For anyone interested in addiction and drug policy, the last year or so has been the most fascinating period in recent memory. Having kicked heroin and cocaine in 1988 and written about the subject ever since, I can’t remember a time when public opinion and actual policy have changed so quickly—and in such a rational direction.
I’m not just talking about marijuana—although the fact that the Obama administration has allowed two states (Colorado and Washington, as of January 1) to legalize the recreational use of marijuana is a seismic shift. Six other states are considering either recreational or medical marijuana legalization. Internationally, Uruguay has also legalized, and Mexico has a decriminalization bill in the works.
A U.S. congressman recently ridiculed the nation’s deputy drug czar for his failure to admit the obvious—that marijuana is less harmful than methamphetamine—when, previously, few politicians would publicly do anything except thunder about the evils of marijuana as a “gateway drug” while pushing for longer sentences, harsher penalties, and increased “anti-drug” spending. Being seen as “soft on drugs” was viewed as a political death sentence in the Clinton and Bush years.
There were some despicable and reactionary attacks on Philip Seymour Hoffman’s character, but virtually no one called for a crackdown on dealers and users or for more policing.
But today, even the staunchly prohibitionist Smart on Marijuana (SAM) claims to support cannabis decriminalization: a stance that was seen as tantamount to promoting drug use just a few years ago. Although what SAM actually seems to favor is coerced treatment or “education” for marijuana possession rather than full decriminalization, the fact that almost no one seems to think locking up marijuana users and saddling them with criminal records is a good idea anymore is an incredible reversal.
Indeed, SAM’s Kevin Sabet and Patrick Kennedy seem to be nearly the only people willing to go on TV or be quoted by the media as firmly opposing what’s going on in Colorado and Washington. Former drug czar Barry McCaffrey no longer accepts TV requests because, he told the Washington Post, the networks “only wanted a rented idiot general who didn’t understand that marijuana was harmless and filling America’s jails.” He’s still anti-marijuana, but he says, “the opposition has gone silent.”
And when columnists David Brooks of The New York Times and Ruth Marcus of the Washington Post recently editorialized against legalizing weed, the nearly universal response was not just disagreement but ridicule. In the past, it was the legalization side that was marginalized.
Only a few years ago, in fact, the position of the "very serious people" (the phrase Times columnist Paul Krugman has popularized regarding the upholders of questionable conventional wisdom) was to occasionally decry the excesses of decades-long mandatory minimum sentences for non-violent drug offenders, while failing to even question whether incarcerating people for drug use is a good idea in the first place. Now, the once-radical view that criminalizing drug possession is harmful is starting to dominate, at least with regard to marijuana. Even Sue Rusche, who helped found the parents’ movement against marijuana in the ’70s, now doesn’t believe criminal penalties for drug use are effective.
Views on addiction are changing as well. While the endless debate over whether addiction is a disease, a bad habit, or a moral failing continues, even treatment providers who have defined themselves by the 12 Steps are no longer insisting that this must be the only route to recovery. Hazelden, the founder of the Minnesota Model, which once banned coffee during rehab because it is a drug, began offering opioid maintenance with Suboxone last year. That’s basically the rehab equivalent of the Catholic Church allowing the use of contraception—and it is a profound step toward treating addiction as an actual disease in which scientific evidence, not “treatment philosophy,” determines practice.
In addition, more people are coming around to the view that 12-step programs, while useful as support for many, should be an adjunct to treatment—not treatment itself. (Incidentally, this would be the case if people actually followed the 12 Traditions and never got paid for doing 12-step work. The industry couldn’t function without the thousands of low-paid counselors whose prime qualification is their own recovery and who spend much of their therapy hours trying to get patients to get with the program.)
The Affordable Care Act (“Obamacare”) and its unprecedented requirement for parity of treatment for addiction and other mental illnesses with physical disorders is another profound change, as is the DSM-5’s controversial new view of drug problems as a spectrum, rather than “addiction” being distinct from less severe drug misuse.
Hazelden, which once banned coffee during rehab, began offering opioid maintenance with Suboxone last year—the rehab equivalent of the Catholic Church allowing contraception.
The response to the tragedy of Philip Seymour Hoffman’s death has also been markedly different from drug war tradition. While there were some despicable and reactionary attacks on his character, virtually no one called for a crackdown on dealers and users or for more policing. Instead, the media focused on how Hoffman’s death might have been prevented, asking whether access to the overdose reversal drug, naloxone, should be increased, and whether Hoffman should have been given maintenance treatment.
In other words, harm reduction. While for years, drug warriors like McCaffrey and Sabet fought against maintenance, needle exchange, and other harm reduction policies—and even opposed the use of that phrase in official policy documents—harm reduction has finally come out of the closet.
In the early ’90s, at the height of the AIDS epidemic, needle exchange advocates had to fight with treatment providers, parents of addicted people, and others who should have been natural allies in protecting addicted people from their high risk of HIV infection. Today, the governor of Maine’s opposition to expanded access to naloxone is denounced by parents of overdose victims and rejected by the Office of National Drug Control Policy itself. Indeed, the drug czar’s office now claims to be doing “drug policy reform,” which may stick in the craw of those who have been doing that work for years, but is, at least in the case of advocating naloxone, accurate.
In the coming months, I’ll be covering these issues for Substance.com, exploring their potential for both positive and negative outcomes for people with substance use disorders. While I believe that almost all of these changes are positive, it’s important for people who advocate new ways of doing policy to be aware of the pitfalls of going too far and to adjust their approach to deal with the changing situation they face. Some past attempts to liberalize drug laws have been met with a harsh backlash when predicted benefits were not as great as promised or when harms were dismissed rather than addressed.
Drug policy is complex, as is addiction: Both involve not just biology and psychology, each of which is staggeringly complicated, but also culture and fashion. It’s clearly the case that incarceration doesn’t treat or prevent addiction; it’s also true that commercial interests like the alcohol and tobacco industries can exacerbate it. There is no perfect solution here, only ways of balancing risks and benefits, which may vary from substance to substance, from person to person, from social class to social class, from country to country and in countless other ways.