Please tell me what the compelling reason not to decriminalize drugs is: jail does not improve treatment access, it reduces recovery rates, it increases mortality. See: https://www.nytimes.com/2022/01/26/opinion/oregon-drug-decriminalization-addiction.html?searchResultPosition=22 and https://www.nytimes.com/2023/08/29/opinion/arrest-drug-treatment-addiction.html?searchResultPosition=4 and https://www.nytimes.com/2024/03/01/opinion/moral-hazard-drug-addiction.html?searchResultPosition=1 I am being serious here: we have the highest rate of drug arrests and the highest rate of overdose deaths in the world and there is no study I've ever seen showing that criminalization of possession helps. If it were a good approach, Black people should have massively better rates of treatment access than everyone else, since they are arrested at about twice the rate of whites. Guess what? They are *less* likely to get treatment— which is the only reason anyone ever gives for jail being potentially helpful. In fact, fewer people have access to evidence based care while incarcerated compared to outside (is there any aspect of health care where jail and prison care is superior?) Unless you want to take it from anecdotes that punishment treats a condition that is literally defined as compulsive behavior despite negative consequences (AKA punishment by definition doesn't work), where's your data for jail helping? This is why Nora Volkow of NIDA and virtually anyone with any familiarity with the literature supports it. Really curious why you would think there are reason to keep it? (Not being facetious, I respect your views)
Hi Maia, I agree with your take and support your advocacy (which is part of the reason I wrote this piece). One area where I have spent a little bit of time digging on this relates to traffic accidents. While you can argue that these can be handled separately (that is, enforcement of driving while impaired laws), I've worried (and seen some data) that made me concerned that legalization laws may have some secondary effect on that. So, that's an area where I think further study is warranted. If that connection were to be clearly made--and some people have said they are not, but I just am not certain--it would in my view be a compelling reason to think about how to handle this issue. 100% with you that what we are doing is not working. And our approach to alcohol is not great either (i.e., legal and also responsible for thousands of traffic related deaths per year). Thank you
Thanks!!! But this is NOT legalization, it's decrim, so that means there would be no legal sales, just no possession arrests. I have seen no evidence that traffic issues increased in places with decrim like Portugal and British Columbia. I definitely think you would have legitimate concerns about potential traffic problems with full legalization of all drugs (marijuana is complicated: it's not that impairing and it sometimes substitutes for alcohol, which is much worse for driving, so you might overall reduce harm even with commercialization of marijuana. different for different drugs). I'm curious about this traffic data you have seen— would be good to see cites. The worst two systems of drug regulation are prohibition and commercialization. We need to be somewhere in between.
The point about legalization vs decriminalization is really key here. I'm looking forward to learning more about this from Maia and others.
One thing I know is that for people who have stern views on this ('lock 'em up'), the thing that moderates their viewpoints is actually taking the time to think the issues through. It's a lot of work to do it, but it leads somewhere.
A little more info re: Oregon was reported in the 1440 Daily Digest today: An Oregon bill to reinstate criminal penalties for hard drugs is heading to Gov. Tina Kotek’s (D) desk. HB 4002 will, if signed, upend a 2020 voter initiative to decriminalize possession of small amounts of fentanyl, heroin, methamphetamine, and other drugs.
The news comes three years after residents voted (58%) to decriminalize hard drugs—the first and only state to do so. Instead, possession was met with a $100 fine or the option to enter treatment. However, drug-related deaths in Oregon have since skyrocketed, on track to surpass 1,250 people last year and up 42% year-over-year in September, compared to a nationwide 2%. Those supporting decriminalization still point to research failing to show an immediate correlation between drug law and overdose fatality rates. If the bill is signed, possession will be punishable by up to 180 days in jail, with options to be redirected to treatment facilities.
The news in Oregon comes as the popularity of decriminalization wanes (support for undoing the law is around 56%). Meanwhile, a recent poll found 40% of voters in Portland list homelessness as their primary concern.
Thanks Pamela. As above, the increase in fatality is not all that clearly linked to the legal change. It's more likely a combination of fentanyl penetration into the market and other existing trends. If it helped decrease mortality, that means that deaths *would* have been even higher in 2021-2022, but there's no real way to know that.
I'd argue that from the standpoint of mortality, the law did not make a difference--or if it did, it was a smaller contributor to the increase than most people realize (or are willing to accept).
