We are approaching the 100th anniversary of the “war on drugs,” and we are still mired in it. We cannot be proud of this war and its results.
The “war on drugs,” fought largely within our national borders, is widely thought to have begun with President Nixon’s efforts in 1971 to stem the heroin-related crime epidemic in the U.S.
In fact, the federal “war” really started in 1914 with the passage of the Harrison Anti-Narcotic Act and two 1919 Supreme Court decisions: U.S. v. Doremus, which held the Harrison Act constitutional, and Webb et al v. U.S., which made it illegal for physicians and pharmacists to dispense narcotics solely for addiction maintenance.
Despite two subsequent court decisions – U.S. v. Linder in 1925 and Robinson v. California in 1962 – which attempted to modulate this “zero tolerance” campaign, America remained committed to harsh, punitive measures against a vulnerable population of addicts.
Historically, drug treatment opportunities have always been severely limited. From the 1880s through the 1930s, wealthy drug-dependent patients found some relief through the beneficent (or self-serving) efforts of their private physicians or at private sanitaria. Forty-four short-lived clinics, scattered throughout the U.S., served patients from 1919 to 1923, when they were closed by the federal government, which always opposed their existence.
The first national treatment effort, the “Federal Farms” – which existed at Lexington, Ky., from 1935 to 1974 and at Fort Worth, Texas, from 1938 to 1971 – found limited success in helping addicts. All of these efforts failed because “success” was defined strictly as abstinence, a goal that was not achievable by the vast majority of addicts – a principle that is still true today.
It took the pioneering efforts of Vincent Dole and Marie Nyswander in the mid-1960s to show that opioid substitution therapy in the form of methadone could block an addict’s craving for heroin and could provide a pathway for successful rehabilitation when combined with psychosocial support.
Fifty years of experience have shown that methadone and other substitution opioids improve the health of drug-users, slow the spread of HIV-related disease, reduce crime rates and allow addicts to re-enter the work force, contribute positively to society and regain some self-esteem – all at a significant cost saving!
Providing this type of medical treatment in a humane and accessible way has always faced strong opposition in this country. Politicians seemingly cannot get elected unless they are “tough on crime and drugs.” Since 1971, the “war on drugs” has cost America an estimated $1 trillion and led to 45 million drug arrests, most for nonviolent offenses. In 2007 alone, illegal drug use cost the United States an estimated $193 billion in productivity losses, anti-crime measures and health expenditures.
Other countries, most recently Portugal in 2011, have taken a more enlightened approach. Decriminalization (but not legalization) has led to a decrease in serious drug use, drug-related deaths, infectious diseases and costs to the criminal justice system by increasing drug treatment opportunities in the context of a more humane judicial system. Recently the ex-leaders of Brazil, Colombia and Switzerland urged the United States to rethink its drug policies.
It is encouraging that a number of states, including North Carolina, are considering or have already expanded “drug courts” to better deal with specific aspects of this problem. This would place us in the mainstream of national drug policy since the National Drug Court Institute estimates that over 116,000 criminal offenders found relief in drug courts in 2009.
The Affordable Care Act expands opportunities for treatment on demand. We should build on this effort in tackling the complex and refractory problem of drug addiction, rethink our focus on the “supply side” of the drug equation and try to reduce demand through a comprehensive program of opioid substitution therapy in a humane, inclusive and comprehensive manner. It is time for our national and local politicians to address this problem with honesty, compassion and creativity.
Stephen R. Kandall, M.D., of Raleigh served as chief of Neonatology at Beth Israel Medical Center from 1976 to 1998 and retired in 1998 as professor of Pediatrics at the Albert Einstein College of Medicine.