Opinion: Drug use a medical and political issue
Mental Health Matters
There’s a tension, a dynamic, built into all societies about acceptable behavior. The Rule of Law, whether dictated by the monarch or enshrined in the Constitution, is a measurable barometer in a given place and time of how we determine acceptable behavior.
So much for the academic framework.
In all countries, drug use is both a medical and political issue. Medicine sees drug use through the lens of public health, illness, and treatment. Politicians, in contrast, tend to see drug use through the lens of acceptable behavior.
For medical personnel, drug use contributes to cataloging drug types, measuring biological properties, and inventing pharmacologic and psychosocial treatments for drug abuse and addiction.
For politicians, drug use provides a means to be “tough on crime,” to criminalize and penalize drug usage. It was this temptation, which led to laws demanding mandatory minimum prison sentences, long periods of incarceration, and overflowing American jails and prisons over the last 40 years.
Slowly, during the last 10 to 15 years, both the international and American fever to punish drug users has started to yield to science.
First, we learned that the “War on Drugs” was proving to be a dismal failure; drug users were demonized and incarcerated for long periods; billions were spent worldwide on military driven eradication programs, while drug use, overdose deaths, and recidivism rates climbed ever higher.
In the United States, criminal drug policing has gradually started to give way to a science-based public health approach to drug use. Treatment driven alternatives to incarceration and probation, including medication-assisted treatment (MAT), residential and outpatient care programs, and, critically, Medicaid, and insurance funded treatment have saved countless lives, rehabilitated lives otherwise lost to drugs, and helped to lessen the population jailed solely for drug use.
By reducing sentences for low-level drug crimes, the federal prison population has declined after peaking in 2009. Moreover, solid research demonstrates that longer and harsher drug sentences do not reduce crime or improve public safety.
To reduce recidivism in offenders, punishment, if administered, needs to be swift, certain, and brief. Longer sentences, in fact, correlate with increased reoffending. All this is an encouraging start to a more humane, realistic, and science-based approach to drug use and abuse.
Enter Filipino President Duterte, elected a year ago. The Philippines, you might recall, has a history of murderously dictatorial presidents; Ferdinand Marcos, ruling in the Philippines during the Vietnam War, declared martial law in 1972, arrested 70,000 citizens, tortured 35,000, and killed 3,257 between 1975 and 1985.
Duterte, in his campaign for the presidency, promised to crack down on drug use. Previously, as mayor of a large Filipino city, he earned a reputation as endorsing vigilante groups who killed hundreds of street children, petty criminals, and drug users.
After his election to the presidency in the spring of 2016, he encouraged the public to “go ahead and kill” drug addicts. He went on to champion a campaign, which is now responsible for a ghastly spectacle, the extrajudicial killing of nearly 10,000 people.
In December 2016, the New York Times documented 57 homicide victims over the course of 35 days. The Times reported that police and vigilante groups had killed thousands. Said the Times, “Police officers summarily shooting anyone suspected of dealing or even using drugs, vigilantes’ taking seriously Dutertes call to ‘slaughter them all.”
His actions have drawn near universal condemnation from politicians of both parties in the United States, as well as many human rights groups.
But not the Trump administration. In April 2017, President Trump, in a subsequently transcribed call to Mr. Duterte, had only kind words, telling Duterte, “I just want to congratulate you because I am hearing of the unbelievable job on the drug problem.” Later, Duterte, in defending his drug policies, said that Trump endorsed his anti-drug campaign.
And then there’s Trump’s Attorney General, Jefferson Beauregard Sessions III of Alabama. Sessions — scaldingly critical of recent federal criminal justice reform policy deemphasizing punishment and incarceration for low-level drug offenses — told federal prosecutors to charge offenders with the maximum possible penalties again, prompting 31 current and former prosecutors in an open letter to the attorney general to label his directive an “unnecessary and unfortunate” return to harmful and discredited incarceration practices.
In a fact, free world criminalizing drug use and promoting long prison sentences for low-level drug users plays to the bias of a fearful, victimized, angry, and uninformed populous. It also produces more misery, both for drug users, and eventually, all of us.
Incline Village resident Andrew Whyman, MD, is a clinical and forensic psychiatrist. He can be reached for comment at email@example.com.