If only they devoted half the propaganda they have for climate change against đrugs and alcohol we might turn this thing around.
7
As usual we are treating the symptoms and not the disease. Addicts are treating internal pain. Large numbers have suffered childhood abuse and neglect. For whatever reason they feel estranged and disillusioned and drugs give them momentary respite from the agonies of daily living. Clearly putting them into the prison industrial complex doesn't heal those wounds. Then there are no jobs, ongoing poverty and we have a recipe for a disaster much greater than Harvey or any other hurricane. We have also created drug lords, dealers and more crime. Data shows very few addicts got their start from legitimate pain treatment, yet physicians are saddled with ever increasing federal requirements and regulations. With the introduction of elephant fentenyl addicts are dying in droves and adding to ever increasing treatment costs. It is time that we end the war and treat addicts with compassion as human beings not enemies like Portugal has.
15
It is becoming clearer that hallucinogenic drugs have a part to play in ending addiction, nonaddcitive themselves they often seem to enable peope to break addictions.
An amusing ture stroy is that the founder of alchoholics anonymous was given the pschoactive drug belledonna and swore off alchohol forever to start AA-what enabled him to get sober was the revelation he had on a physcoactive drug.
It is almost too amusing to be true, hallucinogenic drugs can give us the insight that enables people to quit drugs-to break free rom the labrat brain that keeps pushing buttons for its fix.
This is a missing piece of the puzzle
13
The problem of heroin addiction has the same root cause as most of the other problems decent people have trying to live humanitarian lives in peace: Heroin is a business with a profit motive. The profit motive is the evil of this world. Certainly there is merit in earning a living, but profit past reason is the killer of the human spirit.
4
NK: Thanks for a thoughtful article about two countries I have lived in and a topic that hits very close to home. No need for war stories except to say I have seen the devastation of addiction up close and personal multiple times. Addiction is a public health, mental health, psychological/physiological, and economic development issue that knows no boundaries of class, race, ethnicity, nationality, or gender. If there were such a thing as the devil, this is it. I have followed and supported the Portugal model since day one and remember friends and colleagues laughing in my face when I suggested this should become a global approach. Sad that it takes decades of deaths, broken families, destroyed neighborhoods, and stockpiled jails and prisons to realize another approach is warranted.
12
Duterte's philosophy, though vile and too broad and without the due process that should be included, is closer to an expression of the truth with respect to where heroin addicts and dealers belong in modern society. Given fair trials to free the innocent victims, he's got the right end game. That useful end does not justify his means, but given some jurisprudence he'd be a lot closer than Portugal.
A good start might be to stop calling it a war on drugs. Do we have wars on cancer, diabetes or alcoholism. No we call them diseases and react with research, education and treatment. A "War" on drugs only serves to provide politicians cover and enriches the industrial prison system.
9
I bet Jeff Sessions didn't read this article. The US is hell bent on killing off the poor and addicted. We have no soul. And we elect representatives who have no soul. If we did the right thing, we wouldn't imprison drug users.
17
The title of this column "How to win a War on Dugs" is way off. Rather it should be: How to negotiate a peace treaty with drugs and accept that addicts, like the poor, will always be with us.
16
It sounds good, but our administration would rather spend money on the military. They are so arrogant they would not take another country's advise.
Besides a lot of money is being made in for-profit prisons and the emergency rooms.
Maybe some day we will get leaders who really do want to make our country great and put the people first.
For now, we just have an idiot President who thinks he is still on TV and wants to fire NFL payers.
7
well duh. this and prostitution should be fully legalized. maybe precious white people dropping like flies may 'smack' some sense to 'chase the dragon'? nah. look at how deeply vindictive and conniving red-state republicans are...
prostitution is illegal because it gives women power.
8
So, this program is seen as a success because less people are dying from overdoses in Portugal, presumably because of access to treatment, but also due to less punishment for continuing their habit. Is that really success?
I think it's quite clear that this is seen as a 'crisis' because it's now affecting cute young white people. More 'not so cute people' still die yearly from complications of tobacco and alcohol addiction but we don't call that a crisis. Tobacco and alcohol are sold in stores at relatively reasonable prices so people don't have to murder and rob others to fulfill their habit. That makes me feel safer. Treatment for both is still much more expensive than continuing the habit, and that is something we just don't hear discussed. A box of nicotine gum costs a hell of a lot more than a pack of cigarettes. Regardless, according to the National Institute on Drug abuse, rates are falling. Could that be because of the message many young people are getting?
Legalize all drugs. Sell them at facilities that both sell and treat drug addiction and have connections to job, education and health improvement programs. Let's use the income generated (and saved from reduced incarceration rates) to 'change the message'. Many people turn to drugs not just because of mental illness but because of a sense of hopelessness. Reducing the reasons for hopelessness is what will reduce drug use.
12
I believe the culture and most people in Portugal are Catholic, a faith that emphasizes forgiveness for those of us who are merely mortal.
The US. culture has always been heavily influence by our early Puritan heritage and its new world offshoots, which emphasize a vengeful God, sin and damnation. Woe unto anyone who is having a good time, or is weak, or miserable. more soap and prayer will do the trick, and if it doesn't, that proves God is against you and you deserve to rot in hell for all eternity.
time for yet another great awakening! pour that evil liquor down the sewer and outlaw those reefers, too. while you're at it, ban dancing and showing a hint of female ankle in public.
so the field was fertile in the USA for all kinds of punitive social aberrations and a Portugese type of response to those who are doing so damnably wrong is out of the question.
cut to: lots of interests have figured out how to turn this to their power ad financial interests.
cue: Mike Pence.
13
The US is a playground for sadists who call what they do "tough love", and people just accept it as "God's will", and call death a "better place".
10
Who was the fool that made taking drugs "cool?" Get rid of the "coolness" factor would help a lot of young people from starting. There can be no doubt many become addicted to cigarettes because it was cool. Thank goodness we haven't had a President who thought drugs was cool as a youth and was a smoker.
As opposed to president who advocates the tough on crime failed policy regarding drugs.Don't say he doesn't. He picked sessions as his AG and a "big beautiful" wall will stop the scourge of drugs coming across our southern border.lol
5
Methadone seems to be a bigger problem when heroin is cheaper, less dangerous, less addictive, according to my addict acquaintances. My problem with drug addicts is they steal a lot and commit crimes to get their dope--and it is a terrible sight to see a person destroy himself day after day.
2
I lost a 44 year old nephew to drug-alcohol addiction. Anything, something, needs to be done.
1
When anyone of any age, anywhere, can get any drug they want whenever they want it, you're not winning a war, you're not even fighting a successful holding action. The war on drugs is a colossal failure...only a half-wit or a DEA employee would argue otherwise. That being said, there needs to be a radical rethinking of the problem and an equally radical reimagining of the solution. Like it or not, one of those is the Portuguese approach...one that has been proven to work. Look, you're never going to be completely rid of drugs. Why not take our heads out of the sand, admit our failures and try something new? Otherwise, we're just digging the same hole and filling it up ad infinitum.
11
If we are starting to treat rather than punish drug addiction, it will be because of the huge rise in drug use among white people. As Ta Nehisi Coates has made clear, compassion for whites, criminalization for blacks.
6
It is a throwaway culture and we do that to people, too. Is ending better than mending? Does it make sense to imprison a sick person whose only offense is addiction...a Disease? Not to me. Our origins in an austere branch of Christianity have come back to bite us in the bottom.
2
I feel sorry for you and for those people who think that the US will adopt a sensible drug problem now that it has become 'white' problem. Any country which is stupid enough to elect Donald Trump president and whose most important politicians are Paul Ryan and Mitch McConnell simply doesn't have sufficient intelligence to pass the kind of drug laws as Portugal has done. The US is great at making weapons of mass destruction but has zero ability to solve social problems. Keep in mind two aphorisms: Einstein "Doing the same thing over and over and expecting a different result is a sure sign of insanity" and Mencken "No one ever went broke underestimating the intelligence of the American people."
10
Decriminalize drugs and take away half the crime in America. Gun violence would decrease significantly, the Mexican Cartels would lose their market and the sixty thousand deaths in Mexico each year would subside.
Gee we can't have that, what would happen to the DEA, what wold happen to the billions stolen from citizens through civil asset forfeiture, what would happen to bloated police forces and prisons?
This is truly blood money and the American Congress has enabled our injustice system to prosper on the backs of the weakest amongst us.
12
Think of all the people who would lose money if we did this and that is why we continue keeping it illegal. Should be "medicalized" given away and dispensed in medical setting to addicts. We would save money and lives..but some would lose money and those people owm the country.
6
Mr. Kristof writes, "Portugal introduced targeted messaging to particular groups — prostitutes, Ukrainians, high school dropouts, and so on."
Who are the people in the 'and so on' group?
1
We also have private for profit prison and without incarceration they would fail. They need a 90% occupancy to be profitable. In America we value money over our most vunerable. How did we get to this place?
7
"Prohibition" is probably the greatest folly in human history, and its consequences have only been disasters: birth & growth of organized crime, corruption at all levels, "forbidden fruit" effect, etc. -- while drugs (much more dangerous than their "controlled quality" equivalents bought in a pharmacy) are available everywhere, and novel drugs (pharmacologically & toxicologically unknown) are produced and offered every day.
A thorough, radical reappraisal of this absurd situation is badly needed:
1. considering that different drugs require completely different approaches. [[[For example, pharmaceutical opioids, correctly used, are much safer than is commonly thought, see: "Opioids themselves are surprisingly nontoxic even when used in substantial daily doses for many years" [Cecil Textbook of Medicine, 20th ed, 1996, p. 52]; “Opioids themselves are associated with remarkably few medical complications, even with long-term use.” [Rastegar-Fingerhood: Addiction Medicine, 2005, p. 97]; "There is no evidence that opiates produce organic central nervous system damage or other organ pathosis, even after years of continuous use." [Goth's Medical Pharmacology,12th ed., 1988, p. 339]. ]]]
2. addressing the personal and social conditions leading to drug "abuse" and overcoming the current "drug culture" (another negative by-product of prohibition).
3. improving overall education and knowledge (freedom means responsibility toward oneself and the others).
2
But where's the part where we get to castigate drug users as immoral? It's no fun if we don't get to do that. And we could make believers out of them if we put them behind bars.
1
What's sad is the people who could do something stand idly by and watch as many are ravaged by drug addiction. When will we become a country that cares about ALL people, where is the humanity?
2
>
Great idea, but anybody over 40 yrs old reading this Op-Ed will never see it happen in this country.
We just elected DJT as POTUS, and you thinking we are going to decriminalize anything much less drugs is a bridge too far.
The law book, with the exception of the sections on tax evasion, will only become bigger not smaller under DJT.
4
I don't see any reference to drug-related crime. Drugs may have been nearly decriminalized in Portugal, but they're not free.
1
As usual. follow the money.
The US taxpayer foots a one trillion dollar annual DEA expense,for maintaining a lot of folks employed, on both sides of the law.
Legalize it and distribute it like we do booze. OOPs can you imagine what all those folks currently employed in "control " would do. We'd have to give them a distributorship.
3
"One crucial mistake that Portugal did not make was to follow the United States in adopting prescription opioid painkillers for routine use. Adalberto Campos Fernandes, the health minister, said that Portuguese doctors resisted overprescribing and that regulators also stood in the way."
How many other industrialized nations have a prescription opioid problem as bad as the US? I'd like to see an NYT article about this. Is it yet another problem created by our terrible health care system?
2
YES! Today it is impossible to deny that by far the greatest part of the immense damage that illicit drugs are causing in the US today is the result of the War Against Drugs. Is is really worth killing all these young people and spreading increasingly dangerous diseases throughout the community just so that politicians can seek votes by appealing to popular superstitions and fanatical moralistic illusions. The war against drugs is killing our young people and corrupting our economic and political institutions. The results are all in: Decriminalization saves lives and reduces innumerable forms of social harm. If anyone deserves to be in prison it is the DEA administrators (and not a few of their agents).
4
Everyone concerned about the disastrous, ill-conceived War On Drugs should read "Chasing The Scream". In spite of the terrible title it is a phenomenal book. (Did you know there is a specific date when that war started? And did you know it was started by an American bureaucrat? Read the book! You will be passing it along to friends, guaranteed.)
While I firmly believe that we have lost this war and to pursue it only worsens the damage to society, doing what Portugal did (gambling, and ultimately winning) with a logical approach--will be very hard for our larger and more complex country to duplicate. We have too many religious zealots who would be horrified at such a governmental cave-in, and gun-worshipers who believe if you kill enough of your opponents you will eventually win, and namby-pamby middle-of-the-roaders in their gated communities who would be too fearful of their grandchildren being issued syringes in public school kindergartens, etc. etc. But if we stuck to the phrase "de-criminalization" of drugs rather than "legalization" of drugs we would get a lot more takers.
For example, gay marriage would have happened, would have been normalized and accepted a lot faster, had that word "marriage" not been insisted upon. Had, I don't know, something like "gay commitment" been acceptable that pill would have washed down society's gullet a lot sooner.
Ditto with legalizing drugs. Just don't call it that even though that is exactly what we would be doing.
