Achieving peace with honor in the war on drugs

When actor Philip Seymour Hoffman was found dead of a heroin overdose in his New York City apartment on Feb. 2, the conversation that followed was predictable in almost every way.

In remarks on the Senate floor on Feb. 4, Majority Leader Harry Reid lamented the “scourge” of heroin addiction, calling those who peddle the drug “purveyors of evil.” Meanwhile, reporters and correspondents dutifully fanned out across the country in search of the front lines of the new heroin “epidemic.”

It was familiar territory to anyone who lived through the acceleration of the drug war during the 1980s and 1990s. Except that something was different this time.

While a handful of editorial writers called for bringing the hammer down on dealers, notably missing from the dialogue around Hoffman’s death was the familiar war cry that has followed similar tragedies in the past. There was no reactionary call to arms, no emergency session of Congress, no hastily conceived legislation.

To anyone paying attention, the message was clear: The “war on drugs” is over, and America is looking for an honorable exit.

As with the end of any conflict short of unconditional surrender, extricating ourselves from decades of unremitting battle will require a tactical shift based on a new set of goals. President Barack Obama laid out those goals last year when his administration introduced a “21st century drug policy” that acting drug czar Michael P. Botticelli said would be guided by science instead of politics.

But successful retrenchment will require something more than an enlightened outlook and fresh talking points. It will mean a top-down overhaul of a massively lucrative public-private endeavor that — in terms of sheer money and effort — makes the Iraq War look like the invasion of Grenada.

On the surface, the top brass in charge of prosecuting the drug war appear ready for their new mission. At its National Summit on Illegal Drugs last month in Washington, D.C., the Police Executive Research Forum embraced what Executive Director Chuck Wexler called a “fundamental shift” in policing drug crimes that would favor treatment over arrests.

That’s certainly good policy; however, the rampant militarization of municipal police forces across the country has created a generation of drug-war foot soldiers more adept with the weapons of war than the tools of harm reduction. The U.S. Department of Homeland Security has spent billions of tax dollars over the past decade ramping up the arsenals of state and local law enforcement agencies, and police have a vested interest in not only keeping them, but using them too.

Turning all those swords into plowshares won’t happen overnight, and de-escalation is likely to encounter resistance.

Police aren’t the only ones heavily invested in the drug war. In the 1990s a new prison opened, on average, every 15 days to support the exponential surge in incarcerated drug offenders. A number of small and rural communities now rely on the corrections industry to offset their failing economies.

According to the Congressional Research Service, by 2008 there were roughly the same number of Americans employed in corrections as in the entire U.S. auto industry; and public sector unions such as AFSCME have fought long and hard against policy changes that affect their members. Meanwhile, nearly all new U.S. prisons opened since 2000 are private, according to the CRS, and the growing for-profit prison industry represents another powerful enemy of reform.

The alternative to incarceration — which opponents of the drug war have been championing for years — is diverting more cases into treatment. A poll released by Pew Research two months after Hoffman’s death found that more than two-thirds of Americans now favor treatment over prosecution for addictive drugs such as cocaine and heroin.

But treating drug addiction is a notoriously complex task. Despite millions of dollars being pumped into the treatment industry every year, we’re no closer to figuring out what works or why.  

Most recovery experts I’ve spoken to lament the lack of evidence-based approaches in the treatment of drug and alcohol abuse. Since the start of the drug war, little has changed in the way drug treatment is delivered in America. Upwards of 90 percent of addiction treatment facilities in the U.S. rely wholly or in part on the principles of Alcoholics Anonymous — a faith-based approach that was developed nearly 80 years ago and, despite a notoriously low success rate, has never been modified.

Even if we had the right tools, we’re still a long way from getting everyone who needs it into treatment. According to federal data, only about 11 percent of the 23 million Americans who needed treatment in 2012 managed to get it. A policy shift will no doubt open the door to more, but a shortage of both beds and counselors remains a significant barrier. The treatment window for opiate addicts is extremely narrow, and yet the average addict in crisis can expect to wait weeks or longer for a bed in rehab to open up.

What’s more, studies show statistically significant ethnic disparities in the successful treatment of addiction, mostly tied to the absence of ancillary support systems and a lack of culturally competent professionals.

As if those challenges aren’t enough, the class of drugs that account for the sharpest rise in abuse — opioid narcotics, in the form of prescription painkillers and heroin — are also the hardest to treat. By far the two most effective (and misunderstood) therapeutic options for opiate addiction — methadone and buprenorphine — are overly restricted and stigmatized, or else prohibitively expensive. The average monthly cost of Suboxone (the mixture of buprenorphine and naloxone most commonly used in treatment) can reach into the hundreds of dollars, and in a number of states Medicaid won’t pay for it.

With more people in drug treatment, further investment of public money for research and delivery is necessary. Yet it remains to be seen if fiscal conservatives, who have been a driving force in the prison reform movement, will be willing to follow through when it’s time to put the cash on the table.

Ironically, while Obamacare promises to open the doors to recovery for more addicts, some experts are bracing for a decline in the quality of treatment offered. Policy experts worry that states looking for ways to implement the Affordable Care Act without expanding Medicaid will funnel more addicts into cheaper, but less effective, outpatient settings.

Even in those states that do expand Medicaid, current law excludes Medicaid funding for so-called institutions for mental disease — which includes most residential drug and alcohol treatment facilities. This is a holdover from the days when state and local psychiatric hospitals housed large numbers of patients at their own expense, and one that policy groups like the National Alliance on Mental Illness are fighting to change.

Those of us who have long fought against the futile and destructive war on drugs can be optimistic that our fellow Americans are finally ready to raise the white flag. But before we prematurely declare the mission accomplished, we must be cognizant of the challenges that lie ahead.