Dear Cosmonaut Editors,
I’m an anti-prohibition activist and I just finished, “Addiction is not a crime.” There were many things I liked about it, but also several aspects I found troubling.
I found it troubling that you mention Oxy and the Sacklers as if Oxy started the opioid crisis we are in. That isn’t really the way it worked. To support this idea is to support prescription monitoring which is also a form of prohibition. So, while saying you are anti-prohibition you are still supporting it. And it is prescription monitoring that has lead to Fentanyl which is the main cause of OD death. So, it is a highly qualified plea to end prohibition if you say that you want people to be able to buy all recreational drugs but you still don’t want them to be able to get them from a doctor, which is the safest method.
You also praise the DPA very highly. The group I represent, Ending Prohibition and Finding Honest Treatment, recently wrote them a letter that explains how bills they are presenting to Congress are worded so as to support coerced treatment for those inclined to believe in coerced treatment and who do not understand that coerced treatment is a problem, which is probably everyone who isn’t an expert in the area. Thus, I wanted to include that letter about this issue as well.
Additionally, it is problematic that you talk about capitalist exploitation and alienation as causing drug “addiction,” which are valid points and ones that I would agree with following the social psychology model of Bruce Alexander’s Rat Park, who you don’t mention but probably should mention. However, you fail to bring in that the 1% benefits from the Drug War and that is they key reason it continues. That is what a Marxist interpretation should do, look at how the 1% exploits the rest of society. You just say that drug “addiction” is the result of exploitation, which is true but you make the solution impossible when instead of doing a hard tap to ending prohibition, you say that the solution is tear down the exploitation of capitalism, despite NOT really explaining what this is.
Thus, you offer a non-solution. You offer something like saying, “The end to drug addiction is for people to be happier.” Yes, this is true but it is meaningless unless you have a plan on how to get there.
I’ve also included my letter to Colorado lawmakers regarding the DPA that you praise so highly in terms their stance on coerced treatment.
Silver Damsen, President Ending Prohibition and Finding Honest Treatment
Dear Colorado Lawmakers:
I’m writing you on behalf of the organization, Ending Prohibition and Finding Honest Treatment to congratulate and encourage Colorado lawmakers on their success with reducing the prohibition on marijuana and psychedelic mushrooms. These changes seem to have benefited society. Thus, we encourage Colorado lawmakers to look at the legalization and decriminalization of all recreational drugs as likely to have similar effects, taking money out of the hands of drug cartels and putting it back into the state. Decriminalizing and legalizing recreational drugs also means spending less money on prison and coerced treatment for those that consume drugs. Tax payers must pay in multiple ways every time a drug consumer or dealer is arrested, and also like the Volstead Act 1919-1933 (alcohol prohibition) laws against consumption and to punish dealers tend to have the most obvious result of creating crime and violence.
Unfortunately, one of the distressing trends, however, in decriminalization legislation is to build in coerced treatment. This is a trend that appears to be helpful but is NOT in fact helpful. The most obvious form of coerced treatment is drug court, but there are many others. (Portugal is often used as a model of decriminalization and this is valid. It also shows less success the more a decriminalization model is combined with the value that those that consume drugs are sick and/or bad, which is key to the push for coerced treatment in the USA and again is something that should be avoided. The included article provides a good overview of these issues concerning Portugal https://substanceabusepolicy.biomedcentral.com/articles/10.1186/s13011-021-00394-7 ). Similar to prison, coerced treatment costs tax payers but doesn’t actually prevent the consumption of the drug that society is trying to ban—the same failure that occurred in the Chinese Opium War in the 1800s, what could be considered the beginning of the War on Drugs. The Chinese Opium War shows that both supply-side and demand-side tactics that governments have the power to apply will NOT work, and yet governments the world over keep repeating the same experiments and getting the same failures.
Thus, the core point is that spending less on the Drug War is the way to stop having casualties. That coerced treatment seems to many as if it should be helpful but it isn’t is why the remainder of this letter is devoted to that topic. The hope is that this discussion will better inform Colorado legislators on what coerced treatment is and how to avoid it when it comes up as part of policy discussion. Our organization has recently written the larger and better-known group, The Drug Policy Alliance (DPA), in respect to the bill they are submitting to the US Congress. In this letter, Ending Prohibition and Finding Honest Treatment discusses the problems in the way that the Drug Policy Alliance lays out the issue of treatment. We see it likely that if Colorado were to propose additional drug decriminalization that aspects of coerced treatment would be in these (hypothetical) bills unless lawmakers worked carefully to keep these aspects out. Thus, the hope is that if you read this letter that you will have a deeper understanding of what might be problematic in hypothetical (but still hoped for future) proposals for decriminalization and/or legalization in Colorado We do not know as of this writing if the Drug Policy Alliance is going to enact the suggested revisions. However, we were told by them that they were seriously considering it.