1
The clue to the hidden agenda of the war on drugs is in the use of the word "war"... This war was started at the end of the American War in Vietnam, and continues in Afghanistan - no coincidence that the war on drugs has a militarised/border guard feel on the streets and in the prisons. You have to ask who are the winners in this perpetual war...
2
Before the Prohibition people drank alcohol breakfast, lunch and dinner. Alcoholism was a pandemic. Something had to be done. Today the drug culture is advanced by the media in music, movies and TV. Fox has a Star Trek like show where the Captain discusses how strong the first officer’s weed was. You can find marijuana references in half Foxes shows. The sixties started with turning on and tuning out. I grew up listening to songs about how great heroin and cocaine was and it continues today because it sells.
If you have a culture that celebrates drug and alcohol use you are going to have a lot of people destroying their lives and the people around them. Some of them resort to crime to pay for their habit. It would be much worse if the government was to make it legal or looked the other way. Remember the crime epidemic during the eighties and nineties.
If there was a war on drugs they would turn those NSA and CIA computers and find out where the money is going from drug sales. No one is suggesting that are they?
It is most helpful for one to gain awareness of the genesis of the federal War on Drugs.
This was not a project to address the outcome of a rigid scientific study; it was a political manipulation by Richard M. Nixon and John Ehrlichman to overcome the very effective resistance put forth by the African-American and hippy communities to the favorite Nixon Administration initiatives.
While they could not make it illegal to be either black or a hippy, they reasoned that a federal initiative on marijuana would allow tens of thousands of blacks and hippies to be arrested and incarcerated, and thus taken out of action in protesting:
https://harpers.org/archive/2016/04/legalize-it-all/
The very logical approach proven by Portugal to be effective has the twin advantages of freeing up scarce police resources for more important and societally beneficial priorities than arresting drug users as well as providing a path to mainstream into the workplace many who have been sidelined by drug use.
We have in the US a dire shortage in a variety of skill categories. Utilizing the Portugal model could release the hundreds of thousands of individuals incarcerated for drug use and possession of a small amount of drugs.
With the ground-breaking research done by Nobel laureate Sir Angus Deason which shows the avoidable deaths of half a million middle aged white men from overdoses of drugs and alcoholism, we can see how much our country could benefit from enlightenment in drug policy.
2
Even better: legalize them entirely (like alcohol and tobacco), and sell measured doses in liquor stores. No criminal drug trade, almost no overdoses because potency is controlled.
2
Excellent Essay ... Wrong Perspective
Let's connect some dots ...
Dot 1: I agree that we should explore "optimal" ways to decriminalize drug use.
Dot 2: Perhaps we should think 64,000 drug-related deaths in one year is a problem and make an effort to tackle that "problem" societally.
Dot 3: I seriously doubt that there is a societal solution to the "problem" in the United States." A society that refuses to explore the root causes of a "problem" is not likely to solve it.
Dot 4: Drug "addiction" and drug abuse are, first and foremost individual and family issues ... societal concerns pale by comparison.
Dot 5: Anyone interested in helping individuals with drug problems, should start by reading the literature and watching some YouTube lectures by Canadian psychologists Gabor Maté and Gordon Neufeld ... and pay very close attention to what they have to say about pain and attachment.
Here, I'll get you started; albeit, only trivially ...
https://www.youtube.com/watch?v=T5sOh4gKPIg
Dot 6: Analysis of the Millennial culture in America will tell you why the solution to the problem is hopeless in the U.S. We are raising an entire generation of youngsters whose attachments are to themselves; not to responsible adults. Bright as they may be, how could we possibly expect them to grow up to be more thoughtful and experience less pain than previous generations. Drugs will help them escape their pain ... if only for a little while.
Okay, I've connected just a few of the dots.
1
The illegal drug " industry " is probably just as large as Big Pharma . It is now , unbelievably , a very vital part of the economy . The money generated by illegal drugs is astronomical . Remove that economic factor and the recession of 2008 would look minuscule . Many people rely on the illegal drug trade for jobs : drug dealers , drug packagers , lawyers , judges , nurses , doctors , cops ad infinatum ! This is the way it is going to be ! MAGA !
1
One of the important reasons Portugal is succeeding in the war on drugs is because they have a good National Healthcare Sustem for all citizens.
Big Pharma in America is reaping huge profits from prescription pain killers .
GREED is what makes America not so great and for sure not FIRST .
3
The War on Drugs ought to mean a war on overpriced pharmaceuticals.
The War on Drugs ought to be about forcing enormously powerful international cartels such as Glaxo-Kline to supply lifesaving drugs at reasonable prices, whilst still ensuring that the fiscal returns are enough to reward shareholders and encourage basic research.
If junkies choose to kill themselves overdosing on opiods or on any other drugs, including alcohol or tobacco, then so be it. So long as users don't kill or maim others in car crashes, or operating machinery at work, then it's their choice. Tax users and the suppliers of recreational drugs to the hilt, provide safe houses, legalise opium dens and the like, and let the laws of natural selection take their course.
3
Kristof knows after visiting Portugal that their model would not have helped the US "win" the war on drugs. It would only soften the human ramifications. Portugal's heroin addicts are essentially the "walking dead," unable to live normal productive lives. But at least they are alive.
Our proximity to the highly-organized Mexican drug cartels and the poppy growing regions in Central America, coupled with the OxyContin Big Pharma marketing push in the last decade, put the US in truly a no-win situation.
1
With the opioid epidemic we're seeing an explosion of drug deaths, increased crime in the affected communities, women selling themselves for drug money, babies born addicted to drugs and children being placed in foster care or being raised by their grandparents. People are saying addiction is a disease and there are calls for empathy, compassion and understanding and jail is ot the answer.
While I feel for the addict, their friends and families I have to admit I am completely disgusted with the response. When the crack epidemic hit with the same results as above, the response was jail. People went to jail/prison and were labeled felons for possessing small amounts of crack. Our jails are filled with predominantly black and brown faces due to drug related crimes. One would think the faces behind bars would become predominantly white given today's crisis but of course this will not happen. More is being done than "just say no" which was heard in the 1980s. Millions are being proposed for drug treatment centers.
People say "we" always have to make things racial. Well guess what? It is.
Legalization, reasonable regulation, and education in the manner of our approach to tobacco is the only sane route.
Please see how many time George Schultz, and panels of esteemed people working with him, have presented this view.
2
Hooray and hallelujah! Thank you Nicholas Kristof for an excellent reporting on a magnificent story. Some of us have been arguing for decriminalization and legalization for over thirty years. Our arguments have fallen on the rocks of doubt. Even my cousin George, like Nicholas, worried for decades that the idea was bad, because logically, the death rate might rise before it fell, and be therefore politically unpopular, maybe even wrong.
But the data from Portugal is game changing. It is irrefutable proof that the US war on drugs is a miserable failure compared to the Portuguese model, half-baked as it is. It still has the most important components, decriminalization for users, and a massive public health initiative to help people who are sick with the disease of addiction. And behold, it costs roughly 5% of what our complete failure of a policy costs. "$10 per citizen per year" (in Portugal), versus "$10,000 per household over a decade" in the US.
I have for years argued that the statistics and history of legalizing alcohol, after the end of prohibition, prove that legalization of addictive drugs will reduce crime, and deaths, and the destabilization of governments, especially if partnered with a Marshall plan to help addicts get off their addiction, or learn to maintain it safely. In this report of the Portuguese model, one paragraph after another, is proof of of the argument.
3
Portugal's success, and our failure, may be another example of how our respective economic systems operate. Our system depends on disincentivizing drug use through the implementation of harsh penalties as a way to separate winners from losers, while their socialist model takes the opposite viewpoint. For that reason, I regrettably doubt that their model would work here.
1
Interesting article--a little short on facts but still encouraging. Maybe the next article could study the Singapore model. It is very different but seems very effective too.
2
As long as JBeau is our AG, nothing like this will even be considered. As Gayle Bigelow states below, this is as much about race as it is about drugs. The overwhelming population in prison for drug offenses is black and Hispanic.
Having said that, the pragmatic approach to drug use seems more appropriate to me. As an example, why not legalize all drugs--heroin included--and have it legally dispensed without a prescription at a pharmacy. A user would only have to give his or her name and address and the drugs would be available. That would allow public health workers to visit and monitor users and try to wean them off drugs. This certainly wouldn't eradicate drug use, but I'd be willing to bet it would dramatically reduce it.
Unfortunately, any idea for drug reform requires real leadership, both at the State and Federal level. In my home State of Florida, that leadership doesn't exist. Even in liberal States like NY, there isn't the kind of leadership that could push an alternative agenda forward, as has been done with marijuana.
2
Mao Tse-Tung proved how to eliminate opioid addiction in a country mired in it. And no, it wasn't by labeling it a "disease" and substituting one opioid (heroin/opium) for another (methadone).
1
Surrender is definitely one way to end the war on drugs or any other war for that matter. How about building walls to prevent tin inflow of drugs?
3
I can't figure out what you are trying to say here. First you talk about how difficult it would be to transfer Portugal's program somewhere else. Then you go on about how what is done in the US is ineffective and harmful. Finally, you seem to advocate a totally decentralized, basically Portuguese, system run by individuals instead of the government. How can that be given that one can be arrested for providing cover for a drug user? I believe Mr. Kristof is correct when he says the (imperfect) key to the issue is an approach like Portugal's. There are two problems that we would need to overcome--our double-r brick wall--religion and racism (maybe that is actually only one problem). You need look no farther than Jeff Sessions and his attitude that "Good people don't smoke marijuana." In his--and many other people's--mind that means marijuana is used by heathens and people of color. I don't see how that makes it proper to arrest so many people, but as others have said, there is tremendous money to be made (and elections won) by locking up huge numbers of the swarthy.
1
This is a fine column. The only item not addressed for Portugal's ground breaking project is: how in the world does the Portuguese government pay for it?? The dark secret here is that sober taxpayers have to pay for this, addicts are human too, but they do not pay much in taxes. All power to Portuguese taxpayers, but since in the USA we scream and whine about the ACA individual mandate, I do not see us supporting the Portuguese system in our lifetimes. Sad!
The terrifying and unacknowleged fact is healthy people have to pay for sick peoples care--whether it's cancer or addiction. The contract of course is even the healthiest will be old and sick one day, addiction can strike anyone or in anyone's family. But that kind of collective responsibility is not in the HSA's cultural DNA. One can dream.
The other USA misfortunes is our US Public Health Service--which includes the NIH, the CDC, the FDA, and six other agencies are way underfunded. And with Tom Price in charge of those agencies and the Trump-Ryan-Mitch axis obsessed with a tax cut, those agencies are not going to get the massive funding necessary for a Portuguese drug system try out. This the USA addicts, love it or leave it.
A hard rain will fall before universal health care or legal recourse for addicts or a medical emergency is set for opioids (and opioids relatives). It is just not going to happen here. The USA does not have enough kind and healthy taxpayers. Where did Portugal find these people??
1
"This issue is personal to me, because my hometown in rural Oregon has been devastated by methamphetamines and, more recently, by opioids. Classmates have died or had their lives destroyed; my seventh-grade crush is now homeless because of her addictions."
Give me a break Kristof. Work hard at getting your hometown to become another Portugal then be sure to write how all that worked out.
I have the feeling the compassion blast will be even greater, but who knows.
I wouldn't judge the success of a drug policy on the number or percentage of deaths but on the number or percentage of drug users and the overall cost to society. Kicking the habit is definitely difficult so the system which produces the least drug users will probably be the best. Portugal apparently has shown a remarkable decrease in users so perhaps we should give their methods a try, perhaps in several contiguous states with severe drug problems.
1
The easiest way to avoid becoming an addict is to never start using drugs. What we need is research and effective programming to get people to stop trying drugs in the first place. Is addiction a medical problem? Probably. But it's occurrence is entirely within the control of each and every person - if you never use heroin you will never become addicted. Opioids are maybe a harder problem if the initial prescriptions were from a doctor, but medical professionals should be on the look out for that by now.
2
kindest greetings mr. kristoff: please know without an educational component teaching body anatomy and what drugs do to one's body, the war on drugs will never be as good and effective as it can be. to believe otherwise is merely to keep one's head in the proverbial sand about drug addiction.
1
Interesting article, but how can you ignore the fact that the current drug crisis in the United States is being driven by legal drugs -- prescription opioids? When you present the devastating statistics of overdose deaths without at least attempting to account for those that would have occurred in your legalized world, you do a disservice to your readers. While the criminal laws should be scrutinized, our public health system and the FDA should not get a pass, which is what happens when we ignore that legalized drugs are devastating our communities.
1
Great article! I'm on board with this. Still like many NYT editorials, you don't feel as if you are getting the whole truth. From the chart Portugal's deaths are right in line with the rest of Southern Europe (France, Italy, Spain). Which in turn as a group are much much lower than the Nordic countries which are also know for humane treatment of drug addiction. So something else is going on. Southern Europeans don't do the dangerous binge drinking that Anglo, nordics do so perhaps they are somehow more moderate in their drug use also. Also my understanding is that in the regions in the US where opiod deaths are the highest, it was never really criminalized in the first place. Thousands OD every week in Ohio, West Virginia etc. but these users never serve long (or any) prison sentences. Police use Narcan to revive them and then put them in rehab programs similar to those described in Portugal. The people in prison for "drug related crime" are more in for the "related crime", not the drugs themselves.
