Amid a century-long drug war in the United States, things are getting worse.
Currently, over 100,000 annual deaths are attributed to “overdose,” most involving more than one drug. That’s a 16-fold increase since I was born, in 1980, and the highest number in US history. Yet the people with the loudest voices promote the same ineffective responses: Lock sellers up and hire more police officers. Continue racist enforcement. And block people who use drugs from policy conversations.
Each year, the US spends upwards of $300 billion on the criminal-legal system, much of it devoted to the drug war. Nearly half of people incarcerated in federal facilities and nearly one fifth of those in state prisons or local jails are incarcerated over a banned substance. Countless more, like me, were arrested for theft or DUI, crimes which allowed our issues with addiction to be ignored in favor of torture over treatment.
Besides the bitter human cost, we are wasting our money. Last year alone, people in the US spent $150 billion on illegal and untaxed drugs along with a boatload more on prescription drugs. No nation in human history has spent as much time and money on intoxicating substances as we do today. We consume far more cocaine than any other country, and we take a full 80 percent of the world’s opioids. We are a nation of drug users waging an irrational war against ourselves. And we’ve known it for a long time. In 1996, the US Department of Justice estimated that as much as $150 billion could be saved every year if we legalized all drugs. Yet the war rages on.
Despite trillions of dollars and millions of lives lost, victory on the drug war’s own terms is no closer than when it began.
There are two main ways for a war to end: victory or defeat.
Victory is the strategy which the US has mercilessly deployed for more than a century, and despite trillions of dollars and millions of lives lost, victory on the drug war’s own terms is no closer than when it began. We currently arrest someone for a drug crime every 35 seconds. For all these efforts, banned drugs today are more common and more potent—per the Iron Law of Prohibition—than they were 50 years ago. The conflicts have been waged largely against poor people, people of color, and those who don’t live inside the United States, while many rich folks wouldn’t know the drug war exists at all if it weren’t for the news.
But what if we keep it up for another century? Or what if we really ramp it up to an all-time level of violence and intrusion? We can look overseas for an example of that strategy.
Former President Rodrigo Duterte of the Philippines bragged about groups of police officers and vigilantes who went around murdering alleged drug users and sellers, leaving their bodies lying in the street as a message to others. The tactics of these death squads are not a secret. In fact, many people voted for Duterte because he promised to do exactly what he’s done. Duterte has described people who use drugs as irredeemable and encouraged people to kill them, since “getting their parents to do it would be too painful.” After years of mounting evidence—in 2020, the UN estimated that up to 27,000 people had already been killed in Duterte’s drug war—the International Criminal Court began investigating Duterte’s “crimes against humanity.”
Duterte didn’t end drug use in the Philippines. Despite his violent campaign, he cannot claim victory—and even if he could, no one with humanity would consider it worth the cost.
Despite Duterte’s recent departure, his legacy will be carried on by his daughter, Sara Duterte, who has been elected vice president. She will serve alongside the newly elected President Ferdinand Marcos Jr., whose parents were ousted from power in 1986 for human rights abuses and stealing billions of dollars (which were never recovered) from taxpayers. It appears that, like the US, the Philippines is stuck in a rut of making the same mistakes year after year.
There is another way to end the “War on Drugs,” which is to accept that it cannot be won. Numerous examples across the world show paths to doing so.
In the United Kingdom, various experiments, some still ongoing, have been carried out wherein people are simply given the drugs they use. This is the same basic system which persisted in the United States until the early 1900s, when doctors stopped helping addicted people for fear of being arrested. It’s commonly known as the “British system,” and it actually works pretty well. There were only 342 people who were known to be addicted to heroin in the entire United Kingdom in 1964, when heroin could be obtained with a prescription. But program directors were pressured out of business by politicians and international organizations devoted to permanentizing the drug war, and their results were buried once their patients were again forced to return to the streets for their drugs.
