal funding for sterile syringes to reduce HIV is an important step forward in elevating science over politics. It's a shame, though, that ONDCP appears to have played little to no role in accomplishing that important reform and hasn't yet articulated a plan to improve syringe availability to reduce the spread of HIV/AIDS and hepatitis C.

Director Kerlikowske has spoken eloquently and forcefully in support of reducing fatal drug overdoses from legal and illegal opiates. ONDCP, however, has yet to demonstrate any leadership in advancing the most effective (and cost-effective) means of reducing fatal ODs, such as increasing access to the overdose antidote, naloxone. Thousands of lives a year could be saved if ONDCP prioritized this intervention.

After all, fatal drug overdoses increased more than 400% between 1980 and 1999 and more than doubled over the last decade. Overdose is now the second leading cause of accidental death (second only to automobile crashes) and the leading cause of accidental death in 16 states and among Americans aged 35 to 54. More Americans died last year from drug overdoses than firearms.

ONDCP has also dismissed two other highly successful, evidence-based harm reduction strategies: supervised injection facilities and heroin assistance treatment. Already, an estimated 90 supervised injection facilities currently operate in 40 cities around the world. They have been rigorously studied and their efforts have led to reductions in overdose fatalities, syringe sharing, public injecting, and publicly discarded syringes — and no increases in drug-related crime or rates of relapse among former drug users.

Public health officials in San Francisco and other U.S. cities have considered establishing pilot supervised injection sites in the U.S., but are wary of attempting to proceed in the face of federal opposition. The mixture of arrogance and fear with which ONDCP officials dismiss even the possibility of supporting research in the area is sadly reminiscent of past ONDCP opposition to syringe exchange programs notwithstanding the scientific consensus in their favor. Their opposition provides a powerful reminder that President Obama's mandate that politics no longer trump science does not extend to federal drug policy.

Evidence in support of heroin assisted treatment — which ONDCP likewise refuses to support — is equally strong. These programs enable people addicted to street heroin who have not succeeded in other treatment programs to be prescribed pharmaceutical heroin as part of a broader treatment regimen. Heroin assisted trials have now been conducted in six countries — Switzerland, the Netherlands, England, Spain, Germany, and Canada. Denmark recently decided to skip pilot projects and go straight to offering heroin-assisted treatment for those who need it because the evidence from elsewhere was so conclusive.

Director Kerlikowske has previously said that "We [the U.S. government] support evaluating individual programs and policies on their own merit, not on whether they do or do not fall under any particular ideological label." Sadly, ONDCP's persistent refusal to support even trying what has worked so well in every foreign research trial can't help but call that statement into question.

Congress and the Obama administration have broken with the costly and failed drug war strategies of the past in some important ways — by allowing federal funding of syringe exchange to reduce HIV, by allowing state governments greater latitude to regulate the availability of marijuana for medical purposes, by moving forward on reducing racially discriminatory crack/powder mandatory minimum sentences, and by working more diligently to integrate effective drug treatment into ordinary medical care.

But Congress is still emphasizing interdiction and law enforcement — in short, supply reduction initiatives — over demand and harm reduction efforts. All of this suggests that ONDCP's plans for the future are far more wedded to the failures of the past than to any new vision for the future.

Photo credit: Manu le manu