4
Thank you Mr. Kristoff, again. An excellent piece.
This reminds me of the debate about climate change. Scientific fact is one thing in this country and ability to be rational is another. Addiction is classified medically as a disease but is treated as a crime. Climate change is caused by releasing stored carbon but is treated as unimportant or fictional.
We can debate the causes but we should first acknowledge the hypocrisy. It is profoundly destructive to run your organization, country in this case on a deliberately false narrative.
2
Switzerland tried dealing with it years ago but it failed. Decriminalize all drugs and have them sold (not sure with or without prescriptions) in drugstores. People are going to abuse stuff to get high one way or another. At least we can eliminate or reduce overdoses, profits for drug cartels, much street crime and offer help this way. 40 years of the war on drugs has proven jail and simply calling them illegal does nothing.
3
How much do we spend on people who choose a life of drug addiction? I'd rather my tax dollars supported people who actually want to better themselves. Sometime we need to be judgmental.
1
Thank you for this great contribution to our national discussion about how to deal with the long-time crisis that is drug addiction. Taking a radically new approach in this country is long overdue. When something doesn't work, it's idiotic to keep repeating it. I used to think one of America's strengths was its ability to change and adapt. I think that's no longer so much the case. They country has become so conservative, so scared, so afraid of change, so ignorant, so reactionary.
1
This is one issue on which I agree with Nicholas Kristof.
Here is a statistic that troubles me, and should trouble all Americans. The US has the second highest incarceration rate in the world, second only to the small nation of the Seychelles. It has 14 times the incarceration rate of Japan, for example. The US incarcerates 2.2 million individuals. And there are additional millions of ex-cons who cannot get jobs because of criminal records.
This costs federal and state governments enormous amounts of money. The California budget for 2017-18 will spend about 11 billion on corrections, compared to a little more than 14 billion on higher education. Thus we spend 3/4 as much on imprisoning citizens as we do on training engineers and doctors. This is a lop-sided misallocation of resources. We need more engineers and doctors, not prisoners!
Part of the reason is that it wildly popular with politicians to lock people up.
The war on drugs represents one aspect of this problem. Yes, Portugal has the right idea. We should regard drug addiction as a disease, and not put people in jail because they have become addicted.
But locking people up seems to be an American obsession. And not just for Republicans.
Joe Biden sponsored a Violence Against Women Act that puts men in jail on the basis of a mere accusation. When first introduced some civil rights groups fought this at first because it denies due process.
We need to solve social problems without relying on jails.
2
Thanks for reporting this encouraging article. I don't think drug addiction must always be a part of our society. I'd like to see reporting on research about why in the same environment, some people try drugs and others do not.
I'm an alcoholic. Lost everything until 1/9/04 when I asked a Higher Power for help. This was after a decade of trying to quit on my own, including multiple rehab stays.
Addiction is a chronic disease. Locking up people for being sick is wrong and accentuates the problem. Portugal's approach is clearly superior and if we as a nation do not try it, then shame on us.
2
I remember when Portugal decriminalized drugs in 2001. I really wasn't sure it would work. Now, 16 years later, with a daughter addicted to heroin, I wish the United States had this much compassion. I've studied and researched drug use and treatment around the world as well as legal ramifications for the addict. (when you are a mother of an addict you will, or I did, do anything to stop it; up to and including driving around with a loaded gun looking for the drug dealer selling heroin to your daughter) I am not proud of these things but this is the desperation in America right now. State agencies ran out of funds to treat my daughter (even when she clearly needed Narcan, we where told to leave). Americans need to look in the mirror and ask themselves why we treat ppl the way we do. It's time to looking at PEOPLE as the HUMANS that they are, not a class or catagory. We ALL need each other because truly we are connected. Love and compassion will always win over hate and materialism.
2
This is important information, Mr. Kristof, especially because the current administration wants to punish users more heavily. Two days ago a woman in recovery told me of an assault on her as she walked home down an alley late one night, was robbed, beaten, raped, threatened at gunpoint and left naked and bleeding profusely from a head wound and other wounds when she ran to the street and waved down the first approaching car: a police car. Another friend in recovery was here for lunch last Sunday and told me of being beaten so profoundly several weeks ago that she could not remember a thing about it nor about how she got to an ER. Her face was unrecognizable to friends from the beating, and she had lost a tooth. Someone picked her up, took her to ER and left her there. She just got out of detox. A woman I knew, who was also in recovery, had told me she had a $200-per-day heroin habit, had never been in prison, but worked the streets regularly during good weather. She died of an overdose last October. This life is its own punishment, and threatening more punishment is not going to work. The recovery houses are good, AA is a good program, the detox people working with users are excellent, firm and caring and yet the epidemic grows. Life for the users is brutal, yet moire and more young people choose this life no matter what they see and hear from users themselves. What is happening in this world that so many young people turn to drugs for escape?
3
Incredible article; so, upbeat and positive. Maybe there is hope for the USA opioid epidemic. Well done Portugal. What have we got to lose? Let's go for it and make this country better. Do it now congress. If you don't, we the people, will insist upon random drug and alcohol screening for every member of the house of representatives and the senate. Want to solve a serious problem? Start at the top!
2
As long as alcohol, tobacco and pharmaceutical drugs are legal and highly profitable, the resistance to a rational humane approach to drug addiction will remain irresistible.
It is impossible to change the war on drugs to treatment, when the Republicans continue their never ending war on health care.
Besides, the war on drugs is profitable to the Republican base of private prison owners, gun and ammunition makers who supply both sides of the war, and some may even get a cut of the action to keep it illegal. Drug dealing would not be as profitable if it were decriminalized - unless they join the for profit pharmaceutical clan, of course.
The collateral damage of the war on drugs is what I find most objectionable. The only victims of drugs should be the drug users themselves. Yes, we can and should help them. But it makes no sense to overturn the entire society in a war that should only involve the users.
2
What will it take to change our culture to stop Hating the Sinner? Our collective morality over the years have engendered laws and policies that lead to deadly outcomes. In our facts-don't matter present even the legalization of marijuana trend is being fought hard by the DOJ. What has become of our humanity?
2
I am a recovering opiate addict. I absolutely think this is the best way to treat addicts. The numbers speak for themselves. I have 30+ years in recovery, and I can state without a moment's hesitation this is the right way to go.
If you are not an addict or alcoholic, there is no way you can truly understand what life is like the same way as someone who is an addict or alcoholic.
As I wrote before, the numbers speak for themselves. People in the USA are ignorant when it comes to this subject.
2
Do-gooders have big hearts that control their thinking, that's noble, and why they can't be allowed the really tough decisions with respect to intractable problems like heroin. Preventing one kid from starting using heroin is worth letting 50 of these methadone addled addicts pass. They sustain dealers, as is stated in this piece, "business is good." To get rid of dealers, let the users go. Stop enabling this social entity to exist in the midst of vulnerable society.
1
But if we treat drug addiction as a disease, how will judges, prosecutors, and cops seize assets without cause? Think of the cost to the civil asset forfeiture-industrial complex!
1
One question people should be asking is what happened to the estimated 75,000 heroin users in Portugal after the period when the new policy began?
" Today, the Health Ministry estimates that only about 25,000 Portuguese use heroin, down from 100,000 when the policy began."
Did they become clean, die or what?
The "war on drugs" in the US is popular, in part, b/c we like war. We like retribution and punitive measures regardless of effectiveness, because they feel right. They also are money makers for some (who have outsized voices in our political body).
If the US valued the well being of its citizens as much as war, we wouldn't be spending 20% of every dollar on the Dept. of Defense, while we futilely fight about trying to provide decent, affordable health care to our citizens.
3
There have been other experiences in similar programs, for instance in Vancouver, BC Canada. It worked there, too. So why not start this program now in the US? Probably because, as a country, we are more in love with punishment than reward. i.e. we prefer the stick to the carrot.
If the billions we spend on the war on drugs were to be spent on a Portugal type drug program we could probably expect results much like Portugal's.
It isn't perfect but it is the best known. Why not start it today? We would have to change quite a few laws and quite a bit of bureaucracy but we could do it!
The carrot does work better than the stick.
2
Great piece. You miss one important distinction in the difference between Portugal's approach compared to the US. Portugal's politicians and leaders had humanity and empathy when they adopted the policy. The US uses drugs to disenfranchise millions of black and has turned mass incarceration into a major industry. It's all for profit and making people richer. Greed drives the US. Politicians and elites here don't give a damn about their fellow human beings.
2
For 13 years we had a constitutional amendment that prohibited production and transportation of alcohol. It was passed in response to a terrible problem and it failed to stop people from misusing alcohol. It nurtured a criminal class which exploited people's desire to get drunk. Why did we fail to learn from that experience when it came to controlling other drugs?
It used to be common to see people smoking in public. Yesterday, I happened to see the movie Julia and there was Julia Child puffing away in a restaurant. A combination of sin taxes, public relations campaigns, education and laws restricting where people can smoke have reduced the numbers of people addicted to tobacco. There has also been some effort to wean farmers away from a profitable cash crop. It is possible to have a rational approach to problems of addiction.
Of course, the Portugal approach is not going to be 100% successful. Punitive attempts to stop the misuse of drugs are also doomed to failure and their cost in human suffering and money is unacceptable. We can do better.
5
Without the backstop provided by universal health care, would it be as effective in the US? I suspect not. Nevertheless, having heard about the Portuguese efforts years ago I have long been in full support of trying it here. Good luck convincing our law-and-order obsessed country to buy into it.
8
Part of the problem in America is that the war on drugs has made a lot of money for a number of groups and many of them lobby and fund election campaigns. There are plenty of people profiting from the status quo.
Many Police departments have become addicted to the money from the impounding of property and cash from drug cases and use it to fund overtime that is used for more drug arrests and impounds. Private prisons and the whole monetization of criminal justice make money from the large population of addicted people caught up in the financial shakedown that so-called criminal justice has become. If we adopted Portugal’s model there would be far fewer new entrants into the cycle that provides income to private jails, lawyers, bail bondsmen, parole companies and those who rip off prisoners via overpriced phone calls and commissary products. Most jails now forcibly the giving of “free world” items to the incarcerated, but sell them stuff at inflated prices and only with prepaid cards that carry stiff fees.
The Portuguese model is the right thing to do, but America has turned law enforcement into a for profit industry.
10
The sad truth about it all, is it's all economical. There's much more money to be made by treating drug addiction like a criminal offense.
Building jails in nominally low-income rural states is a viable cottage industry, giving people with basic educational skills a chance to work; whereas the same can't be said about staffing medical facilities and clinics.
Add to that a pharmaceutical company that has no interest in losing the vast profit it's reaping by manufacturing highly addictive opioids -- and you have the 'perfect storm' of reasons why treating addiction as a crime instead of a disease is so rampant in this country, and is unlikely to change.
12
It's economical in the sense that many abusers don't have decent jobs and see no prospects for a better future. We see that among poorly educated white people in rural areas and small towns where jobs have disappeared. But that is no excuse. People have always had to adapt to economic conditions by moving to where the jobs are or seeking out new careers and training. The people who don't have the imagination or confidence to adapt are the ones who fall into the drug trap.
@Patriot
Don't fool yourself. There a lot more people who fall into the drug trap for far more reasons than the ones you have noted.
That said. My point is that it has become a economical success to treat drug abuse as a crime, because that allows the the penitentiary system (and the pharmaceutical industry) to thrive.
And that is what makes it so insidious.
2
It might work there and I would challenge say California to try it out. I wonder it they give out free drugs as well.
1
According to national statistics, California is not one of the states with the highest incident of opioid drug addiction.
One correction needed in this article concerns the claim that the "cost" of methadone programs is frequently expensive. in Chicago it is $50 per week or less. $50 per week is vastly less than the money opiate addicts spend each day for their "fix." The money spent for medicated treatment is a comparative bargain. There are other hassles like the daily trips to the methadone clinic, and some medication side effects. Still, these issues are minor inconveniences compared to the torrents of addiction to illegal opiates. All in all, the preponderance of evidence shows the decriminalization model is vastly superior to our innane drug policies.
12
Seattle spends upwards of 75 million of taxpayer money each year on programs for the homeless. Many, probably most, are addicts. Few (none?) are jailed for drug use. Some are jailed for dealing, but not many, and not for long. Many of the addicts are in their prime working years. So . . . are Seattle taxpayers going to keep paying millions year after year for these programs to "help" homeless addicts? Is this sustainable?
Talking about drug addiction without talking about a return to the larger community (including getting a job) is missing a big part of the picture. The Surgeon General's report on opioid addiction notes that forced addiction treatment is as successful as voluntary addiction treatment. Get addicts in treatment.
14
Sadly, those statistics are misleading. With the exception of medication-assisted treatment, most of what passes for addiction treatment in the United States is not evidence based and is generally not effective. Specifically I'm referring to the traditional rehab industry. Yes those who are forced into treatment fare the same as those who voluntarily enter. What that statement fails to make clear is that outcomes are poor for both groups. So it's not that they are equally successful. They are equally unsuccessful. I have serious reservations about forcing treatment until major changes are made to how we treat addiction in this country and until oversight and accountability are put into place to minimize abuse and increase effectiveness in the rehab industry.