The question I have is whether the law has had positive secondary effects--keeping people out of jail/prison (as long as they are not a danger to others) is inherently a good thing. Think of some person with substance use disorder who has kids. That person getting treatment is better than them going to prison, both for the individual and the family. So, I think it's important to think about the real upsides of decriminalization, thought I am sure they are not as easy to measure or observe as any downsides (such as seeing use on the streets, etc).
Overdose deaths are something to take very seriously and I agree it's not that clear if they're related to the legal change. There was a podcast discussing that proponents for recriminalization wanted the law changed for the people that are ignoring citations, sometimes multiple times a day, regardless of the availability of treatment. So, I wonder now, how many people were actually going into treatment? If they weren't going, maybe it had something to do with the increase in fatalities? It's a complex issue and I hope the new law doesn't create a revolving door between prison and release back into the community, where people may be worse off than they were before. I read where opiate addiction costs the healthcare and criminal justice systems more than $1 trillion a year. It'd be nice if that kind of money could be poured into comprehensive treatment that provided stability, treatment, housing, mental health and robust social services.
Do we have better treatment? Is rehab any more effective than dieting was for obesity? It’s fantastically expensive and I imagine pretty unrewarding for the providers unless they have a special interest in the subject.
Certainly for some substances, we do. When it comes to expenses, though, I can't think of anything more unbelievably expensive than the costs associated with incarceration.
Everything goes back to prevention and early intervention in terms of public and mental health educational programs and policies. Kids need better information, to make better decisions, to not ever use in the first place. I can say from a family experience that sometimes decriminalization doesn't work, drug use escalates and others get hurt. My 39 year-old nephew beat and robbed my 86 year-old mom after she refused to give him money for his $150/day heroin and fentanyl habit. It's not the first time he resorted to violence for a fix, not the first time he was given a court-ordered drug treatment program and not the first time he had to leave because he used in treatment. Although given yet another chance to complete the program, he failed to show. Now he's on the run with a warrant out for his arrest. He's relapsed after every out-patient and in-patient program, and after being sober in prison. As a teen, he began experimenting with alcohol and marijuana. Then, there were Percocet and Oxy parties on weekends. Instead of vocational school or college, he went into treatment and probation programs. My nephew's life would have been very different if he hadn't made that first poor decision to use. He was bright, lived in a middle-class neighborhood, went to a parochial school, neither his parents nor his siblings are "party people." All along the way, his parents invested lots of time and money getting him help and treatment programs. Sober he makes a good impression. There have been lots of medical professionals, counselors, coaches, judges and probation officers that have all wanted to help him succeed and kick this addiction. Even after being Narcanned 3 times, he's still in the active throws of addiction and not beyond committing violent acts, even against loved ones, to keep from going into withdrawal. Addiction is overwhelming to users, families, the public and the healthcare system. I'm may date myself, but Nancy Reagan wasn't wrong when she said, "Just Say No."
This is so tragic. When I read this, I think about just how deadly and destructive this disease can be. There are indeed people who resort to violence. Would there be less or more violence if we had decriminalization? That's what I want to know. If it's more, it should give us pause. But it could be that there's less. This is important.
And you do bring up another key thing: you can't become addicted if you don't ever start. That said, the stuff in the market today is a lot stronger than in the past. It makes mistakes have higher stakes. Very sad to watch.
Thank you, it's very sad. You've given me lots to think about with respect to violence and decriminalization. Not certain what part, if any, decriminalization addiction, relapse or mental health issues have played in my nephew's violence. I do know since his felony conviction, he's had much more difficulty finding employment. And since his release, he's developed a habit over a $1,000 a week, and has unfortunately resorted to crime to support it. I wish peer pressure had been easier for him to resist when he was younger. Somehow, I hope my nephew will find sobriety and that he and others have access to the best treatments possible to help end their dependency.
The issue with Oregon is more tied to their inability to make progress overall in their issues. They are leaning on the drug issue and legislation as a band aid to show they are doing something when the reality is ineffectual government and failure to provide the improved mental health and support services required with this kind of initiative. It goes hand in hand with their struggles to deal with their homeless crisis.