That wasn’t just a one-off, however. In the 1990s, Switzerland tried a version of the British system and saw similar results. Deaths and new cases of HIV and other infectious diseases contracted from needle-sharing fell. Switzerland’s scaled-up efforts worked to minimize what researchers have called a structural “risk environment” evident in countries where prohibition is the norm, like the US. Structural risk manifests in laws and policies which make the lives of drug users more difficult and dangerous than those of others. Swiss doctors found that when structural risk was reduced, people seemed to do just fine, even when they were using drugs like heroin.
Drugs aren’t responsible for the majority of problems people find themselves struggling with. It is the environment in which we use those drugs that lands us in jail or the hospital.
Swiss doctors weren’t handing out heroin to anyone who wandered in and asked for it, but they were willing to write limited prescriptions to those who were going to use the drug one way or another. While writing those prescriptions, they inevitably had a chance to chat with their patients, to offer alternatives and safer use practices, and to screen them for other mental health or medical issues. That’s harm reduction. And it worked. Crime decreased, as well as disease transmissions and overdose. And people who had been running the streets and hiding out to use their drugs could instead do things like work and go to school.
The world watched as Portugal made what many saw as the biggest drug policy mistake in history.
Some countries took notice and followed their own paths. In 2001, Portuguese policymakers made the unexpected move to decriminalize all drugs. At the time, one in 100 people living in Portugal was estimated to be struggling with heroin addiction, and the country had already tried punishment, prison, huge fines, cracking down on supply—and none of it had worked. More than half of its prison population was locked up for drugs, and HIV infections from drug use were higher than anywhere else in Europe. The country had nothing to lose.
The world watched as Portugal made what many saw as the biggest drug policy mistake in history. Drug warriors anticipated that they would soon have a case study to use as evidence that their bloody war was justified. But that didn’t happen. Twenty years later, the reason most of us still haven’t heard about Portugal’s then-experiment, now-norm is because it was so successful. Carnage generates bigger headlines.
Portugal saw huge reductions in the rates of HIV and hepatitis contracted by sharing needles, from 52 percent of all cases in 2000 to 7 percent in 2015. Its jails cleared out, and many people, now able to seek help and resources without fear of arrest, were able to find more balance in their lives. Methadone vans now travel the streets at all hours, handing out medication to people who would otherwise use street opioids. And with this kind of support, a lot of people stopped using heroin. In 2001, around 100,000 people in Portugal were addicted to heroin; in 2015, only 25,000 people were.
Overdose deaths fell dramatically, thanks in part to the opening of safe consumption sites, spaces where people can use their drugs without fear of arrest, and where overdose-reversal medication and trained staff are always on hand. Tellingly, not a single overdose death has occurred at a safe consumption site anywhere on Earth, and they now operate legally in at least 14 countries, including two which recently opened in New York City.
Portugal’s allowing people to use drugs without fear of arrest reduced both harms related to drug use and crimes related to illegal markets. Decriminalization had the opposite effect of what opponents had expected.
So drug warriors got to work ignoring it. That’s traditionally been the American way.
But other countries learned some lessons. In 2013, Uruguay legalized cannabis—nationwide, not state-by-state as the US is doing. In December 2017, Norway announced its intentions to follow Portugal’s lead—to decriminalize all drugs and offer people with addiction treatment rather than torture. And recently, the US state of Oregon effectively decriminalized small quantities of all drugs. But it’s our neighbors to the north who have taken the lead on safe supply.
Those who have been receiving safe supply for years have experienced many life benefits, besides increased safety.
In January 2019, Canada began its first safe supply pilot program, providing hydromorphone (Dilaudid) to a number of people in British Columbia. It didn’t take long for the evidence to start piling up, indicating improvements in quality of life and decreases in purchases of drugs from the dangerously adulterated illicit market. The US government has meanwhile been busy scaring doctors and pharmacists into thinking twice before writing or filling prescription for opioids; the streets, relatedly, became awash in unpredictable doses cut with various forms of fentanyl(s) and opioid enhancers, like xylazine.
