A Health-Centered Proposal for the President-Elect

by Michael Beaudet

While the Philippines are normally on the international periphery, the country has become another test of the global commitment to human rights. At a time when many countries are turning away from hardline drug policies, President Rodrigo Duterte has declared a new drug war in the Philippines. While some believe that Duterte’s war has brought about enhanced security, the policy shift has cost over 5,500 lives according to Al Jazeera.

It has also provoked nearly universal condemnation from the international community and human rights activists. But there is one leader that challenged the consensus and allegedly voiced support for Duterte’s  policy: U.S. President-elect Donald Trump. Mr. Duterte has purported that Trump approved of the policy during a phone call. According to The New York Times, Trump called the campaign, “the right way” to deal with narcotics.

This raises concerns for two reasons: either Mr. Trump is ignorant of the specifics of Mr. Duterte’s policy, or he understands the specifics and still fully supports it.

It is difficult to know which side is true because Trump did not develop his stance on substance abuse during the campaign. Examining Trump’s campaign website reveals that he does not have a specific section devoted to drug policy. But during an on stage interview with the Conservative Political Action Conference Trump stated that recreational marijuana was, “bad”, but that medical was “100%”. Since drugs were not a major campaign issue, Trump’s team may have never developed a substantive policy framework. With that in mind, I will offer a set of substance abuse policy options for the next administration in order to achieve change and address the nation’s growing opioid crisis.

 


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While these policies are a break from the normal Republican consensus of increased enforcement, Trump has a record of breaking Republican policy norms. Admittedly, some of Trump’s comments defending stop and frisk are contradictory to reform. Also, his appointment of Rudy Giuliani, a punitive policy hawk, does not bode well for reform policies. However, Trump has made promises to restore trust in law enforcement. During the second debate he agreed that improving relationships between communities and police is necessary. A novel approach to drug policy has the potential to lessen distrust by removing punitive policies that generate negative feelings among minority groups.

If Trump is serious about improving race relations, removing punitive policies could be an effective olive branch.

Another opponent of a novel approach may be his Republican base, but the unfortunate trend of opioid-related deaths makes it an opportune moment to enact drug policy reform. Currently, deaths from the opioid crisis now rival the number of deaths from the AIDS epidemic. The growth of the opioid crisis is one piece of evidence that demonstrates how punitive policies have been an ineffective response to addiction. The combination of punitive policy failures and the rising opioid crisis make Trump’s term an opportunity to enact substantive policy change.

According to the Global Commission on Drug Policy, “punitive approaches have unequivocally failed in their goal to extinguish the market.” In theory, punitive approaches such as the broken windows policy in New York City attempted to make the consequences so dire that the market for narcotics would disappear. Additionally, the GCDP argues that punitive policies can commonly serve as a cover for human rights abuses, which Duterte’s policies are evidence of.

First, we must examine a country that has abandoned punitive policies. Portugal enacted novel drug policies in 2001 after recognizing the worsening health conditions among drug users. They rejected punitive policies which failed to address the increasing number of drug related deaths and drug related disease. Instead, they decriminalized the possession of all drugs; it is no longer a criminal offense to possess 10 day supply of any drug for personal usage. If someone is found to have drugs by police, instead of being arrested they are referred to a 3 person dissuasion board. The board can recommend fines or treatment. In addition to decriminalization, Portugal also directed additional funding to prevention, treatment, harm reduction and social reintegration programs.

Together the policy changes create a complementary framework that reduces the stigma of drug usage and provides health-centered resources to users.

This health-centered approach has been quite successful in improving public health outcomes. According to a report from the Drug Policy Alliance, the number of people in Portugal receiving drug treatment increased by 60% between 1998 and 2011. Additionally, the number of new HIV/AIDS cases among drug users has fallen precipitously. Besides health benefits, Portuguese authorities have also seen a significant increase in the amount of drugs seized. A health-centered approach allows law enforcement to focus on large scale dealers instead of users. Touting these benefits of the Portuguese approach could be another way to sway challengers like Rudy Giuliani. These public health and enforcement successes are encouraging, but decimalization may have also brought about some negative consequences.

According to the Berkley Foundation Drug Policy Programme, decimalization may have led to increased lifetime usage of drugs but decreased public health problems. This means that citizens are more likely to experiment with drugs at some point in their life. Depending on the drug, there could be increased adverse effects. Increased lifetime usage is still debated however. Transform, a charitable think tank, argues that lifetime drug usage is an inaccurate measure of, “a country’s current drug use situation.” Transform states that excessively punitive policies only have a marginal impact on drug usage.  

Overall, decriminalization and significant public health programs have resulted in a healthier public that may or may not be slightly more likely to experiment with drugs.

There are many different reasons for supporting more or less punitive policies. For example, Libertarians support less punitive policies due to their inherently paternalistic nature. Another source of support for less punitive policies is the extremely prejudicial nature of the United States “War on Drugs.” According to the NAACP, even though five times the number of whites use drugs, African Americans are 10 times as likely to be sent to prison. This disparity is unacceptable. The ACLU argues that utilizing the term, “War on Drugs,” has been critical to ensuring that the population accepts hardline drug policies: anything goes in war.

If punitive policies have proven unable to erase the drug market, are we still willing to accept these social costs? Portugal’s health-centered experiment, which generated lower incarceration rates for drug offenses, offers a possible solution but the United States is not Portugal. If a health centered approach is to be successful, it must take into account the country’s unique drug problems. In the U.S., this would entail developing policies that specifically target opioid usage. The first step towards a health centered approach would be to secure increased funding for rehabilitation and treatment efforts. Simultaneously, decimalization policies that mirror Portugal’s should be enacted. The key is securing both of these policy changes at the same time. Enacting one policy without the other could cause poor results.

Part of the funding should be focused on education regarding the connection between prescription pain medications and heroin usage. According to the same National Institute on Drug Abuse, the abuse of prescription pain medication may be a gateway to heroin usage. Since the average person is more likely to assume that prescription painkillers are safe, painkillers are overprescribed and overused. Furthermore, increased access to prescription painkillers and heroin has been correlated with increased overdoses. Changing the public’s perception is not easy, but a coordinated educational campaign could show real benefits. The key would be targeting claims made by pharmaceutical companies that are untrue or questionable. These tweaks to the Portuguese strategy are necessary in order to address the opioid crisis.

Decriminalization and health-centered policies represent a novel approach to substance abuse in the United States.

Just like any public policy these choices are not without their negative aspects. That being said, the opioid crisis cannot be ignored and requires some sort of novel solution. Portugal’s experiment offers an approach that has a proven track record of positive health outcomes. Additionally, it lacks the prejudicial externalities that have decreased the effectiveness of punitive policies. Overall, this novel approach may allow our society to move past the abject policy failure of the punitive approach.


Michael Beaudet is a senior economics and foreign affairs major from the University of Virginia. He describes himself as possessing unquenchable ambition and limited knowledge, he hopes to make a difference in the world. His goals are to succeed, meaningfully impact the world in a positive way for others and be happy working hard.


The views expressed in this article are those of the writer. The Contemporary takes no position on matters of policy or opinion.


The picture above is under a CC BY-SA 2.0 license, was adapted from an image created by Andi Sidwell which can be found here.

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