Agree with you on everything you say here. Glad you’ve spoken out.
thanks. no easy answers...but that's the point
Please tell me what the compelling reason not to decriminalize drugs is: jail does not improve treatment access, it reduces recovery rates, it increases mortality. See: https://www.nytimes.com/2022/01/26/opinion/oregon-drug-decriminalization-addiction.html?searchResultPosition=22 and https://www.nytimes.com/2023/08/29/opinion/arrest-drug-treatment-addiction.html?searchResultPosition=4 and https://www.nytimes.com/2024/03/01/opinion/moral-hazard-drug-addiction.html?searchResultPosition=1 I am being serious here: we have the highest rate of drug arrests and the highest rate of overdose deaths in the world and there is no study I've ever seen showing that criminalization of possession helps. If it were a good approach, Black people should have massively better rates of treatment access than everyone else, since they are arrested at about twice the rate of whites. Guess what? They are *less* likely to get treatment— which is the only reason anyone ever gives for jail being potentially helpful. In fact, fewer people have access to evidence based care while incarcerated compared to outside (is there any aspect of health care where jail and prison care is superior?) Unless you want to take it from anecdotes that punishment treats a condition that is literally defined as compulsive behavior despite negative consequences (AKA punishment by definition doesn't work), where's your data for jail helping? This is why Nora Volkow of NIDA and virtually anyone with any familiarity with the literature supports it. Really curious why you would think there are reason to keep it? (Not being facetious, I respect your views)
Hi Maia, I agree with your take and support your advocacy (which is part of the reason I wrote this piece). One area where I have spent a little bit of time digging on this relates to traffic accidents. While you can argue that these can be handled separately (that is, enforcement of driving while impaired laws), I've worried (and seen some data) that made me concerned that legalization laws may have some secondary effect on that. So, that's an area where I think further study is warranted. If that connection were to be clearly made--and some people have said they are not, but I just am not certain--it would in my view be a compelling reason to think about how to handle this issue. 100% with you that what we are doing is not working. And our approach to alcohol is not great either (i.e., legal and also responsible for thousands of traffic related deaths per year). Thank you
Thanks!!! But this is NOT legalization, it's decrim, so that means there would be no legal sales, just no possession arrests. I have seen no evidence that traffic issues increased in places with decrim like Portugal and British Columbia. I definitely think you would have legitimate concerns about potential traffic problems with full legalization of all drugs (marijuana is complicated: it's not that impairing and it sometimes substitutes for alcohol, which is much worse for driving, so you might overall reduce harm even with commercialization of marijuana. different for different drugs). I'm curious about this traffic data you have seen— would be good to see cites. The worst two systems of drug regulation are prohibition and commercialization. We need to be somewhere in between.
Good point. I think “compelling” was probably overstating the reason for criminalizing.
The point about legalization vs decriminalization is really key here. I'm looking forward to learning more about this from Maia and others.
One thing I know is that for people who have stern views on this ('lock 'em up'), the thing that moderates their viewpoints is actually taking the time to think the issues through. It's a lot of work to do it, but it leads somewhere.
A little more info re: Oregon was reported in the 1440 Daily Digest today: An Oregon bill to reinstate criminal penalties for hard drugs is heading to Gov. Tina Kotek’s (D) desk. HB 4002 will, if signed, upend a 2020 voter initiative to decriminalize possession of small amounts of fentanyl, heroin, methamphetamine, and other drugs.
The news comes three years after residents voted (58%) to decriminalize hard drugs—the first and only state to do so. Instead, possession was met with a $100 fine or the option to enter treatment. However, drug-related deaths in Oregon have since skyrocketed, on track to surpass 1,250 people last year and up 42% year-over-year in September, compared to a nationwide 2%. Those supporting decriminalization still point to research failing to show an immediate correlation between drug law and overdose fatality rates. If the bill is signed, possession will be punishable by up to 180 days in jail, with options to be redirected to treatment facilities.
The news in Oregon comes as the popularity of decriminalization wanes (support for undoing the law is around 56%). Meanwhile, a recent poll found 40% of voters in Portland list homelessness as their primary concern.
Thanks Pamela. As above, the increase in fatality is not all that clearly linked to the legal change. It's more likely a combination of fentanyl penetration into the market and other existing trends. If it helped decrease mortality, that means that deaths *would* have been even higher in 2021-2022, but there's no real way to know that.
I'd argue that from the standpoint of mortality, the law did not make a difference--or if it did, it was a smaller contributor to the increase than most people realize (or are willing to accept).