5
they thrive on repeat business ..even with their abysmal success rate it is always the patients fault when they use again.so they have no to need to ever improve this way
1
seattles main contribution to housing the homeless is refugee camp style tent cities ..there are no inpatient mental health or treatment facilities available or funded with the money spent..so they rationalize this by saying they are all criminal drug addicts never taking into account that even with a $13.50 an hour minimum wage its very difficult to find a place to live
1
I had long maintained that the whole "war on drugs" idea is a misconception. It turns out that the war on drugs is just plain wrong. All praise to Portugal. All the world needs to take example.
For further progress, could full legalization help?
Would it also help if the government creates an alternative, higher-quality, safer supply, to undercut the unsafe stuff available from the street dealers?
Would an all-out investment in education, prevention, treatment and relapse prevention also help?
in any case, the Portuguese are doing a much better job than the countries that throw what are essentially sick people in jail.
12
Let's not only legalize it, but pay for their habit, too. *Sigh...As someone who has lost a loved one to addiction after a decade of struggles, I feel the system constantly stepping in to help (i.e. enable him) led to his demise.
There was no urgency or desire for him to overcome his addiction because the system enabled him to continue it (and assured him it was not his fault for wanting to).
The point is not to judge, but to help the addicted OUT of the situation. It's a very complex issue and those who have not been through it personally or with a loved one can't fully understand that. Hence, these simplistic, utopic suggestions like Kristof's.
14
You saw the statistics for Portugal and the US in the article and then ignored them in favor of your own emotional anecdote. Too many of your fellow Americans choose to advocate for public policies based on emotion rather than logic while the country crumbles around them.
1
He's not proposing a "utopic" solution, but providing evidence that the Portuguese system works better than the US system.
1
Why is it that America seems incapable of learning something from other countries? Are we so proud we're unable to learn from others, or at least study what others are successfully accomplishing? To quote a wise person: "Pride goeth before a fall".
10
What may work in a country that has a significantly much smaller population such as Portugal with just over 10 million people in comparison to the US of 325 million, may be one factor to why what one country does may not work in the US.
Another factor is location in respect to the supply / trafficking of illicit drugs.
I've had addiction in my family for generations. It's broken hearts, ruined us financially, broken up marriages, caused stress-related diseases to the family members trying to help, & exposed young children to things they shouldn't have seen at that age or really ever. If you haven't had an addict in your close family, you simply cannot understand how truly painful it is and how helpless you can be What we need in the US is appropriate (truly efficacious) treatment options that are accessible and affordable to all. We also need mental health diagnosis and care as part of the treatment. And we need to help people find their way back into the world with financial support to buy toiletries, clean clothes, for a place to live, public transport. This is a very complex problem. And we need to take away the shame both from the addict and from the family trying to care for or protect the addict. Families need family therapy. Historical trauma and PTSD needs to be addressed. There is so quick fix. But I can tell you this: we are no where close to being in a decent place as a country. We are failing miserably & it's affecting generations by not only the addiction but the care takers stress, fear and inability to affect change.
25
"If you haven't had an addict in your close family, you simply cannot understand how truly painful it is and how helpless you can be What we need in the US is appropriate (truly efficacious) treatment options that are accessible and affordable to all. "
I've had such family members and close friends. Their con went on and on and on crying the same things you are. "I just can't catch a break like you did bro." This was said to me many times after I returned from South Vietnam to a crime ridden neighborhood and was attending a public university in Detroit. Privilege indeed.
And on and on and on it goes...
We seem to be in a very weird situation in the US, where nothing ever gets done because someone will lose. Good policies never happen because some group will lose jobs, money, and power.
Can't actually stop the war on drugs because pharmaceutical companies will take a hit. As will the DEA, all law enforcement, people who work in jails, and let's not forget the everyone else involved in the US justice system.
This is repeated for almost every issue in the US. Anything that will benefit the whole will hurt the few.
23
I seriously doubt the groups you mentioned lobby Congress or run tv ads arguing that decriminaliztion will cost jobs in the US. If you have proof, show us.
Treatment hard to access, incarceration and guns---the elements of the US system that adds up to tragedy.
Add to that racial bias. Add to that millions of US jobs sent to Asia for decades, causing increasing economic insecurity. What a recipe for disaster.
America the incarceration nation, defended by conservatives as the moral way.
Our gun issue is worse due to how our elections are financed. The NRA gun lobby is one of the main legalized sponsors of our politicians running for office. Their profits and power stays entrenched. Our own lawmakers help in promoting guns for all everywhere. That equals profits and death.
Portugal has a robust social fabric and safety net, so fewer people self-medicate with drugs? Obviously the US has a weak social fabric and safety net, per our political culture of small govt, and non interference in corporate private profit. This leads to our social instability and pathology, as more people have been self medicating with various drugs and opioids.
It all works together in a cause/effect pattern. All justified by American ‘morality’ allied with private profit. To change the US system is labeled too liberal, so it endures.
Hurray for America the Beautiful. Guns for all everywhere, the most % of population in prison, and the drug problem continued with our ‘small govt’ philosophy.
Thank you Mr. Kristof for this international comparison that shows how differently things are done in other nations---so rare in our news media.
16
Looking for answers, always. Losing a child to drugs (a son who struggled for over 20 years) brings the issue to us in the most painful manner.
Methadone here is more of a racket than a solution. $14 a day with counselors not really trying to wean users off of it. The problem is everywhere in the US, no one escapes. Treatment centers are underfunded and staff both underpaid and under qualified. It is heartbreaking in the extreme so when someone like Nick brings it to the foreground we are encouraged.
However, the GOP leadership is absent from the discussion, bound only to donors who benefit from the corruption. AG Sessions offers only punishment, not solutions: Punishment that feeds his private prisons who function as a warehouse whose sole purpose is to generate profits. "Unfettered Capitalism" at its worse.
The US has slipped into a corrupt, comatose nightmare for many of us. Hopefully we have not lost our souls altogether.
20
For the record, methadone users don't "hold jobs." What would you suppose they'd do? They can't use tools, they can't drive, they can't be trusted with money or kids or other people's property. The height of irresponsibility in this world is to hand your life over to drug abuse, just what jobs does the author think methadone users have? $100 a day in heroin? Most working Americans with back ache and lack of sleep and constant worry don't spend $100 a week on themselves!
Question: when you save an addict's life, just what did you save? They don't work, they mooch and steal. They don't study. They should not be near kids or anyone susceptible to being lured into drug use. Their minds are on hold for the duration of their addicted lives. Supposedly every life matters but really, what is the life of a criminal zombie?
Personally I'd rather not be, than be a heroin addict, and I think I'm using reasonable and rational judgement. And it's that sort of judgement that means I've never touched the stuff, though I could have. You let people be worthless and on the dole, and they will be. Life is a challenge and you have to meet it, not go become a junkie, because you can, because there's a world of PC sympathizers enabling you.
11
Or, your mindset could be "we live in a compassionate society and we take care of our own". Your choice.
2
Lee Beri - I do have that mindset. You seem to not be completely aware of what heroin addiction is. Heroin addiction is such a doom for the user that it is utterly humane to let 50 addicts "pass away," if that prevents them from creating one new user. It's that bad on both ends. Doom for the addict, and an awaiting horror for the innocent. I am compassionate. I understand the struggle, I value innocent life.
1
When two countries are at war, the carnage in human toll -- the wounded, maimed and dying -- are attended by medical professionals. But as this problem cannot be contained by the health professionals alone (or engineers and artisans for broken and fallen buildings and infrastructure) the drug problem will never be completely solved by the health sector. As the eventual solution to the war that creates demand for healthcare providers can only be solved when the two countries decide to enter truce, the problem of drug use, too, will find its eventual but most effective solution when societies decide to tackle issues that make people so vulnerable that they do not mind even taking high and dangerous levels drugs to get by their daily misery. The earlier we start thinking along societal lines, the sooner we'll have a containable problem.
4
Very interesting and somewhat compelling. But haven't we in the US been hearing for years that 'addiction is a disease'? I do not disagree with that premise -- and I have plenty of experience in the arena-- but the author's assertion that we do not see it that way in this country seems odd. Law enforcement almost universally targets the supplier, not the user. Unless the user gets involves in other illegal activities. Even the acclaimed series 'The Wire' -- whose creators certainly disdain drug policy in America -- rarely depict users as drug-enforcement targets.
What Portugal is doing may be working reasonably well for them, and I am not suggesting that elements of their approach could not work here. But, as much as addiction is a disease, it does require the choices and participation of its host, particularly in the earlier stages. No amount of suggestion or cajoling -- whether from loved ones or strangers -- can prevent human volition.
3
Your comment is filled with caveats about how you agree with the principles and policies, etc, but still, human choice!
Except that addiction to synthetic drugs is a syndrome which physically affects the brain. The brain is responsible for behavior, so it stands to reason that if your brain is twisted by a poison, it will not work correctly. Cancer does that to organs, right?
There is no reason to separate brain poison from any other. Lose the prejudice against scary brain behavior and think of it as recoverable poisoning!
1
Someone is arrested for marijuana possession every 51 seconds in this country. If that's not asinine and indicative of the idiocy of our drug policy, I don't know what is.
1
"Top 20 drugs recorded in emergency presentations in sentinel hospitals in 2015"
alcohol should be included in this list, including cases involving accidents under intoxication.
n.b. according to the report, alcohol and tobacco use in the US for 15-16 year old students is now less than 1/2 of the rates in europe, while cannabis use for US 15-16 year old students is about 2 times as high.
3
Nick,
This is a valuable report on this critical issue. The chart entitled, "A Stark Difference: Drug-Related Deaths" confirms that the policy response of the US is the wrong approach. The US health policy community needs to dig in on this issue and change their approach.
There is a lot of wisdom in this column and in the commentary that it has provoked.
I have been interested in the addiction contracted by people who were prescribed addictive drugs after experiencing a painful recovery from medical procedures. I also have looked at the economic stats reported by economists Ann Case and Angus Deaton and the rising death rates in working age white males. https://www.nytimes.com/2015/11/03/health/death-rates-rising-for-middle-...
Addiction is powerful. I know because I was addicted to tobacco until age 35 and made many, many attempts to break the grip it had on me. I sought professional help to kick the habit. I was successful and I made it to a healthy 80 and wish I had never touched a cigarette.
Tobacco and alcohol were the drugs of my generation but I am aware that the social pressures and availability of new neural altering drugs have created a huge market that attracts entrepreneurs.
Clearly, we need a different policy and medical response to drugs.
10
There are 320 million people in the US. 10 million in Portugal. While 64K deaths sounds large, it is not in context of the population. Note that this writer left out the exact number dying from overdoses in Portugal, gliding over it with an "85%" reduction.
2
According to a Washington post article in 2015, there were 3 overdose deaths for every 1 million Portegeuse citizens or 30 per year which would equate to 960 in the U.S. if we had similar levels. It's interesting to minimize 64,000 annual deaths which is roughly equal to the lives lost in September 11th multiplied by 21...every year.
9
The per capita death rate in the US is 50 times that in Portugal. There is a chart in the article showing this. Did you read some other article?
read the article again. it clearly gives the deaths as a rate per million people between 15 an 64.
6 people in Portugal, 300 in the USA.
1
And we don't use this system because...?
4
For many reasons, but to take one, have you ever heard of something called ALEC? For some reason, we think it's a good idea to have private, for-profit prisons in this country, and the corporations that run these prisons have a vested interest in maintaining the "war on drugs" because it's profitable for them. It's really that simple. Our entire political system is based on putting the well-being of corporations over the well-being of people. Or to be more precise, since our legal system treats corporations AS persons, we privilege corporate persons over human persons. Making certain drugs illegal is also a useful tool for maintaining white supremacy by providing a ready-made justification for locking up large numbers of black and brown people.
1
Too many industries --- not to mention those actually on the take while trumpeting how depraved the addicts are --- find it profitable. Those who manufacture and oversell painkillers, those who run for-profit prisons,and many a police department or agency that benefit from "civil forfeiture" --- that is taking property somehow "connected" to the drug trade before any adjudication of guilt or even complicity --- and keeping it even after exoneration (if that happens).
Because what would we do with all the "war on drugs" infrastructure? The law enforcement economy, the useless legal system and jails? What would we do with all the money saved? Spend on prevention and treatment???? That would be too enlightened! And we would have to free the 1 million black people who were jailed by this race driven system.... read the book The New Jim Crow and weep.... BTW. I am white.....
1
Good article, except for this apples vs oranges comparison.
The Health Ministry spends less than $10 per citizen per year on its successful drug policy. Meanwhile, the U.S. has spent some $10,000 per household (more than $1 trillion) over the decades on a failed drug policy that results in more than 1,000 deaths each week.
4
The War on Drugs since the Nixon Era has been a trillion dollar initiative with very little results to show for it. It was part of a popular mantra for 'tough on crime' politicians to get elected on. It provided a ready made enemy that had black and brown faces and seen strictly as a inner city problem. The subtext was if we only lock them up for life then our national drug crisis would vanish. Then within the last 5 to 10 years the demographics shifted where suburban bedroom communities were getting hit with a new scourge. Cheap high potency heroin to over prescribed opioids that is affecting a largely white clientele. Now that the drug crisis is hitting close to home and these more affluent white communities are clamoring for alternatives other than prison. For an inmate is still a junkie until treated. Yes we need to adopt the best practices in drug treatment combined with education and jobs to truly solve this 21st drug epidemic.