“I think the biggest problem in the letter is that the DPA doesn’t explain what coerced treatment is and why coerced treatment is harmful. An individual or group that supports coerced treatment is NOT going to label the act of coercion as coercion. Rather it will label the act of coercion as “helping,” probably even “helping” someone find “evidence-based treatment.” So, if activism wants to discourage coerced treatment in a society that is headed in that direction, it needs to be clear what coerced treatment is and why it is a bad idea to do it. This draft doesn’t do that.
And in the contexts that treatment is discussed, and it is discussed frequently in the letter, the context is always prefaced with the idea that treatment works. Never is it brought up that rehab for opioids increases the chance of OD death so that coerced rehab has rates of OD death similar to those released from prison. This is an important omission.
Related to these larger issues is that at the core the letter seems designed to cater to those that want prohibition, want to believe that drugs should be illegal, and want to take the money that is being badly spent on the legal system and prison complex and just move that to the treatment sector. This is even a problem in the Oregon decriminalizing, which at the time members of Ending Prohibition and Finding Honest Treatment celebrated with others in the Harm Reduction movement, but we have increasing reservations about now. For example, it makes no sense to have prescription monitoring laws and murder charges for low level drug dealers if a society is working towards decriminalization (while this letter is not meant to be an academic paper that sites dozens of studies, this additional reference is useful it that it indicates that the homicide laws for OD are making the drug crisis worse https://www.healthinjustice.org/drug-induced-homicide Similarly, another study, an analysis of previous studies, says that the most effective treatment for “opioid use disorder” is what activists refer to as prescription heroin, which means the government provides free, safe, and legal heroin for those that quality as a way to stop OD death and the traffic in illegal drugs https://www.journalofsubstanceabusetreatment.com/article/S0740-5472(21)00245-2/fulltext.) If a society is working towards coerced treatment for all drug consumers but still with prison for low level drug dealers (even if all regular drug consumers are low level dealers), then what the DPA is asking for would help accomplish that. But that is making the problem worse, not solving it.
Thus, this proposal could mean more money than ever before poured into ineffective treatment, which will also increase the OD death rate. Worse still, we know that Republicans and Conservatives are uncomfortable with drugs being legal and like the idea of punishing offenders (perhaps going back to the USA Puritan roots?) so that if a system can be shown to be more ineffective and also more expensive than the previous prison complex system, this could bring in the actual enforcement of the death penalty for users and low level dealers. These laws are in place. All it is going to take is a nudge to make them happen if we get another Republican President.
Thus, more effective legislation would work to dial back prohibition without increasing treatment. This will decrease OD death rate and save tax payer dollars. The greatest problem with pouring more money into treatment is that the OD rate and also the problem with illegal drugs is likely to stay more or less the same or even get worse. As in, note that the OD death rate has climbed since rehab became more popular, but, of course, there are more factors than just rehab that goes into the higher OD death rate. The number one driver is Fentanyl but Fentanyl is the result of prescription monitoring combined with policing low level dealers, which make the most concentrated version of the drug the most profitable for illegal dealers. So, even if it is indirect, increased prohibition laws are what has increased the OD death rate and thus the logical way to reverse this is to decrease prohibition rather than spend more on treatment that doesn’t work.
The DPA should also know all of this and thus should work to find solutions that are actual solutions and work to educate politicians on why coerced treatment won’t work, why the death penalty for drug dealers should be repealed, and why prescription monitoring needs to be ended. But the DPA doesn’t do that. Instead, the DPA attempts a seeming solution that will satisfy everyone, or rather the people that don’t ask enough questions and assume that because the DPA doesn’t say that it is advocating for coerced treatment that that is NOT what will happen. Context indicates that unless there is a strong push back at the local level for the end of coerced treatment that coerced treatment will be part of this bill. But it will make the DPA look like it has done something useful even if in the long term the bill will only make a more confusing tangle of ideologies that will make it even harder for those that want to end prohibition to bring about truly effective change in policy.
The below is a listing of all the problematic references to treatment. Reworking these sentences so that they can NOT be interpreted as supporting coerced treatment, is then something we would strongly recommend.
“invest in alternative health-centered approaches.” – this one is obvious. It calls for financial investment in treatment as an alternative to prison which is going to mean coerced treatment unless carefully specified as NOT meaning this.
“a growing number of lawmakers and others have taken a more compassionate stance towards people who use drugs, calling for alternatives to arresting people who struggle with drugs and treating addiction as a health issue. This shift towards less punitive attitudes has been fueled by the misleading perception that the overdose crisis has almost exclusively impacted white and affluent communities. The shift in tone, however, has not translated into policy reforms that can help mitigate an underlying factor driving the overdose crisis: criminalization. To turn the tide, we must remove criminal penalties for the possession and use of drugs. “—this is interesting and, as much of the letter does, gives helpful information. But again it is problematic for just saying more money needs to be spent on “addiction” as a public health issue, which unless explained is going to translate into more coerced treatment.
