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Drug addiction is a chronic disease. It alters the way the brain works, stripping people of self-control and their ability to resist further drug consumption. Yet unlike responses to other diseases, in the United States, arrests and incarceration serve as the primary treatment for drug addiction.
This approach has been a failure. It's time to treat drug addiction as a public health matter and not a criminal law one. This begins by investing in a treatment infrastructure and decriminalizing the personal possession of drugs.
Police in the United States make 1.16 million arrests a year for drugs. The vast majority of these arrests, 87 percent, are for personal possession or use of drugs, meaning that police arrest a person for drug possession, not drug selling, every 32 seconds. Drug arrests represent the number one activity that police engage in, at nearly 2.5 times the volume of arrests for all FBI-classified violent offenses combined (homicide, rape, robbery and aggravated assault). Despite people of all races using drugs at similar rates, Black people comprise 27 percent of all drug-related arrests—even though they make up just 13 percent of the U.S. population. There are about 350,000 people incarcerated in jails and prisons for drugs.
Yet for all these arrests and incarceration, we have little to show for it, other than more people in handcuffs and jail cells. New data released just last month revealed that nearly 110,000 people in the United States died from drug-involved overdoses in 2022, compared to fewer than 20,000 in 1999. The CATO Institute estimates that taxpayers spend approximately $47 billion a year on drug prohibition. In the 23 years that drug overdoses rose from 20,000 to 110,000 a year, taxpayers spent more than $1 trillion.
Drug addiction is a serious problem, yet focusing on arrests and incarceration is not working. If insanity is doing the same thing over and over again and expecting different results, then the war on drugs has reached a new level of madness, especially given that there are other more effective ways to address this serious problem of drug addiction.
Take, for example, the nation of Portugal. In 2001, Portugal began treating drug use as a medical matter rather than a criminal one. At the time, around one percent of the population in Portugal was addicted to heroin, representing one of the worst drug epidemics in the world. In response, Portugal's government decided to do something different—decriminalize the personal possession or use of any drug and treat it like a health issue.
The result? Drug-involved deaths in Portugal plummeted and are now some of the lowest in the European Union. In 2020, there were six drug deaths per million among people age 15-64 in Portugal, compared to the European Union average of 23.7 per million. In the United States, the rate of overdose deaths in 2021 was 324 per million for all age groups. Cocaine and heroin use in Portugal decreased by about 75 percent. HIV infections related to drug use fell by 95 percent.
When done right, drug decriminalization saves lives and builds healthier communities. It took years to build Portugal's treatment infrastructure, but once doctors and addiction specialists replaced lawyers and prosecutors, the results were a success.
In the United States, voters in Oregon approved a referendum in November 2020 to make it the first and only state in the nation to decriminalize possession of small amounts of drugs. Drug possession is still punishable by a civil citation, similar to a parking ticket. The ballot also expanded funding for addiction treatment, using the revenue raised from taxation on the sales of marijuana to invest millions in treatment.
Oregon's model is still in its early phases, focusing on building its network of care for a state that has long suffered from a high rate of substance use disorder. A recent audit criticized the state for its delays in funding its treatment capacity, and much more work still needs to take place to build Oregon's system. But even so, during the earliest phases of implementation when only a small portion of the funding was available, more than 60,000 people in Oregon received services. Hundreds of millions of dollars have begun to be invested in harm reduction and treatment services. Oregon's overdose death rate has remained below the national overage, and there has been a 60 percent decrease in the number of people arrested for drugs. Like in Portugal, it will take a few years for Oregon to be able to fully put in place its treatment and support infrastructure.
As too many families know, drug prohibition and the war on drugs have failed. Overdoses are up, and the supply chain continues unabated. Drug prohibition is costing our nation tens of billions of dollars a year, occupying much of the time of police and courts, and has not worked.
It's time for a new approach that invests in drug treatment while decriminalizing personal drug use.
To be clear, decriminalization alone is not the solution. But it must be part of a broader strategy that is grounded in health policy and invests in harm reduction and treatment.
But drug use must be treated as a health, not a criminal justice matter. This is why leading public health organizations, like the World Health Organization and the American Public Health Association, have endorsed drug decriminalization. Sixty-six percent of voters support "eliminating criminal penalties for drug possession and reinvesting drug enforcement resources into treatment and addiction services." It's time for America to follow the will of the voters and public health experts.
Udi Ofer is a professor at Princeton University and founder of the Princeton Policy Advocacy Clinic. He previously served as the Deputy National Political Director of the ACLU.
The views expressed in this article are the writer's own.
