It is clear that Americans have an opioid prescription drug problem of massive proportions. This problem has resulted in a surge of heroin addiction that is affecting Americans across the country. In California, overdose deaths from prescription drugs have increased 31% since 1999. In Orange County the drug du jour has become heroin as the price of heroin is 80% cheaper than it was 30 years ago. This issue is impacting public health resources and contributing to death, disease and addiction. In an effort to protect the public last month, both the county of Orange and Santa Clara filed civil lawsuits against several pharmaceutical manufacturers. In the press release announcing the litigation the Orange County District Attorney stated:
“We have charged these pharmaceutical companies for knowingly harming public health by waging a massive campaign to sell huge quantities of these dangerous drugs for profit. It is imperative for prescription drugs to be taken to promote health, not endanger lives, and that those responsible for producing these drugs not engage in deception.”
These lawsuits are reminiscent of the many lawsuits filed against the tobacco companies 20 years ago that resulted in payments to the states for medical costs, curtailed marketing practices that targeted children, developed public education around the dangers of smoking, and helped to end some of the lobbyist organizations that included the Tobacco Institute. The results of the tobacco lawsuits contributed too many positive public health outcomes including the reduction of smoking by those most at risks, our children, while holding the tobacco industry accountable for the damage caused to not just individual victims but to our institutions.
It’s not often I applaud lawsuits, but I believe that these suits are warranted and will be followed by others, as evidenced by the city of Chicago filing a similar cause of action as well. But what is ironic to me is that our government officials have not linked the success of control and regulation of these dangerous legal products with the continuing failures of our national drug prohibition policy to help us reduce the damage done by drugs in our society. The success of the tobacco lawsuits and the future success of lawsuits against “Big Pharma” are only possible because their industry is regulated and controlled by the government and not by cartels and criminals.
One of the inevitable consequences of our policy of prohibition is reflected as prescription opioid addicts have transitioned to heroin. According to a recently released RAND report there are close to 1.5 million “chronic heroin users” in America. Heroin today is cheaper, easily accessible even in our high schools, and more lethal than it was when Nixon declared the war on drugs. Despite the increase in heroin seizures drug trafficking organizations have won the economic battle by flooding the unregulated streets and capturing market share. The result a 45% increase in overdose deaths. In 2012, over 100 men, women and children died of a heroin (38,329 in 2010) overdose each day, sparing no community, not even ours.
But what are our alternatives? First we must stop stigmatizing drug users. Yet it’s not just our government officials that continue to stigmatize chronic hard drug substance abusers (Yes, I’m pointing at you, Vern!) I call it the “ick” factor as our communities understand that locking up someone for marijuana maybe a waste of law enforcement resources but can’t wrap their head around other substances such as heroin or methamphetamine. I hear this from not just marijuana policy reformers, but journalists and others. Yet the same principles apply. What fuels death, disease, violence and addiction is the policy of prohibition.
But there are solutions that start not just with public education but also with reducing the harms to our communities, and to the individual drug user itself. In an article in the Huffington Post I posited how even law enforcement has begun to evolve, and is now starting to recognize that we can no longer arrest our way out of America’s drug problems. Those working in public health understand that harm reduction strategies produces many benefits to our communities. There have been many studies that demonstrate that drug treatment is both cheaper and more effective than arrest and prosecution; yet we continue to fund enforcement (supply reduction) over treatment (demand reduction) by almost 2 to 1.
Yes, even law enforcement is beginning to understand the necessity of thinking outside the “drug war” quagmire to save lives by implementing and supporting programs that use the precepts of reducing the harm to those actually using drugs. They have done so by enacting and supporting “Good Samaritan” laws which have recognized that the threat of criminal sanctions has contributed to too many deaths, and they have created a safe space for witnesses to an overdose to save a life by calling 911 without threat of criminal prosecution. Seattle Police now give their officers the ability to connect low-level, non-violent drug dealers and users with treatment and services as an alternative to jail through the Law Enforcement Assisted Diversion (LEAD) program. The accomplishments of the program are being touted by politicians, civil rights organizations, and most importantly, street-level cops.
In an email I received from retired Police Chief Jim Pugel, discussing the success of LEAD, he reflected that “helping addicted people out of crime and disorder into a safer place for all is a measure of a caring society, and certainly a caring police department.”
And by recognizing that our obligation to public safety also includes saving lives we can and should strive to implement programs such as the Police Department of Quincy, Massachusetts, and others, which have saved hundreds of lives by stocking Naloxone, a cheap and effective drug that can reverse opiate overdoses. It is evident to me that implementing harm reduction strategies is a necessary step on the way to a smarter drug policy and should be supported. But we cannot stop there as that would still leave unresolved the violence associated with the illicit market, as well as the many collateral consequence of an ineffective drug policy based on politics rather than what we know works.
Clearly though, the answer is right in front of us if we just opened our eyes, and remembered that our success in combating the harms of tobacco was a direct result of a regulated industry. There’s no doubt that we can address and resolve the same issues of public health harms caused by the pharmaceutical industry as well. We know that public health education and increased regulation worked with the tobacco industry, so isn’t it “high time” that we realized the policy of control and regulation is likely to be more successful with ALL drugs, rather than leave the market to the illicit criminal profiteers?