In Canada, just over a year after the hydromorphone pilot program launched, and as COVID-19 entered the world’s lexicon, the federal government released updated “risk mitigation” guidelines in March 2020. These encouraged physicians across the country to prescribe morphine, amphetamines, benzodiazepines and other pharmaceutical drugs to “support a reduced risk of withdrawal, exposure to COVID-19, and exposure to a limited and toxic drug supply.” Results are still preliminary, but those who have now been receiving such care from their regular medical providers for years have experienced many life benefits, besides increased safety.
After a century of war against people who use drugs, and decades of fighting against harm reduction efforts, the US government has finally changed course—at least, somewhat—with the Biden administration. In April 2021, the White House released Biden’s “First-Year Drug Policy Priorities,” which, for the first time in history, included “enhancing harm reduction services that engage and build trust with people who use drugs.” The seven-item list of priorities begins with: “1. Expanding access to evidence-based treatment, particularly medication for opioid use disorder.” Biden’s 2023 budget request to Congress includes an investment of $42.5 billion for National Drug Control Program agencies ($3.2 billion more than 2022), with $85 million earmarked for CDC evidence-based harm reduction services.
Biden has a long record of endorsing laws and policies which contradict a harm-reduction approach, and his government still has much further to go, but these updates are notable. A change is in the air, slowly as it may be manifesting.
But harm reduction is not enough. The legalization and regulation of all drugs is where all of these positive paths—decriminalization, safe supply, legal cannabis—logically lead. And it is this future that will finally represent victory over the harms created by the drug war. Not because we want people to use drugs, but because we recognize that people always will use drugs, and providing safe access prevents a host of harms.
People who use drugs deserve to know exactly what they’re consuming, and in what dosage. They shouldn’t have to risk their safety to obtain their drugs. Citizens of the “Land of the Free” should be able to purchase heroin, methamphetamine, tobacco (or better, nicotine vapes), alcohol or cocaine any time we want, though not without reminders of how to practice safer, responsible use.
Legal regulation will save countless lives from overdose, criminalization and other harms. Another beauty of it, given the huge demand for drugs, is that such a market will pay for itself.
It means a supply chain with product testing and inspections, accountability, labeling, secure and sanitary packaging, and affordable, accessible distributors.
But what would a legal drug market look like?
In the US before 1914, when drugs were cheap, legal and easy to find in pharmacies, most drug users had a steady income and healthy connections to their communities. As Richard DeGrandpre described in his book, The Cult of Pharmacology (2006), more than 20 percent of regular drug users in the pre-drug-war United States were wealthy, while only 6 percent were poor. In a regulated US market, drug users worked fulfilling jobs, paid taxes, bought houses and went to church. People struggled with addiction from time to time, sure. But there were few structural risk factors until we began erecting them.
That doesn’t mean we should just go back to the way things were, with unregulated snake oil salesmen pedaling unlabeled products and access reserved for those who can afford it. Neither should we promote a free-market free-for-all, ushering in the Budweiser or Marlboro of heroin. But there are some clues in those original drug laws, which were actually focused on ensuring customers knew what they were consuming, not on preventing them from consuming it. We should start there, because overdoses happen when people don’t know what they are taking, or how much.
That means a supply chain with product testing and inspections, accountability, labeling, secure and sanitary packaging, and affordable, accessible distributors. It also means creating markets and regulations designed to include and benefit the populations most harmed by the drug war, with proceeds from taxation directed to programs and facilities supporting underserved communities. Properly regulated, the legal market will protect future drug users. Through labeling and accompanying educational campaigns, it will empower us all to learn about the drugs we plan to take and their safer use.
The path taken with cannabis, moving it from sinful to acceptable in the minds of so many US citizens, is a roadmap for other drugs. A chemical that appears to enrich bad guys and harm vulnerable people is bound to attract hatred. But when it benefits society financially and improves quality of life, we tend to feel a lot better about it. Colorado has already taken in more than $2 billion from marijuana since it began collecting taxes on legal sales in 2014. It’s hard to complain when public coffers fill up, even if we can then debate expenditures.
