June 15th, 2016
This morning, the Senate Committee on Homeland Security and Government Affairs held a roundtable hearing to examine “alternative approaches” to “America’s Insatiable Demand for Drugs.”
The Senate called on four witnesses to testify. Two represented progressive views, advocating decriminalization and harm reduction: Ethan Nadelmann, executive director of the Drug Policy Alliance, and Dr. Scott MacDonald, lead physician at Providence Crosstown Clinic in Vancouver—the only North American clinic prescribing medical-grade heroin (Heroin-Assisted Treatment).
Frederick Ryan, chief of police for Arlington, Mass., whose department runs an initiative in which police help people who use drugs access treatment rather than jail, represented a sort of middle way. The reactionary at the table was David Murray—a former ONDCP official from the George W. Bush Administration who supports expanding the drug war.
A spirited discussion was moderated by Senator Ron Johnson (R-WI). Since this was the Committee on Homeland Security and Government affairs, he framed the discussion accordingly. Everyone he’s spoken to in border security agrees, he said: “The primary cause of our unsecured borders is America’s insatiable demand for drugs.” And if that’s the case, he said, it’s a big problem.
Sen. Johnson also referred to other costs of drug use (and/or the way it’s addressed): addiction and overdose. He added that his nephew had died of a fentanyl overdose in January.
Nadelmann invited the participants to look to history: “Alcohol prohibition led to Al Capone, overflowing jails and courthouses, Americans being blinded and poisoned and killed by alcohol that was more dangerous because it was illegal and unregulated, levels of corruption that were unparalleled,” and a “rising level of cynicism and disregard for the law.”
“What didn’t we see?” he asked. “Reduction of alcohol use; the major switch was from beer and wine to hard liquor.”
“Fast forward to now,” he continued. “We are witnessing the results of another failed prohibitionist policy. We have five percent of the world’s population, but over 20 percent of its incarcerated population. We have a rate of incarcerating black people that puts South African Apartheid to shame.”
Not ideas that you hear too often in Congress.
But race and racism were otherwise mentioned very little. David Murray challenged the notion that the War on Drugs hasn’t worked. He said it depends how you define success. “When you have roughly between a 10th and a sixth of as many people engaging in illegal substance use compared to alcohol or tobacco, that is a form of success.”
He also said that “law enforcement can be a powerful partner in referring people to treatment and recovery” and that “harm reduction undermines the most effective way to refer people into treatment, and ultimately weakens social norms and our approach.”
Yet Chief Ryan said: “We as law enforcement cannot solve this problem alone” and “we must stop telling America that with more resources we can do so. This strategy only fuels the epidemic and complicates recovery.”
“Arrest is never a deterrent,” Ryan continued. “The need for the substance is stronger than any rational deterrent the police impose.”
He also criticized the drug court model, after being asked his opinion on it by Senator Kelly Ayotte (R-NH): “When you push the button for criminal drug system, it’s incredibly hard to reverse. When you put them into an incredibly complex legal situation, it does more harm than good.”
He spoke gravely of the “shame and stigma” that has prevented so many, including people he knows, from getting help. In Massachusetts, he said, “we lose four people a day from opiate overdoses.”
Ethan Nadelmann made the important clarification that “opiate overdose” usually involves opioids plus alcohol or benzodiazepines: “What is called overdoses, is in fact fatal drug combinations.” He also attempted to reframe the drug “epidemic“: “What we’re really dealing with is an epidemic of pain,” he said. “Physical pain, psychological pain and existential pain.”
Dr. MacDonald spoke of the work at his clinic, where long-term heroin users can be prescribed the drug. Participants have a “chronic disease for life” that “needs to be managed just like Type II Diabetes or Hypertension” he said—if it’s not managed in a clinic, the only other option is “illegal opioids through narco-traffickers.” He described how some of his patients decide to “step down” to use reduced levels of heroin or maintenance drugs, or to quit opioids altogether. The choice is theirs.
Murray argued that more stigma, not less, would be helpful: “I don’t want to be the guy making a case for stigma, but the perception of medical risk was a major factor in lowering tobacco use. Stigmatizing worked—making it about ‘people on the loading dock out in the rain,’ saying ‘why are you doing this, only losers do this’… Can we borrow some of these tools? Yes.”
He also spoke out against marijuana legalization: “We have lost our moral leadership when we enable highly potent marijuana.” He stated that “marijuana is linked to the opiate epidemic” because there is “a clear gateway dimension.”
The “Gateway Theory”—the idea that marijuana use leads to the use of other drugs—has long been debunked.
Nadelmann dexterously poked holes in Murray’s tobacco-stigma argument. He said young people need to hear true, scientific information, not scare-mongering.
“There is no other substance on earth that is so addictive and so deadly as tobacco,” he said, clarifying that he was “not talking about vaping,” which is a valuable harm reduction tool. “When you interview heroin addicts, and ask them what’s the toughest thing to quit? They all say cigarettes,” he pointed out. “But we cut cigarette use in America by 50 percent—the greatest drug success story in American history—and we did it all without jails, without ‘tobacco courts.’ We did it through the provision of real information to young people, through education.”
We cannot use the exact same strategy in all cases, Nadelmann qualified, noting the difficulty of explaining that opioids are deadly when we also have to explain that they are useful as pain meds. It requires education, he said, but of a more nuanced kind than has previously been available.
Murray doubled down on his fear of marijuana: “I need to address that marijuana is actually dangerous,” he said. “The risks are very great, for those genetically predisposed—catastrophic. Early adolescent onset of marijuana use leads to depression, psychotic breaks, schizophrenic risks. Anyone who denies that is misleading the nation and misleading themselves.” He scoffed at the notion that “marijuana is called medicine—it’s treated as a joke in the national media.” And he warned: “there’s damage coming…we haven’t seen it yet, but it’s coming. What price are we going to pay in broken lives, psychotic breaks, depression, cognitive limitations in this new generation?”
Nadelmann said that he too wants to keep kids safe. “My first message to kids is: Do not use. My second message is: Do not use. But my third message is, if you do use, here are some things to know, because the most important thing I want you to do is come home safe.”
“We don’t need arrests to send a message to kids,” he emphasized. “That’s an expensive and destructive way to send a message.”