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Never Before Has Our Approach to Drugs Improved So Much, So Fast

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We’re winning: More progress has been made toward enlightened drug policies and treatment in the past five years than in the previous 25. Here’s an advocacy agenda to take us even closer to the future we need.

By Maia Szalavitz

Source: Substance.com

There has never been a more exciting time to be writing and thinking about drugs and addiction. For most of the ‘80s through the ‘00s, policy and treatment debates were stagnant, with all sides taking hardened positions and often repeating the same tired talking points. But now change is in the air and those who would like to see reform have a chance to make a real difference. By looking at where we’ve come from, we can see where we need to go.

Until 2011 or 2012, the war on drugs, while much bemoaned, was simply a fact of life, with pretty much everyone agreeing both about its failure and, simultaneously, about the impossibility of doing anything significantly different because of the “tough on crime” arms race between the Republicans and Democrats.

The science didn’t matter: No one seemed to care that marijuana was objectively less harmful than alcohol or tobacco or that our drug laws originated both in the time of Jim Crow and, quite explicitly, as a way of oppressing people of color by other means. In fact, merely stating these facts, as I did many times, would often get me in trouble with editors who wanted to “balance” them with a prohibitionist claim to prove that the publication was “objective”! No one ever seemed to consider balance when a drug warrior made a demonstrably untrue statement.

It didn’t matter that the data on needle exchange was overwhelmingly in favor—and that no study had ever found that it encouraged drug use or prolonged addiction. A quote by someone who was ideologically opposed had to be obtained, even though they had no data to back their concerns about these programs to prevent infection with HIV and hepatitis C “sending the wrong message.”

The failure of drug enforcement either to prevent or to reduce “drug epidemics” and the ineffectiveness of incarceration at fighting addiction was irrelevant, too, even as the necessity of such punitive efforts was simply accepted without question.

Nor did it matter that harsh, confrontational treatment was known both to backfire and to be incredibly common—Dr. Drew, Intervention, Beyond Scared Straight and similar shows even portrayed it as exemplary.

At the same time, 12-step supporters were adamant that their way was the only way—or at least the best way. Drug warriors were convinced that criminalization of both possession and sales was the only way to avoid addiction Armageddon—and even many people in recovery bought into the idea that law enforcement must always play a role in policies related to illegal drugs.

In 2000, for instance, during the fight over California’s Proposition 36, which gives drug users three chances at treatment before jail becomes a sentencing option, the Betty Ford Center was among the opponents. Speaking for a coalition that included the rehab, actor and sobriety advocate Martin Sheen wrote in an op-ed, “Without accountability and consequences, drug abusers have little incentive to change their behavior or take treatment seriously.” (He didn’t explain how Betty Ford gets alcoholics, whose drug is legal, to comply with care.) But Prop 36 passed anyway, an early sign of the drug war’s waning hold.

And so, even when reforms would actually send patients to rehabs, treatment providers remained firmly aligned with drug warriors on the necessity of harsh criminalization, while they begged for crumbs of financing from the abundant table of law enforcement and argued that treatment is better than jail.

Now, though, the winds have shifted. Four states and Washington, DC, have legalized recreational use of marijuana. President Obama has directed the justice department not to interfere with these experiments and said last week, “My suspicion is that you are going to see other states start looking at this.” California, which rejected recreational legalization as recently as 2010, may pass it in an expected 2016 ballot initiative. National polls show majority support for legalization.

Neither Colorado nor Washington—the first two states to legalize—has seen anything near the predicted disaster in the first year after the passage of the law. In fact, in Colorado, crime is down, auto fatalities are down and teen use is stable or declining. (Because Washington took longer to implement its regime, good statistics aren’t yet available).

All of this is excellent news for reformers. So what should be next on the agenda? Here are a few things I’d like to see, which I think could build on the increased openness to more effective policy:

1. Over-the-counter naloxone

Naloxone, an opioid antagonist that can reverse opioid overdose, is now widely available to first responders and, through many harm reduction agencies, to friends and families of people at risk. No adverse effects have been reported; just more and more lives saved. The FDA should make naloxone available over the counter, and sales should be subsidized or prices capped to make it affordable. This safe, effective lifesaver should be in every first-aid kit.

2. Expand access to medication-assisted treatment

As I noted recently, it’s outrageous that any doctor who discovers that a patient has an opioid problem can’t simply prescribe the most effective treatment: maintenance with Suboxone or methadone. Federal limits on the number of patients a doctor can have on maintenance and laws that literally ghettoize methadone treatment should be repealed. Insurance limits on prescribing also should be challenged: These exist for no other medical condition.