“Criminalization is a driver of the overdose crisis because criminalization actively dissuades people from getting help for fear of arrest and experiencing stigma from law enforcement, healthcare workers, and others.ii Criminalization perpetuates the stigmatization of people who use drugs, making it more difficult to engage them in treatment, health care, and other vital services that are proven to transform and save lives.” –the wording here slants towards a favorable opinion towards coerced treatment without defining coerced treatment as what it is. As in, the goal is to “engage” people in treatment rather than to just allow recreational drug consumption as we do with alcohol and as we know historically can be done with these drugs because it was done so for thousands of years, and with opium products tens of thousands of years, prior to the Harrison Act of 1914.
“Additionally, there is a significant human cost to criminalization. Research shows that in the first two weeks after being released from prison, formerly incarcerated people are 40 times more likely to die of an opioid overdose than someone in the general population. Even an entire year after release, overdose rates remained 10-18 times higher among formerly incarcerated individuals compared to the general population. Incarceration of people living with substance use disorder produces the worst outcomes and often leads to accidental, fatal overdose.” –as mentioned earlier this data is relevant but it is a dangerous omission to pretend that those released from rehab don’t also have a high OD death rate.
“Removing penalties for drug possession would facilitate a divestment from criminal justice systems and an investment in public health to fund projects that can benefit society and help curb addiction, such as investments in health care, education, housing, and life-saving treatment services for those who want and need it.”—this sentence is the one that most seems to define non-coercive treatment. If it were expanded to explain why coercing treatment is problematic much of the problem with the letter would be resolved, but again ideally the letter should never include a reference that the reader could interpret as favoring coerced treatment.
“The brunt of these collateral consequences disproportionately harms poor people and people of color, while wealthy people typically have the resources to address criminal justice issues and/or problematic drug use voluntarily and privately.”—This is one of the more interesting sections. Of course, the wealthy have always opted for treatment that doesn’t have to work rather than prison, but the wording suggests that this is a good option for everyone. And getting everyone into treatment is NOT the solution.
“Portugal removed criminal penalties for drug possession in 2001. Studies have revealed that the country did not experience any major increase in drug use, all while enjoying fewer drug-related arrests, plummeting rates of HIV and drug-related deaths, and an increase in the number of people seeking treatment.”—what is most interesting and also most frustrating about Portugal as an example is that they didn’t want to invest in treatment but to a certain extent the USA forced them to, so that Portugal can even be used as a model that coerced treatment works. But really what has worked about Portugal is just allowing adults that wanted to consume drugs to do so.
“Sixty-six percent of voters support “eliminating criminal penalties for drug possession and reinvesting drug enforcement resources into treatment and addiction services.”—here the issue is the wording of the survey. This is the most clear support of coerced treatment in the letter but the DPA in a way can be said to NOT be responsible since it is the wording of the survey and NOT the DPA’s wording. But it is clear that the plan is to take the money that is put into arresting, convicting, and incarcerating people for drug possession and instead put it into “treatment and addiction services.” If “addiction services” were defined as Harm Reduction outreach and “treatment” was defined as non-coercive that would help but it is problematic that society assumes that coerced treatment is helpful. If the DPA wanted to change these unhelpful ideas on coerced treatment, they would challenge them, not seem to go along with them.
“We applaud this historic bill that will end the criminalization of drug use and possession, invest in evidence-based, public health approaches to drug use, and eliminate the life-long consequences of drug law violations. “ – What is meant by “evidence-based”? “Evidence based” can even refer to 12 Step, which is faith based and most research says is ineffective but it is true that a few studies say that it is more effective than no treatment, but still at about 10% success rate. That this very low success rate does appear in some studies is what qualifies it as “evidence-based” but that makes the term meaningless. And the idea of “public health approaches” sounds like it means treatment. If the DPA were more specific and talked about increasing the economic and emotional well being of those in crisis, whether drug consumer or not, that would help get away from the idea of coerced treatment. However, the USA is uncomfortable with helping the poor, which is a related and huge problem connected to heavy drug consumption.”
Sincerely,
Silver Damsen, President Ending Prohibition and Finding Honest Treatment
Marcus Mikesell, Vice President Ending Prohibition and Finding Honest Treatment, and Outreach Coordinator at Virginia Harm Reduction Coalition
Carol Terwilliger, Director of Investigations into Corrupt Practices Ending Prohibition and Finding Honest Treatment
Adam Dorsett, International Coordinator Ending Prohibition
Douglas Andrew Williger, US Coordinator Ending Prohibition and Finding Honest Treatment, and Creator of the blog, Freedom of Medicine and Diet
References Cited
Karqmouzian, M. Kebriaeezadeh A, et al. Opium tincture—assisted treatment for opioid use disorder: a Systematic Review. Journal of Substance Abuse Treatment.129. 108519 (October 01, 2021).
Rego, X. Oliveira, M. J. Lameira, Cl et al. 20 Years of Portuguese Drug Policy—developments, challenges, and the quest for human rights. Subst Abuse Treat Prev Policy. 16. 59 (2021).
