A former acting White House “drug czar” says the United States has a lot to learn from Portugal’s move to decriminalize drugs and treat addiction as as a health issue through a harm reduction approach.
Regina LaBelle, who held top positions in the Office of National Drug Control Policy (ONDCP) under the Obama and Biden administrations, wrote an op-ed published in The Hill on July 12, touting the success of Portugal’s move to decriminalize drugs and arguing that the US should take a lesson from the country.
“Portugal took a pioneering approach to its drug crisis and implemented a comprehensive public health-based drug policy approach,” she wrote. “This included decriminalization of personal drug possession while maintaining criminal penalties for drug trafficking. At the time, Portugal faced a severe heroin addiction crisis and the highest rate of HIV infections in the European Union.”
“Portugal’s approach to drug policy yielded positive results, including drug overdose death rates among the lowest in the European Union,” she said.
LaBelle notably did not publicly embrace drug decriminalization while serving in the federal government.
While the ONDCP under Biden has promoted the administration’s efforts to promote harm reduction policies and also cheered the president’s directive to review the scheduling status of marijuana, it hasn’t supported calls to broadly decriminalize drugs. So it’s notable that a former acting drug czar is putting the spotlight on the reform.
“Portugal’s experience demonstrates that a comprehensive public health approach to addiction, one that is consistently funded and supported, can yield positive outcomes and save lives,” wrote LaBelle, who notably did not publicly embrace drug decriminalization while serving in the federal government.
She also responded to a recent story published in the Washington Post that challenged the idea that Portugal’s decriminalization model has been successful, drawing opposition from reform advocates who’ve challenged the reporting.
LaBelle, who is currently director of the Addiction and Public Policy Initiative at Georgetown University Law Center’s O’Neill Institute, said that the report “only serves to emphasize one of these lessons: Consistent funding is essential to sustained, long-term results.” She then offered “three key lessons from Portugal that could benefit the United States.”
The first is a common refrain from reform advocates, which is a call to treat substance use disorder as a public health, rather than criminal-legal, issue.
“The US has made some progress in recognizing substance use disorder as a disease and reforming drug policies; however, the emergence of fentanyl in the drug supply has rekindled a focus on criminalization as a response,” she said, referencing legislative efforts to increase enforcement and penalties for possessing or selling the opioid.
“The US has a unique opportunity right now, given opioid litigation proceeds and federal grants, to invest. However, long-term solutions require more than grants and short-term infusions.”
The second lesson, LaBelle said, is to invest “substantial and consistent funding in public health services, including treatment and harm reduction,” such as syringe service programs to reduce transmissions of blood-bourne diseases.
“The US has a unique opportunity right now, given opioid litigation proceeds and federal grants, to invest in long-term public health solutions,” she wrote. “A 2014 analysis found that $1 spent on treatment saves more than $3 in crime reduction. However, long-term solutions require more than grants and short-term infusions of litigation proceeds.”
The third lesson, she wrote, is to make “robust financial investments to data collection and reporting” so that the country can better understand what’s working and what’s not working as it addresses the overdose crisis.
“By embracing and staying committed to reform, the US can enhance its response to the overdose crisis,” she wrote. “It is time we take decisive steps toward a more compassionate and public health-centered approach to drug policy. One that addresses public safety concerns while prioritizing access to treatment and support for those affected by substance use. By doing so, we can improve outcomes and save lives.”
While LaBelle was considered a top contender as President Joe Biden looked to fill the role of ONDCP director, Biden ultimately picked Rahul Gupta, who previously chaired a state medical cannabis advisory board.
Gupta hasn’t directly commented on the idea of enacting decriminalization in the US, but he has promoted the administration’s harm reduction steps, which include a review of safe consumption sites as a strategy to reduce overdose deaths.
Nora Volkow, the director of the National Institute on Drug Abuse (NIDA), meanwhile said in 2021 that the ongoing policy of criminalizing people for drug use needs to be rethought, suggesting that the government should instead consider a policy of decriminalization.
She also said that, when it comes to the drug war, there’s no need for further research to prove that such criminalization has disproportionately impacted communities of color.
In March, the American Pharmacists Association (APhA) officially backed the decriminalization of all drugs and “paraphernalia,” earning praise from drug policy reform and harm reduction advocates.
In February, the American Society of Addiction Medicine (ASAM), which has historically aligned itself with prohibitionists and resisted modest marijuana reforms, called for the decriminalization of all currently illicit drugs in the interest of public health and racial equity.
Another major medical group, the Minnesota Medical Association (MMA), also recently endorsed broad drug decriminalization, expungements for low-level possession convictions and the promotion of statewide harm reduction programs.
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