3. Decriminalize personal possession of all drugs

Now that even once-staunch prohibitionists like Kevin Sabet no longer argue strongly for arrest and incarceration of those who possess marijuana, why does it still make sense for heroin, cocaine or other illegal drugs?

82% of all drug arrests are for possession, and half of these are for marijuana. According to the ACLU, the US spends $3.1 billion annually arresting and adjudicating marijuana possession cases, and at least as much is likely to be spent on the other half of possession arrests for all other drugs. And yet no data suggests that arresting drug users for possession fights addiction or reduces crime: In fact, addicted people often get worse due to incarceration, with very little treatment available in jail.

Moreover, Portugal’s 10-plus-year experience of complete decriminalization has found it to be associated with less crime, more treatment and less disease. What’s not to like? The World Health Organization recently came out in favor of decriminalization. Drug reformers should not make marijuana arrests the only focus of their abolition campaign. Arrests for use are expensive, harmful and ineffective: They need to stop.

5. Reform treatment

People with addiction and their loved ones are often shocked at what occurs in treatment: Evidence-based care is so hard to find that even leading addiction researcher and former deputy drug czar Tom McLellan didn’t know where to turn when his son needed help in 2009. Anne Fletcher’s Inside Rehab, David Sheff’s Clean and this 2012 report from the Center on Addiction and Substance Abuse all demonstrate the need for better accountability from treatment providers.

To start, private and public insurers should simply refuse to pay for treatment that is little more than indoctrination into 12-step groups, which can be had for free at many church basements. Instead, treatment time should be devoted to evidence-based therapies like motivational interviewing and cognitive behavioral therapy, which aren’t free—and provider reimbursement should be based on results, respectful and empathetic care and genuine fidelity to evidence-based therapies.

And this isn’t a change that only opponents of 12-step programs should favor. Even those who are helped by the steps know that such treatment clearly violates the Eighth Tradition, which states that AA should be “forever nonprofessional” and that the 12th-step work of trying to bring others into the program should be unpaid. Both 12-step groups and treatment will ultimately be better off disentangled.

5. Reframe addiction

As I’ve argued here before, addiction is better characterized as a learning or developmental disorder than as a brain disease. While those who support the brain disease concept see it as a way of reducing stigma, in actual fact, this idea can increase fear and hatred of addicts because the notion of “brain damage” suggests permanence and poor odds for recovery.

What addiction actually does in the brain is similar to what love does—it strongly wires in new memories and pushes us to seek certain experiences. This is not “damage” or “destruction.” When we understand addiction as one more type of neurodiversity—not always a disability, sometimes even a source of strength—we’ll really cut stigma.

Also, it’s impossible to fight stigma while the legal system enforces it: The whole point of criminalizing drug possession is to stigmatize it. Without changing both criminalization and the view of addiction as the only disease treated by prayer and repentance, stigma reduction won’t get very far.

There’s much more, of course, but these are areas where real progress can be made. Never before have I seen more openness in this area: Now people who used to blanch at the words “harm reduction” are singing its praises and those who were once horrified by needle exchange are calling for naloxone. We still have a long way to go—and there’s always the chance of backlash—but as Martin Luther King, Jr., put it, “The arc of the moral universe is long, but it bends towards justice.”

Maia Szalavitz is the nation’s leading neuroscience and addiction journalist, and a columnist at Substance.com. She has contributed to Time, The New York Times, Scientific American Mind, the Washington Post and many other publications. She has also published five books, including Help at Any Cost: How the Troubled-Teen Industry Cons Parents and Hurts Kids (Riverhead, 2006), and is currently finishing her sixth, Unbroken Brain, which examines why seeing addiction as a developmental or learning disorder can help us better understand, prevent and treat it. Her previous column for Substance.com was about how to treat people who need, but misuse, opiate painkillers in a more helpful and enlightened way.

After Legalization, Why Can’t People’s Prior Pot Convictions Be Wiped Clean?

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In states where marijuana is now legal, many people still have small-scale possession convictions on their records. Advocates for “expungement” face uphill battles, from Washington state to Washington, DC

By Jake Thomas

Source: Substance.com

Marijuana won in November’s midterm elections, with Oregon, Alaska and the District of Columbia joining Colorado and Washington in legalizing it. But it’s a bittersweet victory for people who have a prior cannabis conviction for doing something that is now legal in their state. For now, efforts to clear pot marks from people’s records in states that have legalized the drug are facing uphill battles.

