As COVID-19 erupts again, we are deeply concerned about collateral health damage; amid our “war” on COVID-19, we are simultaneously witnessing a steep increase in opiate overdoses, emblematic of our failed “war on drugs.” It is imperative that we see both the COVID-19 epidemic and the increasing overdoses not as competing crises, but as interconnected issues in need of urgent and organized responses.
The persistent and potent crisis of substance use deserves a thoughtful, coordinated and science-based response. Such an approach is counter to the recent declaration by the Trump administration that Seattle is an “anarchist jurisdiction” at risk of losing its federal funding for programs to address the opioid epidemic. Public health emergencies are not wars, and public health cuts mean people will die.
For decades, the U.S. has tried to crack down on illicit drug use by spending hundreds of billions of dollars to incarcerate drug users. The result? The largest prison population in the world, an ever-increasing number of users, and rising overdoses and drug-related deaths. This is the time to reallocate those resources into public health systems rather than continuing to support an ineffective system.
In 2018 alone, 1,173 people died from overdoses here in Washington state. As physicians on the board of the King County Medical Society, we are tired of seeing the spiral of addiction and the woefully inadequate response. We are tired of admitting the same patients over and over again with no treatment options for their addiction. We are tired of seeing young and old people not only die from overdose, but from drug complications leading to heart valve infections, kidney failure and liver failure.
Despite our national conviction that the treatment of addiction is punishment through incarceration, there are other blueprints. In Portugal, the personal possession of drugs was decriminalized in 2001. In the subsequent 15 years, the prison population dropped nearly in half, the spread of HIV decreased by 95% and the number of drug overdose deaths decreased by 80%. And there was a decrease in drug use among those aged 15-24. By approaching drug use through a public health lens, Portugal saved millions of dollars in criminal-legal costs, and more importantly, saved thousands of lives.
We must stop viewing the epidemic of addiction as a personal failure. This is abundantly clear in the aftermath of Purdue Pharma pleading guilty to criminal charges for its opioid sales, “accept[ing] the responsibility of misconduct” that led to the loss of nearly a half million lives. As addiction experts explain, addiction is a response to pain. Instead of focusing on the underlying trauma(s) that underlie substance use disorders, we cause trauma by choosing incarceration. This only further prevents rehabilitation.
With another COVID-19 surge poised to enact further trauma, it is now more important than ever to decriminalize drug use and use that money to invest in comprehensive approaches to help people with addiction rather than push them through a revolving door. Seattle can build on its leadership with the Law Enforcement Assisted Diversion program, where a collaborative, community effort to offer credible alternatives to incarceration for low-level drug crimes has led to a 58% reduction in likelihood of arrest. Such programs should be embraced and expanded.
Washington legislators can also take cues from Oregon, which just passed Measure 110, which would decriminalize drug use and replace incarceration with meaningful and funded rehabilitation. It is time to recognize that incarceration for drug offenses is ineffective; drug incarceration disproportionately affects communities of color and is increasingly dangerous for inmates with rapid spread of COVID-19 through prison systems. The risk to these patients and the overt racism in this system does nothing to protect our communities.
For decades we have waited for the purported safety and benefits from our “war on drugs.” As doctors, we are tired of waiting. We are ready for a new prescription.