3
Why not do 'test' a city in the states and bring in a program like the safe injection 'Insight' that piloted in Vancouver over 10 years ago? There has never been an overdose where an addict died at Insight, and they are up to 600 injections a day at the facility. The science is in. Oops, forgot the GOP hates science.You can find Insight on Google maps, but that's no big deal, the users know where it is. The unwillingness of the American lawmakers to make changes while sipping on their after-hours whisky is beyond understanding. In some ways we are all addicts to something, but the lack of compassion by the Americans to their own citizens is stunning.
3
Personally, I don't want to pay taxes to incarcerate drug addicts, nor do I want to pay taxes to send them through repeated courses of failed drug treatment--both of which seem to me to be money-making scams. Honestly, what one does with one's body is one's own business, as long as it doesn't involve me or my property. As far as I am concerned, the government can buy the heroin directly from the Afghani drug lords and distribute it to medically-confirmed addicts along with clean needles. That way, the addicts get their heroin free of fentanyl, and they won't be breaking into my house to steal my property to sell and then buy drugs with the proceeds.
16
drug use is something like a fever. the underlying disease that causes the symptom is despair, possibly together with an addictive personality or physiology.
declaring "war" on fever is not going to do anything about infection.
prayer and giving yourself up to a different fantasy is hopeless.
having a meaningful life you can be enthusiastic about would go a long way.
blaming your personal misery on strangers you've never met or a war on coal is less than helpful.
we don't all have to be paragons.
1
A powerful piece of writing, Nick. Too bad it is falling on deaf ears and blind eyes, those of our current legislative majority and executive office, and not just a few of the Democrats, it must be said.
You do good work, kid. Keep it up.
3
One of the significant challenges in the US...is the various states would have different implementation policies. Portugal is a singular state with uniform policies which result in the implementation of a program throughout Portugal.
For those who have traveled thru Portugal...it is so different than the US. With the aspect of "everybody has guns" in America to Portugal where gun violence is nothing near ours. Also, the family structure is much more solidified and centralized..unlike in America where "we" are "spread out" throughout the US.
In closing, combine the out of control gun violence with drug smuggling, violence and crime results in a America which is failing socially.
1
I think that the statement regarding the usage of "targeted messaging to particular groups - prostitutes, Ukrainians, high school dropouts, and so on." needs some further explanation!
1
The truth needs to be told and deseminated about these drugs and substances. Americans have been misinformed since before I was alive. When lies become exposed the liar loses credibilty (sometimes forever). Pot is the easyest and most likely substance to be tried. After the experience turns out to be nothing like what was told, the person may not believe whatever was told him about these other substances. Heroine, cocaine, and methamphetamine are indeed not harmless.
Heroine, cocaine, and meth need to be decriminalized and distributed in dispensaries (like methadone). Decriminalization will put the producing cartels out of business. Decriminalization will also eliminate the gangs that sell these substances. It will eliminate the violence and much of the crime associated with drugs. Decriminalization will greatly clear the courts and prisons. It will also take much of the adversarial relationship from the police and many neighborhoods.
Keeping the current laws and attitude concerning drugs will not improve the situation. We have nothing to lose.
5
I agree completely with your sentiment about changing the legal status of drugs. I mean no disrespect when I interject that most of the benefits you mentioned would actually be more likely from legalization rather than decriminalization. Under legalization, currently illegal drugs would join the ranks of the drugs that are currently legal and regulated like alcohol and nicotine. For those who worry about teenagers using drugs this should be a relief because teenagers currently report it is easier for them to get illegal things like marijuana than it is to get alcohol because of the age restrictions enforced by licensed sellers.Legalization and standardization would also go a very long way toward stopping ovoid overdoses since like any other drug the ingredients and dosage would be strictly enforced. Many overdoses today are the result of people not being able to determine the purity and therefore potency of heroin. Decriminalization would be a huge step forward from our current position because being caught would not bring such ruinous consequences onto people that used illegal drugs but those drugs would remain illegal. They would still have to be obtained by people not legally permitted to sell them. Because they would remain illegal the artificially high prices would not be lowered as they would under legalization. Without legalization it is unlikely to completely eliminate the theft sometimes associated with getting money to buy drugs.
All drugs should be legal, and instead we should focus our efforts on education and treatment. So much of our drug education in schools revolves around what bad effects drugs can have on people's lives, but so little drug education focuses on how and why people start using those drugs. Our programs demonize the user, which is the exact opposite of what they should do. Kids need to know that not only bad people get addicted to drugs, that good people with good intentions and good backgrounds can get in trouble too. Kids are smarter than we give them credit for, it's no wonder they don't respect our condescending and incomplete drug education efforts. Be honest with them about human nature, drug use, and what really happens in the world and you might be surprised at just how much they'll learn.
6
So true. We have been brain washed to consume poisons - drugs, alcohol, prepared and prepackaged food, the very air we breath. We have been told so often that we forget that we really know better.
1
The worst part of drug abuse is the younger lot are mostly affected. And I agree with the writer punishment is not the cure but a part of the problem. I feel most youngsters take up such substances due to some emotional instability and punishing them can make matters worse.
Creating awareness is the way to go. Group activities and most importantly friends have a huge role to play if they want their peers to come out of any such habit.
We hope a better future ahead everywhere - Without any substance abuse.
Regards - Team https://goo.gl/hZVTiU
2
We have a cure problem more than a drug problem. America could and can cure problems when there is a will to do so. The problems we have are of our own making and cures will not be forthcoming because most of us only care about ourselves. The country and people who have the most are the ones who care the least. It is what it is, and it thoroughly debunks religion and christian beliefs. Only when the hypocrisy ends will we return to humane and civilized behavior.
2
This is the problem with all "wars on drugs." They purport to attack the supply, but they do not explain how that lowers demand. Treating drug addiction as a disease actually reduces the demand and helps people. That is the way alcoholism is treated in the US, as a disease. "Drug wars" are just another example of the US giving in to its prejudices. Curbing supply was the basis of prohibition. That amendment was promptly repealed when it was shown to have had a deleterious affect on individuals and on society. Let's repeal the 18th amendment with regard to drugs.
1
You know how NOT to win the war on drugs?
Do NOT decrease unemployment, do NOT decrease poverty, do NOT increase the availability of healthcare, do NOT treat non-violent offenders differently than violent ones, and do NOT allow those who have served their time and recovered back into society.
It's no surprise we're NOT winning the war on drugs. The only question is why certain people keep pursuing strategies that even they know are doomed to fail. They must be after something else other than their stated objectives, and money is usually the culprit.
3
This article is an eye opener for me..Nicholas is the best journalist because he is a dedicated human being. I promise to help spread "the word" to help in the U.S. When first learning about our 'opioid' addiction crises, I found it too difficult to understand it. How/when/who /where this this horror come about? But Nicholas pointed out that the great loss of well-paying jobs for men of limited
education - can be seen as the main cause of this horror - here in the richest
country in the world.! Who controls the money & decisions for our health? I know who..Do you all know who and what have we learned since F.D.R. knew that a mature man needs & wants a job if he is to function as a citizen. People do not want handouts.Where is Justice and where is the Mercy? (retired tchr.)
4
Sadly, America now (with Trump & Republicans running the show) knows everything & everything we do is the best and greatest and smartest way....NOT!
If we paid attention to, observed & studied other countries with successful universal health care for all (lots of western countries & Japan have successful universal health care programs), infrastructure & tech to prevent flooding (the Netherlands is the best example). We are too ignorant & arrogant to follow the example of and learn from other countries. Until Trump & Republicans are out of office & power it will not get better, just worse...crumbling infrastructure, skyrocketing health care & insurance and more and more drug addicts etc. Sad and pathetic. I lay it all in the lamp of Trump & the Republican clowns.
2
Since when has American policy been based on evidence? Guns, health care, education, incarceration, manufacturing, sex ed, business regulations, prostitution, military intervention - the list goes on and on. The vast majority of our policies are based on profit and gut feelings, not evidence.
As long as Americans choose fist pounding and screaming over honest dialogue, I don't see much hope for improvement.
4
And most often the result of racism and sense of moral superiority masquerading as 'Christian' values.
I believe that decriminilation is the only way to go to steer young people away from drugs.
If children see a man visibly drunk stumbling around and making no sense, they tend to not want to emulate that. Take children of alcoholics who are so against drinking because they aren't impressed by what they see all the time. The sight and openness let's them actually see the end result.
Drugs like heroin and cocaine are done behind closed doors.its usually one friend introducing another in private. I don't think you'd get 10 or 30 kids at a party who all decide to try heroin or cocaine at the same time. It looks gross watching someone shoot up or shove powder up their nose and have their personality change.
Then they can say, "No, not everyone is doing this" when they are being peer pressured. And enough with the false equivilancies. Alcohol is they most dangerous drug we have and it's legal.
Notice that black young people aren't dying in droves. They already saw and said "No, thanks." They actually already had this epidemic but it wasn't so touchy-feely as today's epidemic.
Why is that people seem so congenitally incapable of learning the lessons of history? PROHIBITION NEVER WORKS! I never has, it never will. In fact the most destructive drug of all and the most widely used, brings in a fortune in revenue for government coffers all around the world. ALCOHOL. Early last century certain elements of society recognised the inherent dangers of the `drink' and the misery addiction to it, brought, and attempted to ban its use. We all know what that led to. Not that I'm suggesting advertising the virtues of one drug over another as we do with alcohol, thereby promoting its use, as we do with the formerly prohibited and morally dangerous `demon drink', but surely, SURELY some sense could prevail.
Portugal has two things going for it, a burgeoning economy, and NO GUNS. I was under the impression that the US has a burgeoning economy, or perhaps that's not quite how the dispossessed and hopeless see it, and that's why certain areas are not only addicted to illegal opioids, but also to legal ones. How can anyone blame Mexico, they aren't touting for business, they're just supplying a demand, like the bootleggers from Canada did in the `roaring 20s.
The problem is deep in the culture and will need a culture shift away from the Jeff Sessions of this world into the light.
2
Thank you for this rich description of another, better approach to helping drug addicts survive and function developed and implemented in Portugal. I appreciate that you didn't describe "winning a war on drugs", an idiotic proposition that denies both human agency and frailty. I wonder if the U.S. tried this approach, would the incarceration industry collapse?
1
I struggle with how to connect one-on-one with these folks, whom I encounter daily as I walk through downtown Seattle. A couple times, I've seen people who were unsafely walking into the street of oncoming traffic. I yell to get back but they don't respond and luckily cars stop. I want to help, but besides giving money or changing careers, what can I do as I encounter these poor souls?
1
Acknowledge them as human beings. At this point they feel invisible to the rest of the world and this is absolutely soul-crushing. Some of these behaviors may be an attempt to 'force' others to acknowledge their existence.
2
Excellent article that should be required reading. The question is not what works to eliminate drug abuse but what works to make the impact of drug abuse less overwhelming. On this point, Portugal's experience should be seriously considered.
The criminal justice system, from the police to the private prison companies to the prison guard unions, gets too much money from the US war on drugs to let it go without a fight.
Mr Kistof describes two models, "The U.S. cracked down vigorously, spending billions of dollars incarcerating drug users. In contrast, Portugal undertook a monumental experiment: It decriminalized the use of all drugs in 2001, even heroin and cocaine, and unleashed a major public health campaign to tackle addiction." So why is does the headline use the word "war"? Both solutions are about policing, not war making. Labeling a policy "war on terror", "war on poverty" and "war on drugs" may have cachet but is ultimately misleading. Crafting effective policies takes nuance, constancy and balance. War is an existential threat that, in my mind, justifies taking human life that would otherwise be incompatible with my morals. Labelling a policing policy a war will lead even the policy makers to overzealous and draconian solutions that may be inappropriate for our larger society. So let's craft solutions to society's problems and leave war to the professionals.
4
when you you gather up millions of people and toss them in jail for years at a time and more each, destroying their personal and family lives for decades on end its completely appropriate to it War !
1
The way most societies are set up requires some losers and apparently ours requires more than others.
I have no doubt the majority of our citizenry across the economic spectrum understand this inequity, wring their hands and on occasion wipe their eyes before falling on their knees to ask some otherworldly deity for assistance in purchasing their next lottery ticket.
However it may be a pleasure for some to enter a state of mind where a drug induced stupor is better than the one which confronts our present reality. Why else would laws of the sort which deny self inflicted pleasures of any sort find such favor among our enlightened?
Almost as though a certain class planned this centuries ago.
5
Good read. Wish the world would bother to learn from the successes of Portugal.
4
Research has shown that the chances that an addict will find recovery increase dramatically if the family gets into recovery as well. As the parent of two drug addict children, one who has been clean for nearly ten years and the other newly clean, I am both amazed and saddened that so many families choose to live in shame without support. The rooms of Nar Anon should be filled with people who love an addict and come to find support for themselves. When a parent discovers that his or her child is an addict, the parenting game changes. Thank goodness that there was a twelve step program for me where I could learn from others who have known the heartbreak of having addicted children. As someone in these rooms once said, "Addicts rely on others for help to continue to use." I made the very tough decision never to help either of my children remain in active addiction. Addiction is a disease, not a comment on parenting.
