An issue brief from the Baker Institute for Drug Policy at Rice University suggests that much of the public perception about drug and alcohol use disorders is incorrect. Using government data, the brief outlines why the dimensions of the issue aren’t at the crisis level that many seem to assert.
For example, authors say in 2014, the number of people who reported misusing prescription pain drugs in the past month was 5.1 million, but note that figure represents just 1.6% of the population age 12 and older. It’s not that the authors seek to trivialize the very real effects of substance use disorders, but rather, they caution that policymakers should evaluate their beliefs and re-examine where resources would be put to best use.
“For 40 years, the official line has been that we’re in the throes of a terrible problem. Drugs are going wild, and the country is engulfed in addiction,” says William Martin, director of the Baker Institute and an author of the brief. “If you look at the data over 40 years, that simply is not true. We have a problem, and where it exists—particularly in the Appalachian area—it’s a serious problem. Nobody who deals with addiction thinks that is not tragic.”
However, Martin says the bigger picture shows that the $1 trillion spent on law enforcement and incarceration in the United States related to illegal substances could be better spent on public health to help those who have true problematic use. He calls the war on drugs in the United States “a colossal failure.”
In fact, the authors go so far as to advocate for decriminalization policies and a legal, regulated market for all substances from marijuana to heroin—within reason.
“We’re not going to put blocks of crack in the gumball machine at McDonald’s,” Martin says.
Reallocation of resources
Evidence from around the world shows that harm reduction strategies—such as supervised injection sites and clean needle exchanges—have greater impact than criminalization, Martin says. Such programs have met resistance in the United States, however.
While supervised injection sites have been proposed in a few communities, none are in operation. And for years, the government has waffled between allowing and not allowing federal funding to support needle exchange programs—albeit for the peripheral services instead of the needles themselves.
“Legislators in Texas are apt to say you’re encouraging sin and addiction,” Martin says. “No, the evidence is clear that needle exchange is not an encouragement to addiction. It’s a gateway to treatment.”
The United States might not be in a position politically or ideologically to make the leap to legalize marijuana, heroin and other substances, but Martin believes the ground is shifting. He knows stories about law enforcement officers who have ignored crack pipes to avoid taking a citizen to jail because they don’t see the point.
“We are very much in harm reduction, decriminalization where appropriate, regulation and taxation where appropriate,” he says.
Where treatment fits
Martin is also quick to say the brief’s observations aren’t a slight to the treatment industry in any way.
“The data are clear that a high percentage of people recover from substance use disorders normally without treatment,” he says. “We don’t think it is the answer for everything. However, we also see a high percentage—80% to 90%—of people who have SUD after age 26 actually developed it before age 18.”
His suggestion is that resources should be directed to younger populations.