Narratives can eventually change. MDMA and ketamine—drugs which were, for decades, blamed for brain damage and death—are seen very differently when someone stops smoking cigarettes after a few MDMA treatments, or their treatment-resistant depression lifts with the help of a ketamine infusion.
Ending the drug war means ending the divide between who is and who is not allowed to use their preferred drugs.
Although these therapeutic drugs, and others, like psilocybin, are already making their way to legal distributors, wealth should not become a barrier to access. I’m not the only one who has experienced guided trips on my couch with a trusted friend that rivaled anything I could have paid for at the therapist’s office. And although there’s little resistance to post-prohibition markets for psychedelics, we should remember that the drug war is bedfellows with a long list of -isms which mark other drugs as more dangerous based on who is believed to be using them. Ending the drug war means ending the divide between who is and who is not allowed to use their preferred drugs.
When it comes to opioids, benzodiazepines and other common pharmaceuticals, we already have a well-oiled distribution machine in place. But we will need to re-train physicians, helping them unlearn many of the toxic treatment techniques they have been forced to adopt. We should devote a section of medicine solely to the task of medications for “substance use disorder,” and we should root the practice in compassionately empowering patients. Methadone clinics across the country are siloed, highly restrictive and punitive. We need to make these medications accessible to all, without judgment or coercion.
As Dr. Carl Hart has repeatedly shown, people who use drugs don’t lack the ability to make logical decisions about their use, or to forgo immediate gratification in favor of long-term goals. Our current system is designed to short-circuit our self control with ostracization and legal penalties. The legal market will change that.
Drugs like marijuana, alcohol, opioids, benzodiazepines, kratom and more should be sold by licensed, accountable distributors, with the tax dollars they bring in used to subsidize health care and providers who are trained to work in ways that empower people with addiction or mental health concerns. The goal should never be to force people to stop using drugs, but to ensure that people who use drugs are given the resources they need to survive and thrive. A regulated market is a path out of our current reality of bodies packed into prisons and morgues.
“Weed, sure. Some magic mushrooms, okay. Even vicodin or heroin, fine. But cocaine and meth? No way!” That’s what some of my friends say when I bring up legal markets for stimulants. Their gut reactions are a testament to the cultural indoctrination we have all received. But exactly the same principles apply. Safe supplies of cocaine and methamphetamine would prevent people from blowing the bank to buy batches of not-quite-right chemicals, risking both their health and their freedom. Legal access can steer people toward safety, and to establishments where they can receive support.
Like Portugal in 2001, we have nothing to lose and much to gain.
Cocaine costs around $1 per gram to produce in South America. It retails at 10,000 percent markups. The only way to prevent people from taking advantage of those profit margins—exploiting consumers and fostering violence over the lucrative trade—is to get rid of the profit margins.
We have examples here, too. In parts of South America, small amounts of cocaine—usually no more than 2 grams—are already legal. Cocaine is used as currency in remote regions of Columbia. In Bolivia, cocaine is legal, not just decriminalized. As a result, it is also cheap. Steve Rolles, a senior policy analyst at the UK’s Transform Drug Policy Foundation, has mapped out a legal, non-prescription market for cocaine and other stimulants, noting the value of proper labeling, affordability and options for less-potent products that offer the same medicinal qualities as cocaine—something like “Cocaine Light.” To those living in places where cannabis has been legalized, the products he proposes will sound familiar: cocaine gum, candies and throat drops, energy drinks and snus packets are a few ideas Rolles has suggested.
We have a choice. We can keep killing, persecuting and incarcerating people who use and sell drugs, fostering dangerous unregulated supplies, and continuing to see the predictable results of that strategy. Or we can do what has worked for every country that has done it so far: We can decriminalize—and better still, legalize and regulate—all drugs. Our drug-war-generated crisis of deaths and other harms has never been worse. Like Portugal in 2001, we have nothing to lose and much to gain.