The question I have is whether the law has had positive secondary effects--keeping people out of jail/prison (as long as they are not a danger to others) is inherently a good thing. Think of some person with substance use disorder who has kids. That person getting treatment is better than them going to prison, both for the individual and the family. So, I think it's important to think about the real upsides of decriminalization, thought I am sure they are not as easy to measure or observe as any downsides (such as seeing use on the streets, etc).
Overdose deaths are something to take very seriously and I agree it's not that clear if they're related to the legal change. There was a podcast discussing that proponents for recriminalization wanted the law changed for the people that are ignoring citations, sometimes multiple times a day, regardless of the availability of treatment. So, I wonder now, how many people were actually going into treatment? If they weren't going, maybe it had something to do with the increase in fatalities? It's a complex issue and I hope the new law doesn't create a revolving door between prison and release back into the community, where people may be worse off than they were before. I read where opiate addiction costs the healthcare and criminal justice systems more than $1 trillion a year. It'd be nice if that kind of money could be poured into comprehensive treatment that provided stability, treatment, housing, mental health and robust social services.
“ We know that better treatment is the answer.”
Do we have better treatment? Is rehab any more effective than dieting was for obesity? It’s fantastically expensive and I imagine pretty unrewarding for the providers unless they have a special interest in the subject.
Certainly for some substances, we do. When it comes to expenses, though, I can't think of anything more unbelievably expensive than the costs associated with incarceration.
Everything goes back to prevention and early intervention in terms of public and mental health educational programs and policies. Kids need better information, to make better decisions, to not ever use in the first place. I can say from a family experience that sometimes decriminalization doesn't work, drug use escalates and others get hurt. My 39 year-old nephew beat and robbed my 86 year-old mom after she refused to give him money for his $150/day heroin and fentanyl habit. It's not the first time he resorted to violence for a fix, not the first time he was given a court-ordered drug treatment program and not the first time he had to leave because he used in treatment. Although given yet another chance to complete the program, he failed to show. Now he's on the run with a warrant out for his arrest. He's relapsed after every out-patient and in-patient program, and after being sober in prison. As a teen, he began experimenting with alcohol and marijuana. Then, there were Percocet and Oxy parties on weekends. Instead of vocational school or college, he went into treatment and probation programs. My nephew's life would have been very different if he hadn't made that first poor decision to use. He was bright, lived in a middle-class neighborhood, went to a parochial school, neither his parents nor his siblings are "party people." All along the way, his parents invested lots of time and money getting him help and treatment programs. Sober he makes a good impression. There have been lots of medical professionals, counselors, coaches, judges and probation officers that have all wanted to help him succeed and kick this addiction. Even after being Narcanned 3 times, he's still in the active throws of addiction and not beyond committing violent acts, even against loved ones, to keep from going into withdrawal. Addiction is overwhelming to users, families, the public and the healthcare system. I'm may date myself, but Nancy Reagan wasn't wrong when she said, "Just Say No."
This is so tragic. When I read this, I think about just how deadly and destructive this disease can be. There are indeed people who resort to violence. Would there be less or more violence if we had decriminalization? That's what I want to know. If it's more, it should give us pause. But it could be that there's less. This is important.
And you do bring up another key thing: you can't become addicted if you don't ever start. That said, the stuff in the market today is a lot stronger than in the past. It makes mistakes have higher stakes. Very sad to watch.
Thank you, it's very sad. You've given me lots to think about with respect to violence and decriminalization. Not certain what part, if any, decriminalization addiction, relapse or mental health issues have played in my nephew's violence. I do know since his felony conviction, he's had much more difficulty finding employment. And since his release, he's developed a habit over a $1,000 a week, and has unfortunately resorted to crime to support it. I wish peer pressure had been easier for him to resist when he was younger. Somehow, I hope my nephew will find sobriety and that he and others have access to the best treatments possible to help end their dependency.
The issue with Oregon is more tied to their inability to make progress overall in their issues. They are leaning on the drug issue and legislation as a band aid to show they are doing something when the reality is ineffectual government and failure to provide the improved mental health and support services required with this kind of initiative. It goes hand in hand with their struggles to deal with their homeless crisis.
Indeed. High profile moves (in either direction) do not negate the need to do other things like the priorities you mention.