1
In what way would a parent be inclined to help their child remain in active addiction?
"As someone in these rooms once said, 'Addicts rely on others for help to continue to use.'"
That "help" includes the insistence that addiction is a disease. I have been in "the rooms" as well, and whenever anyone relapsed, a frequent occurrence, immediately it was "my disease got the better of me" or words along those lines. In short, it gave them an out. Addiction is a set of behaviors; it is not nor has it ever been pathological or biological in nature. When the compulsion is addressed--and in my case, as in the majority of cases, it was set off by some sort of emotional event--an addict can find other ways to cope. Yes, addicts need to be treated, but to compare addiction to diabetes or cancer? Um, NO.
The greatest of all epidemics is still alcoholism and it's a miracle my partner and I survived its' ravages, but death among heroin addicts is so common in the recovery community I belong to I can hardly remember their names. Most were white 20 somethings, a few were black and even fewer were Hispanic, but all of them struggled to stay clean and weren't able to. The difference between a good high and death is a fine line, and the next fix could be their last. Death by alcoholism is usually more gradual.
The addicts who are doing well typically used Suboxone in early recovery to stave off craving, but they eventually weaned off of it because the made a commitment to stay clean embracing a 12-step program, a religion, Smart Recovery--something, almost anything beyond their own limited ability (aka a power greater than themselves), just like we alcoholics. Those who rely on Suboxone to keep themselves clean usually relapse because they never learn the coping skills needed to deal with life on life's terms. They'll take take extra doses to catch a buzz then end up dope sick and they end up using again. Punishment is counterproductive because they stay clean just to stay out of trouble and revert to using when their probation or parole ends.
Portugal's system isn't a cure-all but it's far more effective and cheaper, so lets do what works, Mr. Sessions, rather than going back the unwinnable war.
6
Fifty three years ago, the Surgeon General declared that tobacco causes lung cancer. The human animal, especially the male, likes to ignore reality, when faced with pleasure, social habits, and last but not least, addiction. Alcohol has been know to be addicting since 1819 when a physician termed it Dipsomania. Then, we have had cocaine, meth, pain pills from both prescriptions and oft the street. When there is that much disposable income, even government transfer money, and easy access to all of the above by even children, and teenagers in their own homes or those of their peers, the war is almost a losing one, in that 10% of the population will use. 550,000 died last year because of cigarettes and alcohol, the most deadly killer of Americans by far. The number that died because of pain killers was about 60,000 last year. Basically, when we just admit that we have a highly addicted population, with easy access to all substances, then we will all face be forced to face it within our own families, extended families, co workers, neighbors, community, and society at large.
5
Kristof's article in an important public service tjat can help everyone, including ideologuies of all tpes, understand how to treat individual drug addiction effectively as a public health problem. Kistof should also point out that this approach requires a coordinated community effort that combines state and local controls to support public health efforts. State support funds the people who provide outreach and treatment services, and attacks the drug dealers and illicit markets. Local controls restrict places and occasions where addictive drug use is tolerated, and interdict ilegal dealing; these local efforts include both legal and nomrative (moral) efforts. Portugal is able to coordinate individual treatment with state and local action. In contrast, the US is full of strife and contenton over issues of integrating individual treatment with state and local controls while big pharma in general and foreign producers of heroin and fentanyl continue to flood our communities with addictive drugs. Sadly, our national response is a cyncial, toothless report from the Chiristie-Trump commission and the shameful debacle of Senate Republican efforts to kill Obamacare. Meanwhile, only fervent speeches and pointless "town hall" meetings are heard from state and local officials. This is our US reply to the Portugese. No wonder our drug-related death rate is 50 times higher than Portugal and 10 times higher than the rest of the Western world combined.
Missing in this description is what enabled this Portuguese harm reduction program to be planned,carried out and continued.Transferring it to another country can be seductively misleading.Consider: What would be the necessary conditions enabling US staff to be trained,available and effective?When policy makers can't agree on insuring levels of health and treatment for all will they be barriers or bridges for "the other?"Even as drug users represent a diverse group – types drugs used, manner, patterns, physical, psychological and social health,internal and external resources, meanings and functions of both use and the “drug experience."Copy what into our diverse, daily, violating,stigmatizing WE-THEY state, and national, US culture?Harm reduction is a label.As is the War on Drugs,which focuses, UNWINNINGLY, on selected drugs, stigmatized people and their behaviors.We have yet to adequately understand the complexities of the choice to begin to use.Or not.Continue to use and make a range of use/non-drug use changes.To seek and be engaged in a relevant, indicated treatment.Cease use.Create a different way of life;if possible.WE need to enable “good enough”- however delineated. WE need to keep people alive at levels and qualities of well being.Misleading-Mantras,seductively addicting,are not menschlich.Inadvertently promote harm.Wars are not won.They are begun and are ended."Collateral damage" is not just a word.When it is YOU.Someone you love.Care about. Are responsible for.
20
The Portuguese works because, among other reasons, we have a pretty good public health care system. I doubt it would work without it.
4
The War on Drugs is theater. Our government will never decriminalize drugs because drugs as crime generates rivers of cash. Cash that funds black ops and covert ops and hyper-classified ops (See book American War Machine).
No coincidence that after many years of war in Vietnam, Vietnam was the biggest producer of opium in the world. Flash forward a few decades to today: after sixteen years and counting of war in Afghanistan, Afghanistan is now the biggest producer of opium in the world. Is this the natural order of things? A mere coincidence? No.
Prescription drugs also mean big business, big money. No matter that they be opioids that devastate people. Business is business.
Incarceration is also a private industry hugely profitable here in the USA. Yes, it is cheaper to treat people than to jail them, but prisons generate dependable profits so we build more of them than we build schools or hospitals.
American societal values are now infested with the deep worship of money, riches, domination, luxury, might, and empire. This admixture of bad ingredients is then soaked in hubris.
Putting money capital before human capital ends up dumbing people down, regressing society -- any society -- to primitive violence.
oz.
187
I agree with oz. There is too much money to be made with the American model of war against drugs. If the government were really smart, it would tax the sale of drugs, erasing the national debt. Of course, even that is an issue to be explored.
Corruption both inside governments and in the drug marketers will prevent any solution.
2
Oz- excellent!
The Incarceration Industry is hugely, rather Bigly, profitable.
One of the aspects rarely discussed are all the "Consultants", typically ex-cops, hired by PD's to teach their cops how to better profile, albeit still poorly, and make specious arrests stick. How to make a simple traffic stops turn into an arrest..so to fill a for-profit prison, with guaranteed bed/cell counts.
No one seems to pay attention to why most of the recent killings made by cops always revolve around what PD's call "simple traffic stops." Where the cop seems to be eager, and ready for an escalation. Why? Could it be because they are being taught, by consultants, to escalate the event? And as such enter into them already pumped-up, expecting an outcome, with their fingers already poised near their holsters...?
2
I equate the war on drugs with supply side economics. The government is in a losing position of trying to control supply instead of working on the demand.
Bravo to Portugal.
96
Doug k-- but it is the "oversupply" provided by the Mexican cartels that keeps heroin affordable and less expensive than even a six pack of beer. Snortable free samples of heroin are passed around at parties to addict new clients who quickly lose any aversion to the needle. You all need to get out into the real world. FACT: The cheap oversupply of heroin creates its own "demand" in America.
1
Articles like this completely miss the point. The reason we have a War on Drugs is not to end drugs nor even drug addiction. It's to punish those who resort to drugs to feel good.
Under Old Testament religion, someone who takes a substance (any substance) to feel better than what God wants him to feel is committing the sin of hedonism and must be punished. Under this system of belief, it's extremely important to punish the offenders to avoid God's wrath for not doing anything.
Saving the person's life is irrelevant. Saving as many lives as die in car accidents does not sweeten the deal. Those lives should not be saved. On the contrary, they should be made as miserable as possible. Only then is God satisfied that his good children are walking the straight and narrow.
Now, this is not MY belief, so stop looking at me that way. I'm telling you what Drug Warriors really feel.
6
The follow up on the starkly different policies is interesting, but can we not all see at the outset that a policy of using physical force and incarceration to stop people who choose to chemically alter the way they experience their own lives is immoral and doomed to failure?
2
As I was reading this op-ed I couldn’t help but think about how I would feel if my community adopted a drug policy such as Portugal. Do I want zombie-like people shooting up heroin on my doorsteps? Would it be nice to see them all following a van around, with the hopes for free needles so they could continue their habit? How would I feel walking to work and seeing a crack cocaine sale happening at the corner?
The analogy of a drug addicted user to a diabetic was absolutely pathetic. I wonder how type 1 diabetics would respond to such a comparison. Drug users chose to begin such a life. Type 1 diabetics didn’t choose to have to inject insulin everyday and monitor their sugar levels.
3
That's nice you are protected from everything ugly in the world wherever it is that you live. Current laws in place, regarding hard drugs I regularly encounter people openly shooting up heroin in my neighborhood AND selling crack, and sometimes defecating next to the dumpster behind my apartment building. If people like this had clean needles and a place to use the bathroom, maybe there wouldn't be a rampant hepatitis A epidemic in San Diego.
We Americans are too into punishing "deviant" social behavior to ever use the rational, sensible, science-based Portuguese model of drug treatment. Just to call it a "war" on drugs is the tell for our hold card.
1
Until you reduce the social failures which steer people into drug abuse in the US nothing will change. It is the feelings of worthlessness which drive drug abuse not moral weakness.
3
The problem, I feel, is that with American self-determination there is a large portion of the population that would prefer letting addicts die than pay for treatment.
4
the war on drugs started in the 70's has cost us billions, caused corruption in our police departments and all other branches of government. i suspect a lot of money funneled to our politicians come from the profits made by the illegal drug industry. in my opinion, the corruption is much worse than the damages caused by the users. legalize all of it. i do not come to this view easily as i have heard many stories by users and those in the illegal drug business.
if drugs are so bad to our society, then the only way to stop it is to prosecute users and put them ALL in jail(or worse) for long periods of time. i doubt that our politicians want this because they might lose quite a few of their own kids.
1
Anyone addicted to Heroin and/or Opioid pills should be able to receive Vivitrol shots, Methadone or Suboxone free of charge (& Suboxone should be available widely in clinics like Methadone is) free of charge. Anyone who is addicted and leaving a detox, rehab or jail/ prison, should be given a shot of Vivitrol (it is an Opioid blocker that last 1 month) when they are discharged as well as a referral for treatment. People who have stopped using for a short time are at their highest danger level for overdose.
Citizens need to learn how to administer Narcon/ Naloxone. They can learn widely available community classes. It's easy - just spray in both nostrils and always call 911. Fentanyl is at least 50 X's more lethal than heroin and is being mixed with heroin and even COCAINE. Often a person who has overdosed will need IV Narcon, but you can at least keep him or her alive long enough for an EMT/ Paramedic to arrive.
And let's all fight against these lousy insurance bills that the Republicans keep trying to ram down our throats (thank you McCain - you are more of a hero than you will ever know). I am a Social Worker in the trenches so to speak and our clients are receiving treatment and Addiction medication because they have Medicaid.
Thank you for your interest and this article. The number of people dying is horrific!
3
The hard scientific facts are that behavior is a function of consequences and there are four and only four: 1) positive reinforcement, 2) negative reinforcement, 3) positive punishment and 4) negative punishment. The U.S. approach, to the extent that is is rooted in positive punishment (incarceration) at least makes sense from a scientific (behavioral) perspective. Mr. Kristoff's prose leave the underlying mechanism for what he characterizes as Portugal's "success" unfocused, unclear and speculative.
I am a pragmatist. If Portugal's approach actually works, and by "works" I mean that it gets people OFF of drugs, then let's do it.
But let's not labor under the illusion that drug users, although addicted "victims", are engaging in a "non-violent" crime.
Across the world, the cartels that produce and transport heroin and similar drugs engage in some of the worst, most horrific crimes imaginable, vicious rapes, murders... They also corrupt entire political and police structures, basically forcing whole countries like Colombia into lives of poverty.
And it is the drug users who FINANCE this war on humanity.
Every dollar spent by a "non-violent victim" of drug addiction is going towards the purchase of arms and ammunition, and towards the paying of bribes. The "victims" who purchase drugs are financing the entire system. I call that a violent crime. To consider it less is to live with an illusion.
So, yes, whatever it takes to get these people off of drugs, so that they stop the financing of this horrendous violence and corruption.
1
Really? No comments on the fact that until whites began dying in droves from fentanyl and the potent opioids this was not a topic for serious political discussion in the US.? This goes to the heart of why we've always been so punitive towards addicts - because some were black or brown and poor, so we didn't care, we wrote them all off. Indeed, many L&O politicians once proclaimed - these folks deserve prison and if they die by overdose - so what. You won't hear that very much now - rather many politicians are calling for more naloxone, the rescue medication (btw naloxone has been around a very long time). So - what changed? Well drug companies became street dealers by hawking their latest prescription opioids as "less addicting" and now we've got middle class white teenagers and adults hooked and dying of overdoses. Now it's important! Can this country follow the Portuguese model? Maybe - if we finally view this as the society-wide problem it has always been and not just a problem for "those people".