“It’s pretty much ruined my life at this point,” Aaron Pickel (below), who was busted in Oregon for carrying two to three pounds of pot-infused edibles, told the Oregonian. “I’ve tried pretty hard to find work, and when you’re going against people who have nothing on their record and you do, you’re not going to get it.” Pickel’s California medical marijuana card didn’t get him out of the charges. Although he was slapped with only a $200 fine and no jail time, the 33-year-old now has a felony rap—and stays in his mother’s spare bedroom.

People who have been convicted of misdemeanor and lesser charges for possessing the drug often have a hard time securing housing, jobs and education. Proponents of “expungement”—wiping records clean—argue that the voters of these states made it clear that possessing small amounts of marijuana should not be illegal and therefore people who have prior convictions should get a second chance. Opponents argue that people should abide by laws until they are changed.

The expungement debate does not address the plight of people currently serving time for nonviolent cannabis crimes, however. The ballot measures that legalized pot allow people to carry only small amounts—in the case of Oregon’s Measure 91, up to an ounce. Before the passage of these measures, these amounts wouldn’t be cause to lock someone up in prison—in Oregon, it resulted in a violation and a fine. Someone would need to possess up to four ounces to be charged with a felony. Carrying four ounces is still illegal under Measure 91.

“I’ve tried pretty hard to find work, and when you’re going against people who have nothing on their record and you do, you’re not going to get it,” said Aaron Pickel, who was busted in Oregon for carrying several cookies and other pot-infused edibles.

There were 8 million marijuana-related arrests in the US between 2001 and 2010, according to a 2013 American Civil Liberties Union report. Nearly 36,000 people were arrested in 2010 alone in states and jurisdictions that have recently legalized pot. What’s worse, African-Americans, who already face discrimination in housing, employment and education, make up a disproportionate number of arrests. Nationally, they were 3.7 times as likely to be arrested for marijuana possession than whites in 2010, even though they used marijuana at similar rates.

“There are thousands of people in Washington state who have a misdemeanor marijuana conviction, and it hangs over their head when they apply for jobs or housing or education, and giving them a second chance will remove that obstacle,” says Washington state Rep. Joe Fitzgibbon, a Democrat, who introduced a bill in 2013 that would have cleared the records of people with misdemeanor marijuana convictions.

Fitzgibbon’s legislation ended up stuck in committee. He says that lawmakers apparently want to let the dust settle from pot becoming legal two years ago before further tinkering with marijuana laws. But he got pushback from the state prosecutors’ association, which opposes prior-conviction expungement.

A similar bill failed in the state legislature in Colorado, where pot was also legalized in 2012. But a ruling by the Colorado court of appeals in March could provide limited relief for people with pot convictions. The ruling stemmed from a 2010 court case that involved a woman who was charged with child abuse along with possessing methamphetamine and marijuana. Her lawyer, Brian Emeson, says that he was in the process of appealing her methamphetamine charge when the state legalized marijuana, so he appealed her pot charge as well. The court granted the appeal on the pot charge, removing it from her record.

“Thousands of people in Washington state have a misdemeanor marijuana conviction, and it hangs over their head when they apply for jobs or housing or education, and giving them a second chance will remove that obstacle,” said state Rep. Joe Fitzgibbon.

The ruling only affects people who have an active appeal for a pot possession charge, Emeson says. He estimates that number is anywhere from about a dozen to a hundred. He expects the Colorado supreme court to take up the issue next year and possibly reverse the appeals court ruling.

Emeson says that he was able to separate the marijuana charge from the others in his case, characterizing them as “relatively not that bad.” Emeson acknowledges that child abuse is a serious charge, but he says that courts often see much worse. “It’s impossible for people to ignore really, really bad facts in a case.”

Efforts to provide relief to people with prior pot convictions are likely to be complicated by other crimes on their records. “Most people convicted of marijuana are convicted of other things that are still illegal,” says Sam Kamin, a professor of constitutional law at the University of Denver and one of the nation’s leading experts in marijuana regulation. Their crimes, not surprisingly, often involve possession or trafficking of large amounts of pot or other drugs.

Oregon lawmakers will begin grappling with this problem when they meet in the new year to discuss the implementation of the state’s pot legalization measure, says state Sen. Floyd Prozanski, a Democrat who chairs the senate’s judiciary committee. Prozanski says he does not expect any “blanket bills” that will provide automatic expungement.

People convicted of certain felonies and misdemeanors in Oregon can already petition to have their records expunged after a certain period of time has lapsed. Prozanski says that any effort to provide relief to people with pot convictions will rely on the state’s existing expungement process. Lawmakers may update the expungement process in response to marijuana becoming legal.

