The 2014 report by the Department of Health and Human Services entitled “The Opioid Epidemic: By the Numbers,” offers shocking statistics on heroin and fentanyl (a cheaper synthetic equivalent). In the nation, there are an estimated 78 overdose deaths per day, $55 billion in annual costs related to prescription opioid abuse and a quadrupling of opioid overdose deaths from 1999-2014. In the first half of 2016, New Orleans saw 65 opioid-related deaths, compared to only 47 homicides in the same period. There is a clear need for prevention efforts both in New Orleans and nationally.

In response to this epidemic, the DHHS recommends refined opioid prescription practices and increased access to drugs like naloxone and methadone, which respectively treat overdoses and addiction. Despite these helpful measures, the report neglects to address the federal government’s larger approach to drug policy. The U.S. government’s treatment of opioid addicts is as criminals rather than victims, resulting in nothing more than higher incarceration rates.

The current criminal justice approach is essentially a continuation of policies implemented under Richard Nixon, who founded the Drug Enforcement Administration and declared drugs “public enemy number one,” and Ronald Reagan, who instituted mandatory minimum sentences for nonviolent drug offenders with his 1986 Anti-Drug Abuse Act. While these policies have succeeded in locking up drug offenders, who constitute 46.4 percent of the federal prison population, they have failed to decrease illicit drug use, which has increased by 8.3 percent since 2002. The existence of these two statistics is evidence enough of the failure of federal policy; if incarceration worked, drug abuse would decrease.

The government should recognize this, especially considering the fact that their own agencies, the Bureau of Prisons and the National Institute on Drug Abuse, collected these statistics.

The incarceration approach becomes even more problematic in light of the opioid epidemic. Prescription opioid addicts can seek treatment with little fear of legal punishment or social stigma, especially if they became addicted to drugs prescribed to them in the first place, such as morphine or oxycontin. This does not follow for those addicted to illicit opioids.

Heroin and fentanyl, Schedule I and II drugs, respectively, carry harsh legal penalties for mere possession and the social stigma associated with illegal drug use can be enough to prevent addicts from publicly seeking treatment. Yet, besides an extra acetyl molecule, heroin and morphine are pharmacologically identical and are equally capable of causing addiction and death.

Given these similarities, opioid addiction must be treated as a concern of public health rather than one of criminal justice.

The need for a shift towards a public health policy was first recognized and implemented by the Portuguese government in 2000. In that year, Portugal decided to decriminalize all drugs previously classified as illegal, including heroin and other opioids. Rather than triggering epidemic levels of hard drug use, drug use fell, as did overdose deaths, which are now five times lower than the European Union average. This “harm reduction” model, which provides free, legally mandated treatment for drug addicts and clean needles for heroin users has not only reduced heroin overdoses and use, but also the nation’s rate of new HIV infections, as users are less likely to share needles when they know they can seek clean, free ones from an institution which will neither stigmatize nor punish them.

Perhaps the best part about the Portuguese approach, other than its reduction of drug use and addiction, is the example it has set. Portugal had the courage to deviate from the internationally accepted policy norms and has reaped massive benefits for doing so. Thanks to this, the U.S. need not be its own guinea pig. It can abandon its ineffectual and punitive policies in favor of something that actually works.

There is no better time than now; as the opioid epidemic continues to expand across the country and leave death in its wake, the U.S. government should take Portugal’s lead and move towards policies aimed at treating, rather than punishing drug addiction

Opioid use in NOLA

http://www.nola.com/crime/index.ssf/2016/08/dea_new_orleans_fentanyl.html