As a Portuguese, I have to say that the difference this change in policy has made is huge.
For some time in the 90's there wasn't a day that I did not hear that someone I knew or someone's home had been robbed, that someone had died of overdose, that the drugs AIDS-related cases had increased and the fear of being in danger when you were walking late at night on the street was always present.
I am glad that this policy was implemented. It was not easy to do, there was from certain sectors of society a sense that we were giving a free pass to drug trafficking.
I think that this was possible because it is not only decriminalizing, many, many institutions other than the police and judicial system had to be involved. The needle exchange programs to help combat the new AIDS cases, the methadone program, treating people like humans with a disease, with problems, that they need help more than they need to be punished was the real shift.
Have we ended the drug problem? No, but we sure do not have the huge crisis we had then.
I actually have thought many times that this would not work in the U.S., at least in the way it was implemented in Portugal. We have a different health system, we do not have prisons that are for profit, we do not have the gun and violent crime issue that you have. We don't mind paying taxes so everyone has access to the National Health System when needed and it was needed in a big way.
38
Decriminalization is not enough. Opioids, heroin, fentanyl, should be freely available at health clinics. This would prevent the needles left on the streets and crime is still related to distribution of drugs. Most of all it would allow a health professional to titrate the amount of drug a user is getting, particularly after a period of sobriety. This is the deadliest time for an addict. Addiction is a health issue. Prohibition has been proved not to work, whether it be the number one drug killer in the United Stayes, which is NOT opioids but rather, alchohol - or if it is opiods.
Also, one part of this story that is not written about is that there are large numbers of "functional heroin, opioids or alcholic users". They perform surgeries each day, run companies, trade stocks, are award winning, hard-working musicians, actors, etc. Addiction does not discriminate. Many of these high functioning addicts only die when they have gotten sober for a short period, or a long period and then relapse. Everyone with a health problem deserves care. We must treat all addiction, whether it be the number 1kler, alchohol, or other drugs such as heroin and fentanyl as a health problem and provide medication, which for a user not wanting sobriety, is delivering them the drug in a safe way, clean drugs, titrated for the users history. Counseling and attempts to rehabilitate should of course be offered but not required. If you die, you can't ever get sober. Everyone deserves that chance.
9
This is the sort of articles why I was willing to pay the $140 fee to the NYT, liberal ideas that badly need be implemented to solve big problems.
The problem Mr Kristof is that the US is not about solving problems. Bloggers here have pointed out different reasons why the US is the opposite of Portugal:
-Focus only in profit, the massive incarceration complex, lawyers lobbies and many more, government being actually the worst, just look at Sessions fighting for his right to legally steal from incarcerated people. Doesn't he resemble North Korea's dictator? If you notice the stark resemble then you'll forget about solutions.
-Deeply Christian & conservative culture, never focused on solutions, only on punishment & revenge. They think making them legal and presented in legal terms make them right. Again, just look at Sessions. The Christian theory actually has a strong emphasis on forgiveness & redemption, but in practice Christians think those benefits only apply to they themselves.
-More reasons? Sure there are.
So therefore, none of what this article says actually targets the epidemic drug use problem, unfortunately so and as much as Kristof seems focused on the issue. The problem is the culture where all these drug users live. How did Portugal and the other Mediterranean nations became the way they are may be out of our reach...or maybe not in liberal states who need to work twice as hard copying these European approach.
6
This makes perfect sense, and many people have been advocating a Portugal approach in the US for years. Clearly, what we are doing isn't working. After 50 years of the "War on Drugs", it's a failure. Every measurable outcome is worse.
Billions spent with more drug users, more deaths, more violence, more in prison, increased health care costs, destruction of neighborhoods, and tragedies for families. A few bold state legislators have been working for proven strategies, such as Supervised Consumption Facilities, and hopefully those ideas will gain traction soon. The key is to focus on public health and harm reduction.
2
The War on Drugs has certainly not been a failure. It has actually been a resounding success. If you don't think so, ask yourself, how many lives have been destroyed by long prison sentences? It must be at least in the hundreds of thousands, right? Well, that's not a failure.
And how many black people in particular have started their lives within the prison system thanks to drugs? A whole lot, right? Again, that's not failure. That's accomplishing the goal.
I appreciate your sarcasm, and you are correct. The goal of the Nixon-initiated War on Drugs was revealed by John Erlichman in a 1994 interview, later published in Harper's Magazine. It was a way to target "the antiwar left and black people." https://harpers.org/archive/2016/04/legalize-it-all/
It seems unlikely the US would take on a program resembling Portugal's. It would mean fewer black people in prisons and how would that serve the corporations and prison industry? Their job is to get as many incarcerated as possible and improve profits for their shareholders. Not to mention the lack of medical services for those with addictions - it's a fantasy in this country.
6
I contend that the root of all drug use evil is boredom.
2
Drug addiction will always be with us. It always has been and always will be. Even elephants like to get drunk. So why are some drugs illegal in the first place? Why not make them legal and sell them in drug stores as they used to be? Why are some drugs treated differently than others? Why do we pretend that some are worse than others? Why are heroin and cocaine both useful drugs treated differently than opiods which are also useful drugs all of which can be deadly if improperly used? And why in heavens name is marijuana illegal when no one has ever died of an overdoes of pot? Why is alcohol legal when so many people ruin their lives and die by addiction to alcohol? Why do we play these games?
Portugal didn't go far enough. They should have just legalized it. Many who just want to be daring wouldn't have drugs to be daring with because you can buy them in the drug store. It takes the mystery out of them. People who need to self medicate can do so by going to the corner store. No more back alleys and dirty needles. Prices could be kept low so that crime goes down. Drug quality can be kept in check. And store personnel and cameras in stores can help health workers in identifying those that will need help.
The whole idea that it is okay to ruin your life with alcohol or opioids and not heroine or cocaine is ridiculous. That government gets to choose which ones you can kill yourself with or not.
And don't get me started on sugar.
237
In fact they wanted to go further at the time. It was the international pressure, that Nicholas alludes to in his article, that made them rethink the more ambitious drug policy proposals put forward by the health ministry. I still remember the whole controversy at the time.
2
I get your point and agree on marijuana. But even though alcohol causes huge amounts of misery and destruction, it's not as addictive as heroin or meth. You can drink alcohol several times a week and you won't get physically addicted. (Yes, I know 10% or so of the population get mentally very addicted and ruin their and others' lives). But most of us can enjoy alcohol weekly without any issues. Nobody can do that with meth or heroin.
4
As so often in these columns, there is so much good sense. How come it never reaches those with the power to implement it? Are our politicians the lowest possible denominator on the IQ scale? Is that so that they appeal to the lowest levels of the population and disdain everyone else because that's enough to get them into power? Or are there more sinister things at work? Like the proliferation of prescription opioids that are manufactured and marketed by some of the richest corporations in the country, and you never know quite where some of that might be going?
2
As an addiction counselor in this area we talk all the time how media likes to attach the dramatic images of people in the act of using with their needles and torches. While the content of articles and videos are can be informative I don't want to share them if they include images of an addict placing a needle in her arm, snorting or smoking crack. These are called triggers. If I presented such documentaries or articles to my clients I know several would be gone by the end of the day. They're also clichés. How many images of a spoon, a needle and some powder have we seen in over the decades? As in everything else we're doing we have to be more creative and thoughtful.
7
The fact that the approach to drug use in Portugual is rational and sensible is exactly why the US won't adopt it on a national level. Policy in this country is set based on emotions, mainly fear and anger, not facts. Politicians have to listen to their constituents, most of whom want drug users punished and locked up. Some of the more liberal states have taken a step in the right direction, but on a federal level, unless the republicans are swept out of office en masse, it will be more of the same failed policies.
10
I first heard of the Portuguese approach to dealing with addiction while watching an interview with Johann Hari (author of 'Chasing the Scream: The First and Last Days of the War on Drugs'). The interview was quite compelling and the information was so unexpected--and hopeful! I highly recommend it to everyone.
http://tvo.org/video/programs/the-agenda-with-steve-paikin/johann-hari-e...
America: so many ways to die! Guns, drugs, gangs, poverty, poor health care, traffic, suicide, toxins, stress....
When do we promote the general welfare?
12
The Drug War was never about helping people with addiction. Instead, it was about militarizing the police and imprisoning users.
Inflicting suffering remains the primary goal of the Drug War, as led by our current Confederate AG. He wants to continue the unfettered racial discrimination and abuse of justice the so-called Drug War was designed to accomplish. Jim Crow redux.
Unfortunately, the Drug War goals as defined by DOJ and confederate states are aimed at keeping the prison industrial complex fat and happy while targeting citizens based on their race.
The Drug War is not about saving people from drugs.
20
There are massive job and money-making opportunities in the War on Drugs that I despair of it ending. Dealers, Prisons and their employees, government and especially private--a true evil-judges, prosecutors and defenders and large support staffs of all aspects of the legal angle; the spiraling addiction industry, another fraud insofar as they are 12 step based, sober houses (real estate), the parole and probation apparatus, police, construction (prisons and "walls"), Border Patrol/ICE, the administration of same, military (fighting the drug war in Honduras, Spec Ops/DEA murder civilians with their quick triggers), bogus foundations administering to countries unraveled by US drug enforcement, really, all phases of society have their grift off the dispiriting drug war--it'll never end.
1
Excellent article, but Kristof suggests that "dealers" and "users" are a separate population, when research has shown for decades that they are almost always interchangeable. Many heroin addicts earn around 50% of their income off sales to friends and acquaintances.
The war on drugs promoted by the US has been applied in Brazil too without success. As we fail to copy the good examples that make north america a great place to live our population continues to see drug users as dangerous people that should remain locked up somewhere far way from society. Now, as we drive ourselves to a more conservative society we forget the great benefits we achieved fighting tabacoo as a health issue. Meanwhile, people can't walk freely in Rio and we top Syria war in people killed every year.
2
Why do millions of Americans drink to excess? Why do millions of us swallow, inhale, inject addictive substances? Can we not see how sick our culture and society are that many millions want to escape the pain it inflicts on many of us everyday? We can't even get the basics rights for ten of millions: decent enough education, healthcare, and employment that allow everyone to put food on the table and a roof over their heads, and in doing so, provides a measure of dignity and self-worth. Addicts are not the problem; it is our culture that is killing us.
19
if drugs in addition to alcohol and caffeine were to be legally provided by the govt, then wouldn't much of the illegal drug biz disappear? There would be no demand. if users were to use other drugs that are less lethal than heroin, cocaine, meth, crack, etc. and still not experience withdrawal and get the drugs for a reasonable price or free, maybe they could be induced to come in from the cold? Then perhaps they could be encouraged to consider alternatives to using drugs. Assisted with life style changes, deal with problems, etc. Just think of the hundreds of billions that have been put down a rat hole for the past 25 years or so? Have we won the drug war? Will we win it? Has any progress been made? Anyone really think Trumpie's wall will slow down the drug biz? Does putting people in prison slow down drug use?
5
Some in the US like to torture and punish people rather than help them. If you break the law they want to scare you into abiding their ways. The most brutal are now in charge, sad.
11
I don't expect rabid prohibitionists, the fire and brimstone moralists who demand pounds of flesh for being disobeyed to change their ways. They must be removed.
The history of prohibition shows that sober minds warned of the crime, the cartels, murders, overdose deaths and ruined lives if drugs were to be declared illegal. Even the medical benefits of marijuana were swept under the "Reefer Madness" lies of their deceit.
The outrageous billions of dollars wasted each year, placating the prohibitionist's addiction to punish could have been used for education, health care, infrastructure, building schools instead of prisons.
The loss of many artists; Morrison, Joplin, Hendrix, etc. could have been avoided if these innocent victims of prohibitionists only knew what was in the powder.
Try buying your diabetes medicine from someone in an alley.
7
The war on drugs has been a disaster of turning people who are otherwise innocent into criminals, turning law enforcement into corrupt forces and allowing violations of the Constitution to be a norm. It should be ended and done away with. That said how did doing away with the war on alcohol and treating alcoholism as a disease do for drinkers?
9
No ones dies from improperly made bathtub gin anymore I suppose.
1
Use of narcotics is either (a) a self-chosen or (b) forced poisoning of the body and mind.
The drug-fighting agencies do not seem to distinguish between these two modes of addiction. Neither the touchy-feely, goody-goody, coochiemoochie approach, nor the criminal penalties will cure the problem. Forced, medically-supported rehabilitation would seem to be the only realistic step.
Who says the US war on drugs is a failure? It's a SPECTACULAR SUCCESS! From the beginning it was designed as a win-win program for the police and the 'justice' system. More police, more prosecutors, more jails, more judges, bigger salaries for them all,,,, etc. And police now get to expropriate cars and homes of not only drug users, but their families - without due process. Anything that moves us closer to a police state is welcomed by both the police and the political right.