However, as in Colorado and Washington state, lawmakers will be mainly focused on implementing legal marijuana, Prozanski says. “[Expungement] is sort of secondary issue to the implementation of Measure 91.”

The situation for people with prior convictions is different in Washington, DC, says Mason Tvert, communications director for the Marijuana Policy Project. In October, the city council passed a bill that would allow people convicted of all crimes and misdemeanors that have become legal to have their records sealed.

“It’s astonishing that some congressional members are so concerned about blocking DC from enacting [its legalization measure]. If cartels and gangs had lobbyists on the Hill, preventing marijuana regulation would be their top legislative priority,” said  the Marijuana Policy Project‘s Mason Tvert.

The District of Columbia had the highest overall marijuana possession arrest rate in the country in 2010. African-Americans are eight times more likely to be arrested for pot than their white counterparts, according to the ACLU.

However, both this bill and the measure that legalized marijuana require approval by the incoming Republican Congress, which has not been sympathetic to marijuana legalization or people convicted of pot crimes. Some have already said they will oppose DC’s legalization measure. “I will consider using all resources available to a member of Congress to stop this action,” Rep. Andy Harris, a Maryland Republican, told the Washington Post.

Making good on that threat, congressional Republicans and Democrats struck a deal on Tuesday to fund the federal government through September that includes provisions upending Initiative 71’s legalization of pot, according to the Washington Post. At press time, advocates were debating whether or not the language in the bill offers a loophole allowing the will of DC voters to go forward.

How this mess will ensnare efforts of people to expunge their prior pot convictions remains to be seen. “There’s some uncertainty surrounding the effect the provision will have on the measure. It could end up being a situation in which the courts will decide,” Tvert wrote in an email. “With all of the issues facing the country, it’s astonishing that some congressional members are so concerned about blocking DC from enacting a widely supported local policy. If cartels and gangs had lobbyists on the Hill, preventing marijuana regulation would be their top legislative priority.”

Pro-pot politicians in a few other states are already taking steps to expunge peoples’ old marijuana convictions should the drug be legalized. One Maryland lawmaker has proposed legislation that would erase any prior marijuana-related offense that becomes legal. A candidate in last year’s Democratic primary for Pennsylvania governor called for legalizing pot and expunging records of people convicted of possessing it.

But one of the biggest victories for advocates of expunging peoples’ past drug records came in the 2014 midterm election in a state where pot legalization wasn’t even on the ballot. California voters approved Measure 47, which automatically and retroactively downgraded some nonviolent felonies, many of them drug-related, to misdemeanors. Some 10,000 people are eligible for immediate release, including many who have been jailed for drug misdemeanors—and, once again, a disproportionate number are African-Americans.

Jake Thomas is a reporter in Spokane, Washington. He has written for the Portland Mercury, Street Roots and numerous other publications. His website is here. He tweets at @jakethomas2009. This is his first piece for Substance.com.

Don’t Forget Why Marijuana Legalization Is Winning

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By Maia Szalavitz

Source: Substance.com

When I first started writing about drugs in the mid-’80s—before I got into recovery in 1988—it was almost impossible to imagine an America where four states and DC have legalized recreational marijuana use, 58% of Florida midterm voters just cast their ballots in favor of legalizing medical use (the measure needed 60% to pass), and California passed a ballot initiative to lower drug and other nonviolent crime sentences. (Nineteen other states have legalized medical marijuana.)

The magnitude of the change is hard to understand without knowing a bit of recent history—and if we are going to continue to move toward rational drug policy, knowing where we’ve been and how it has changed is critical. I offer this perspective through the lens of my own experience covering the drug war for nearly 30 years.

My first national column was called, embarrassingly enough, “Piss Patrol.” I was assigned by High Times to write about corporate urine testing policies, starting around 1987, presumably as a service to stoned readers who were considering their employment options.

Over the next few years, the media would spill so much ink and airtime demonizing crack cocaine that by 1989, 64% of people polled by CBS News said that drugs were the country’s biggest problem—and Republicans and Democrats began tripping over one another to race to pass the harshest possible drug sentencing laws.

High Times itself was targeted by the DEA with frequent demands for its list of subscribers and raids on all of its biggest advertisers of growing supplies, nearly forcing the magazine to close.

Testifying before Congress, LAPD chief Daryl Gates said that casual drug users “ought to be taken out and shot,” and the DARE drug prevention program he founded saw nothing ominous in encouraging kids to turn their parents in to the police if they used drugs. Supreme Court Justice Thurgood Marshall warned in a prescient 1989 dissent in a urine testing case that “there is no drug exception to the Constitution,” although Congress and the rest of the legal establishment apparently begged to differ.

