Drugs, Part II – A Global Approach

Last month we looked at the history of drug regulation and prohibition in the United States. But drugs are a global issue, from opium production in Asia and Latin America to the prevalence of drug cartels in Mexico and Central America – which is to say nothing about the United States and Europe, who make up the vast majority of the consumers and users.

From production to use, the same problems inevitably develop: addiction, incarceration, homelessness, and crime. This month, we’re taking a global approach, looking at what other nations have tried, and whether they’ve succeeded in remedying these problems, or fallen short of the mark.

For instance, did you know that Amsterdam isn’t the place with the most liberal legalized drug scheme? Though the Dutch capital has the most notorious reputation for its legalized drugs and prostitution, the Netherlands have a particularly rigorous system in place, regulating the sales of recreational cannabis (marijuana and hashish) at its famed coffeehouses and the prescription-only medical uses of other ‘harder’ drugs in the treatment of addiction. And they’re not alone.

Starting as early as the 1970s, a number of countries around the world have instituted pilot programs seeking to legalize and regulate drug use in an attempt to counter rampant rates of addiction and abuse.

England

We begin in Britain in the 1970s. Since before those times, Britain had allowed doctors to prescribe doses of heroin for treatment, mainly because Britain had never reclassified heroin as a drug. It remained a medication. But with the rise of illegal use and addiction, the administration, along with doctors, began to put prohibitive caps on the prescribable doses, resulting in very weak prescriptions that left these hard-to-treat patients looking for more elsewhere.

Pilot programs in the 1980s and 90s began opening prescription clinics in heavily affected areas to trial-run the belief that allowing doctors to prescribe the doses they saw fit would be the solution. And in Liverpool it was. The evidence collected at the end of a multi-year run demonstrated no incidence of HIV (at all), none of the maladies or side effects generally experienced as a result of consistent drug use, and a high rate of employment among all patients.

Unfortunately in Britain, such programs have yet to gain popular and permanent support under the NHS, meaning that after a few years, the trial is ended and much of the good it seemed to accomplish is undone. This was seen in Liverpool in 1995 when the program was shut down there. And can be seen in the more recent trial runs that began in limited cities in 2008. With no long term program in place, it’s difficult to assess whether the British trials have been a net success.

Portugal

Portugal in the 1980s had developed one of the worst heroin problems in the world. And with rampant heroin use and unclean needles came AIDS. When new punishment schemes didn’t make a dent, in 2001 Portugal decriminalized the possession and use of all drugs to scalable misdemeanors and ticketable fines, though it was still illegal to sell them. The administration then reallocated resources to focus on rehabilitation and treatment. This new approach offered local, doctor-staffed methadone dispensaries and clean needles to those who continued to use and free yearlong rehab to those who were ready to quit. Additionally, the program also gave enticing tax subsidies to employers who hired addicts in recovery.

The result was a drastic reduction in heroin use and addiction, and the incidence of the AIDS virus in the country. Even more shocking, despite having decriminalized all drugs within the country, the drug use and incidence rates in Portugal remain one of, if not the lowest, in the E.U. There, a success.

Switzerland

Where Portugal had a terrible heroin problem in the 1980s and 90s, Switzerland of the 1990s had the worst HIV epidemic in Europe. For Switzerland, liberal drug policies created clean needle exchanges, methadone dispensaries, and even safe facilities where addicts could use their drugs under the supervision of a nurse-practitioner. But none of them worked. Addiction and HIV rates were still high. So Switzerland took a cue from England’s experiment.

Under Switzerland’s national health system, it’s called the Prescription Program, but in reality it’s a number of small clinics across the country that prescribe doses of heroin to addicts, to be administered in the clinic. The idea was to reduce street sales, ensure the use of clean needles, and reduce crime The secondary intent was to provide monitored doses, with none of the contaminants in unregulated heroin. The effect? HIV rates fell dramatically, and crime and homelessness went down.

More surprisingly, almost all addicts provided with prescriptions (on average, for about 3 years) either weaned themselves off the drug entirely, or became high-functioning – holding permanent employment and living full lives. On top of all that, the Prescription Program and everything attached to it cost significantly less than the previously allocated budget for the arrests, processing, court appearances, and incarceration of such drug users. And all this pleased the Swiss people, who had been wary of the program, very much. There, a success.

Canada

The Downtown Eastside of Vancouver in the 1990s was a war zone rife with drug use, addiction, homelessness, prostitution, crime, and murder. Again, the problem was heroin. It was there in 1993 that a Vancouver charity called the Portland Hotel Society set up permanent housing, a prescription program, and in-house doctors, nurses, and therapists, to serve the community.

With a 90% rate of resident-commitment to the program or going into full recovery, it’s been a great success for Canada. So much so, that the program has been permanently funded and continues to operate to this day.

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That brings us back to the U.S. Looking to international models is anecdotal at best, because our problem in the United States is more complicated than a heroin surge – something you may have noticed is the common theme in all the previous countries examined. Which is not to say that we don’t have a heroin problem. Heroin use is the highest it’s been in 15 years.

But the U.S. has other problems, including the highest global consumption of both marijuana and cocaine, as well as widespread prescription drug abuse. One could make the argument that these are in fact opioid issues, not so dissimilar from those other countries’. But one could also say that it’s a problem of access.

Whatever the root cause, the response of the last 20+ years that dedicated resources to criminalization rather than treatment has created the prison-industrial complex we see today. By the mid-1990s, more than half of all incarcerated prisoners in this country were being held on drug-related offenses. Today, the U.S., with only 5% of the world’s population, accounts for 25% of all prisoners.

But these aren’t just comparative statistics. Domestically, having a felony record renders a person virtually unhireable, which has implications for the unemployment rates we’re seeing. And with few prospects, recidivism rates increase, leading to a vicious cycle of multiple felonies, incarcerations, prison overcrowding, and excessive state spending to foot the bill. It’s clear that there’s a problem, so where do we go from here?

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