Drug overdoses are now one of the leading causes of death in the United States and are contributing to decline in life expectancy. The opioid epidemic has cost an estimated $1 trillion since 2001. And yet, to date, there has been no comprehensive response to the crisis.
The United States needs to embrace the policies that have helped reverse heroin epidemics in the past, especially opioid substitution therapy (instead of the current focus on immediate abstinence) and what are called harm-reduction services (needle and syringe programs, drug checking, wide availability of overdose reversal medication, and safe-injection facilities). Decriminalization also has been linked to better health outcomes, allowing people in need to access, without fear of harsh punishment, these various life-saving services.
{mosads}Given the extent of the opioid epidemic, the U.S. government not only needs to seriously rethink the way it regulates prescription medicines but also must consider how to legally regulate other drugs. Legal regulation is often poorly understood or misrepresented, and a complete anathema in the United States. This was certainly the case in a recent op-ed by Jonathan Caulkins and Keith Humphreys, “Drug dealers among us: Look for those wearing lab coats or pinstripe suits,” published in The Hill on Feb. 6. The authors’ comments on regulation, naming the Global Commission on Drug Policy as a prominent proponent, were, we like to believe, based on misunderstanding.
The legal regulation of drugs involves recognizing the potential harms that drugs pose, and regulating each drug according to its particular risks. This is not about allowing “free-market capitalism” to control supply and demand as the authors suggest, but rather about governments taking responsibility for their citizens’ well-being, and not allowing the market for harmful substances to remain in the hands of organized criminals. A state monopoly on dangerous goods and activities where demand is not going to be shunned needs to be considered.
Let’s take the case of heroin, for example, since the main concern in the United States today is opioids. Countries such as Switzerland that allow for its strictly-regulated prescription within the framework of heroin-assisted treatment have seen reductions in overdose deaths and drops in crime rates, e.g. participants do not have to engage in low-level dealing anymore to fund their drug use and, therefore, also do not recruit new users.
This regulatory framework for heroin, provided in a controlled medical environment and designed to address opioid addiction in the minority of cases where other treatments have proved unsuccessful (e.g. methadone or abstinence oriented treatment), is certainly not about “legal corporations sell[ing] heroin as if it were bubble gum” as suggested by the authors. Indeed, in Switzerland, Heroin-Assisted Treatment (HAT) began just over 25 years ago as a pilot project and was not adopted as general law until it had proven effective after 15 years of monitoring and evaluation. Furthermore, it was successfully supported by voters at the ballot box on several occasions.
The prescription medication market in the United States, on the contrary, constitutes an example of misguided regulation driven by commercial interests. Indeed, the Global Commission on Drug Policy’s 2017 position paper on the The Opioid Crisis in North America highlights the troubling aspects of the current regulatory framework, such as the incentivization of doctors and salespeople. The report explicitly states the need for guidelines and training on prescription and regular monitoring, “to provide effective and adequate pain care, while minimizing opportunities for misuse — and diversion — of these medications.”
At the Global Commission on Drug Policy, we recognize that there are risks and unknowns with any policy change, and the authors of the aforementioned op-ed are right to point out the dangers of over-commercialization, which is why we advocate proceeding cautiously. But policymakers also must measure against the manifest harms of unregulated criminal markets, in terms of increased violence, and impure and more potent products.
Regulation cannot make drugs entirely safe but well-designed regulation does reduce risk, particularly if it is not ruled by free-market impulses. Indeed, regulation is important because drugs are risky, not because they are safe.
Ruth Dreifuss is the former president of Switzerland and chair of the Global Commission on Drug Policy, an independent body comprising 25 members, including 12 former heads of state or government, a former U.N. secretary general and three Nobel Prize laureates.