Even today, police can confiscate cash and property they suspect to be involved in drug crimes, without convicting the owners and with virtual impunity. The surveillance revelations about the NSA’s spying on American citizens include cases where that agency has shared information with the DEA that was gathered from phones and computers without a warrant. In fact, the DEA has an official policy of basically lying to defense attorneys—and sometimes even prosecutors and judges—about the source of this data.

Yet even before the rage to pass tough drug laws took off in the 1980s, law enforcement efforts like mandatory minimum sentences were known to be ineffective. The federal government had quietly overturned one set of mandatory drug sentences in the late ‘60s—since they had clearly failed to prevent the late ‘60s.

And New York City would never have been one of the capitals of crack if the 15-to-life “Rockefeller law” mandatory sentences for selling even powder cocaine, which had been in place here since the mid-‘70s, actually suppressed drug use.

As is clear from this brief summary, for most of my adult life, the idea of a rational drug policy seemed literally to be a pipe dream (a term, by the way, from opium dens). So how did we go, in just a few years, from seeing drug users as demon enemies in a war who must be locked up to having the drug czar drop the military language and even speak at last month’s National Harm Reduction Conference in Baltimore?

Many factors are clearly playing a role. Two of the most obvious are the sheer economic burden of having become the world’s most prolific jailer and the drop in violent crime that hasn’t been paralleled by a fall in addiction rates or a reduction in the availability of drugs like marijuana, heroin and cocaine. Some of the crime decrease may, of course, be linked to the 500% rise in the number of prisoners since 1980—but research shows that violent crime fell more in states that have lowered incarceration rates.

Other influences have also been important. One has been the increasing recognition—driven especially by Michelle Alexander’s 2011 bestseller The New Jim Crow—of the racist nature of the drug war. When you know this history of the drug laws it is very hard to justify supporting them.

Another factor is the rise of the Internet. Early adopters of the net tended to be hippies and libertarians: Steve Jobs famously said that his use of LSD was one of the most important experience of his life, for example, and pro-legalization views dominated online before the mainstream media began to realize the web was the future of its business.

This gave legalizers a loud voice—one that had been previously drowned out by a media that had so bought into the drug war that networks and newsmagazines thought nothing of taking government payments to place stories with the “correct” anti-drug slant in lieu of running paid anti-drug ads.

The Internet has also allowed critics—including me—to directly attack inaccurate coverage as it appeared, exposing readers to truthful information about drugs and drug users that was previously hard to find. It is much harder to start a panic when debunkers immediately offer alternative perspectives.

Three other important forces should also be mentioned. First, the Drug Policy Alliance—helped by large donations from billionaire George Soros—spurred activism and funded ballot initiative measures that brought marijuana policy reform out of the fringes and into the mainstream.

Second, the harm reduction movement spurred by the AIDS epidemic quietly racked up successes. As it became clear that needle exchange hadn’t resulted in a massive increase in IV drug use—but had helped halt the spread of HIV—resistance to measures like naloxone to reverse overdose was pre-empted.

In contrast to the fight over needle exchange, when conservative politicians, drug treatment providers and religious leaders actively opposed expansion and claimed, without data, that it would encourage drug use, it’s actually hard now to find anyone who will argue that drug users and their families should not have access to the OD antidote for fear that preventing the deaths of users “sends the wrong message.”

Third, recovery activists have played a role. While there are still reactionary forces like Patrick Kennedy, many people who have come out about their own recovery have made clear that the criminal justice approach has failed. By putting a real face on drug users—not a stereotyped image of a criminal—recovering people have begun to help fight against, rather than support, their own oppression.

Of course, historically, fights for drug law reform have often resulted in backlash—marijuana was almost legalized, for example, under President Jimmy Carter, but instead we got Ronald Reagan’s war on drugs. But the strength and variety of the forces working against that possibility—particularly the rapid access to accurate information—give me hope that we may finally be starting to get drug policy right.

Maia Szalavitz is one of the nation’s leading neuroscience and addiction journalists, and a columnist at Substance.com. She has contributed to Time, the New York Times, Scientific American Mind, the Washington Post and many other publications. She has also published five books, including Help at Any Cost: How the Troubled-Teen Industry Cons Parents and Hurts Kids (Riverhead, 2006), and is currently finishing her sixth, Unbroken Brain, which examines why seeing addiction as a developmental or learning disorder can help us better understand, prevent and treat it. Her last column for Substance.com was about why it is time to reclaim the concept of “recovery” from the abstinence-only establishment.