15
The definition of addiction is using a substance or activity to manage one's feelings. Drugs and alcohol are undoubtedly devastating the country and both are physically addicting as well. None of the other commonly occurring addictions involve dealers or the prison system: e.,g, gambling, shopping, overeating, even sexual addiction so they are usually omitted from the discussion of addiction. On an individual level, they can be as damaging. The emotional/mental side of addiction needs primary treatment.
3
A program such as Portugal's would require expanding our non-existent public health system and social and psychological services. Congress prefers spending money on incarceration and a "just say no" campaign. Such a program will never see the light of day under the current moralistic punishment orientation of Congress. Maybe we should just put dealers and users in stocks in public squares and give them water once a day. Our puritanical system will never forgive them.
3
The article does not mention suboxone (buprenorphine and naloxone) which is an effective treatment for heroin addiction. I've heard it can be quite effective not in curing the addiction but for allowing an addict to feel normal and to resume the activities of a normal life.
1
I am a Portuguese citizen living here in the US...
The ONLY problem that I have with this article is that it does not bring up ONE very important issue -
Portugal has 12MM people and is about the size of Indiana.
The United States has 325MM and is obviously 30-40x bigger (estimate.)
How do you institute this kind of idea or policy in a country of this size, with double, maybe even triple the amount of addicted people?
I am highly proud of Portugal and their model, and feel that it can be successful on many levels in different countries. But the US is a totally different animal and I would be curious to know what the starting point would be for such a massive undertaking.
For all the people struggling with addiction or to those who have lost people to this issue, I feel for you and wish you the best.
Wouldn't it be cheaper to fly all of our addicts to Portugal for addiction treatment? I'm serious about this! For every U.S. addict Portugal takes- we will allow 2 of of their University graduates a work Visa and/or a green card. Portugal has over 10% unemployment- I'm sure many would jump at the chance. Sometimes a drastic change of environment is just what the addict needs to recover anyway- send all of them to Portugal!
There is no doubt that the US policy has not worked in recent years. It's also hardly effective public policy to draw false comparisons between the US and other cultures to simply make a policy or political point. Americans are 4x more likely to use cocaine next to next closest countries (New Zealand). To illustrate further, compare US drug use and Japan. Japan drug use is minuscule - just 1.2% of Japanese claim to have tried marijuana vs 52% of Americans over age 18. Japanese have zero tolerance drug policies and send people to jail for the smallest possession. Their addiction rate, drug use rate and crime rate is a tiny fraction of the US. BTW - their murder rate for the ENTIRE country is <1000 per year - total population in Japan is 127M. Chicago had 762 murders. The point is that you can find perfectly good examples of policies that work. It's a question of the culture of the US and what will work here.
3
Alcohol is a much stronger drug than many that are illegal and is an integral part of Japanese business culture.
1
Lots that's great in this article, but when comparing numbers, PLEASE compare apples to apples. "The Health Ministry spends less than $10 per citizen per year on its successful drug policy. Meanwhile, the U.S. has spent some $10,000 per household (more than $1 trillion) over the decades on a failed drug policy that results in more than 1,000 deaths each week." Classic statistical obfuscation-- on one side, spending is divided by citizens and given per year, on the other, aggregated by households and by an unspecified # of decades: how many? 3? 7? The result looks like Portugal spends a tiny fraction of what we do: $10 vs. $10,000! But divide by (say) 4 decades and an average household size of 2.58, and the apples-to-apples comparison is just under $100 per person per year-- still an impressive contrast to less than $10! Why not say that, instead of fudging the numbers with statistical sleaze?
5
Demand for illegal drugs NOT supply is the crux of the USA drug problem. Articles like this are published every few years, yet as, noted the USA continues to add to the trillions spent on IN-effective one-sided criminalization programs.
The solution is not either or, but a managed mix....talk to anyone who is successfully in the rehab process. Some found religion, some counseling, some AA, some cold-turkey. Some may have had run-ins with the police, but based on the opiate epidemic the police certainly were/are not a solution for most. Nor are the police a deterrent for kids who say yes OR no to drugs. Talk to our frustrated officers who remember why they became officers. For an understanding of those whose brains and ability to negotiate life have already been destroyed by drugs, talk to those contemplating suicide.
Like many other USA problems, the solution is not just another pill or bullet or rant. And like many other problems, politicians will continue to rant at each other rather than demand a cost-effective long-term solution. The reasons are buried in the money trail between the legal & illegal sides of our drug epidemic. Both may continue to fund not finding a real solution to our epidemic.
Let's see more articles about what is working with a candidate platform that defines effective solutions. And let’s vote for representatives who can clearly define a well-managed solution...not the one who can rant the loudest.
We have about two years for another chance.
1
What if we went even a step farther? Offer a 99-year patent on recreational drugs that were not abusable. These drugs would behave in the normal way, but when the dose got a bit to high, the result would be a buzz kill, therefore no incentive to overdose.
The taxes on these legal drugs could be used to treat those unable to avoid illegal drugs.
States that have legalized weed have seen a reduction in people that are hooked on prescription pills. If the pharmaceutical companies were allowed in to the marijuana business somehow I think with the money to be made then suddenly the politicians will see the light on legalization. As long as everyone gets paid.
6
Decades ago, then-Baltimore Mayor Kurt Schmoke proposed treating drug addiction as a medical, not legal, problem. He was widely pilloried for it, most ardently by New York Congressman Charles Rangel. Think of all the money and lives that would have been saved if we had listened to Schmoke, all the people who would have been weaned from drugs by the medical/treatment community, all the kids who would not have seen drug dealers as the richest people in their lives and followed in their footsteps. Ignoring Schmoke's suggestion gave us a great television show, "The Wire," but only because of the heartbreak and tragedy that resulted from our continuing down the path of criminalizing drug addiction. Indeed, one season of "The Wire" showed the good that came about from an ad hoc legalization scheme, and the inevitable condemnation that followed. When will we ever learn?
3
A socialist President, decriminalization of drug use, tight handgun control, and tight restriction on prescription opiates...shall we compare these factors to those of the U.S. which is controlled by a brutal and largely unfettered free market, the lobbying prowess of the NRA and the privatization of the prison system?
3
We know that punishment doesn't work. B.F. Skinner made this clear (as well as Jesus and many religious leaders), and any parent will tell you that support, patience, training, etc. is how you change people, not punishment. It works with gangs, terrorists, and violent people as well as those who are addicted.
Do you want to change someone? Then support them. Hold them personally responsible for their behavior, then help them.
We need prisons for violent repeat offenders in order to keep us safe, but when in prison, and especially before it gets that far we need to help them. The United States embraces punishment and derides rehabilitation. If we redirected just half of that $10,000 per household cost, we too would see dramatic results.
A prison chaplain told me once that he has almost never met an incarcerated person who did not come from a broken home or terrible childhood. If we spent more on social safety nets we would spend less on prisons and help good people succeed in life.
3
Why look to Portugal for a solution to the war on drugs?
America treats white drug addiction as a sympathetic humble humane empathetic potential health abuse problem akin to alcohol and tobacco.
America treats black drug addiction as an inherent morally degenerate corrupt criminal justice prosecution conviction and imprisonment issue.
The major American drug makers and dealers are pharmaceutical companies, hospitals and doctors whose business is legal. While the Mexican Central American "drug problem" is based upon an American hunger for drugs, an American gun fetish and an American love of money that is deemed illegal.
1
A "War" on ANYTHING is destined for failure.
Pitting one against another is destructive.
Wars do not engender compassion and empathy.
Never forget:
The "War On Drugs" was really a war on black and brown people.
1
Paul*** How do explain Police waiting outside Grateful Dead concerts to bust people. Or more recently hanging around and going under cover at the raves, predominately white people, where ecstasy was and is the drug they are looking for.
Orange, NJ
1
We might wonder why, after years and years of failing to reduce drug use or supply, the United States keeps up its Quixotic War On Drugs. If something keeps failing to work, why keep doing it? Well the answer is that it's working just as intended. The goal of the campaign is not to stop drugs, but to control undesirable groups of people. A casual look at the demographics of our prison system makes it very clear. Drug use rates are roughly equal between racial groups, yet blacks and hispanics are arresting and convicted vastly more often. THAT is what the purpose of this war is, and you only have to look at the results to know that is the objective.
3
The sentence about 'over prescribing' opioids can't help but scare me as the caregiver for an intractable pain patient. She was lucky in that her pain condition developed when MD's realized that 'cancer pain' is not different than other intense pain like RSD/CRPS, Fibromyalgia and other rare intractable pain conditions. Somehow it is easier to get drugs as a scammer than as a legitimate pain patient. If my friend was forced to not use the powerful narcotics that allow her a normal life she would likely kill herself. No one can endure pain ( rated more intense than childbirth on McGill pain scale). If we 'crack down' om non cancer prescriptions for pain meds we must rehabilitate Dr Kevorkian. I do not want to hear some preachy words of 'she doesn't need it' other modalities work. No one gets strong narcotics without step therapy in which other modalities are treid first. Suicide is a major cause of death with chronic pain patients. Look up Dennis Pragers excellent article in Jan 2017 National Review. There are tow sides to this. What I wonder is why do so many overdose now? We had had heroin epidemics before such as early 70's or the early 90's. Not nearly as many people died. Is it all Fentanyl? People have been using morphine and the like for over 150 years. Only now is the death toll so high. Why?
3
My mother God Bless Her was a heavy drinker. So was my father. I have a family member addicted to drugs for 15 years, now opoids, that has stifled his ability to set any goals or mature emotionally or psychologically. This drug tragedy in America is like the raging fires in the West, and this opoid addiction is like the horror of climate change, or rather brain change, that will forever burn through and destroy lives, family incomes, and the economic and social stability of our communities. Something different has to be done. I hope some state, maybe Oregon will be brave enough to legalize the drugs with the same policy as in Portugal. Once you have this disease it will never go away. It is incurable but treatable.
2
Because we are not about helping people in this country. We are 100% about profits and free/cheap labor just happens to be easier to attain when you can lock people up for decades for a non-violent offence while at the same time provide them ZERO treatment.
4
Beyond decriminalizing drugs, which is obvious, we need to ask ourselves some questions...
What effect are we seeking from heroin?
It makes you feel invulnerable.
Why does someone need to feel invulnerable so badly?
Because they are deeply hurt and afraid.
Why are we so scared and hurt?
Without a solution to this question we are applying a bandaid.
This is slightly off point but what type of health care system do they have in Portugal? Tax payer funded? Universal Care? Private Public combination?
Orange, NJ
3
Our National Healthcare System provides Universal Care for all.
We also have Private Healthcare for those who choose to have Private Insurance, a lot of employers provide these at no cost to their employees as a benefit.
The best doctors and the best care is provided by our National Heathcare System <SNS>, most people use the private docs and hospitals for quick elective stuff, or quick emergency room visit for something minor, if you are really sick, have cancer, chronic illness...the best care and best docs are in the SNS....no one goes bankrupt and no one has the need skip their required medication because they cannot afford it!!!!
Most important their is wide and frequent access to preventive medicine!
1
There you go ... Thank you Anna
1
Keeping drugs illegal is a jobs program. It helps keep many tens of thousands employed. Also, keeping drugs illegal makes drugs more profitable. As always, follow the money.
6
Left wing California ignores federal law on marijuana, and ignores federal law on Sanctuary cities. Suggest California ignore federal law here and take a treatment approach. It can start by removing all penalties for drug use. If it really wanted to do an interesting experiment, it could draw a line across the state that goes across the state from the Nevada border through Fresno to the ocean. South of that line, the laws would stay the same. North of that line, we would try the new system. Then it can compare outcomes per capita. if California is not willing to do this, then maybe another left-wing blue state could.
1
As someone who has never even tried anything more than pot, I have been a long time proponent of de-criminalazation of all drugs. That said, It will NEVER happen in this country.
Illegal Drugs are a HUGE jobs program for law enforcement,justice, and prison system. It also is easy to enforce and apply pressure on minorities over whites thru police and prosecutorial discretion. Illegal drugs are also integral for the continuation of the schools to prison pipeline.
4
With “good people don’t smoke marijuana” Jeff in charge, we can count on few positive changes in the manner in which the federal government deals with this tsunami. There was the hopeful statement by the White House on the opioid crisis, but that was just one piece of a much, much larger solution. A new, comprehensive, humanistic national policy and programming to match? We might as well be waiting for Godot.
2
Seems like the Portuguese have a more sensible way of dealing with drug addiction. And, it makes sense. Human's are easily addicted and locking them up does not work. It seems past time to do something different but don't count on us to be smart enough to change our approach. We, the morally exceptual country, don't come to grips with our failings very well.
2
Criminalizing drug addicts turns people who have an addiction problem into criminals. And not only in the obvious way.
If they go to jail, they're put into contact with criminals and learn to be criminals.
If they're forced to steal to buy drugs that are super-expensive because they're illegal, they become criminals.
If they're treated as criminals, it erodes their self-respect and makes them more likely to act like criminals.
If they have a criminals record, it's harder to find non-criminal work to do.
Our system in the USA is abusive to people who are already struggling with addiction.
3
Brilliant contrast between our failed, depraved effort to curb drug usage, and the humanitarian approach of a society bent on helping their citizens ward off this monstrous disease of drug addiction. The more I consider and compare the deconstructive approach US policy has towards these contentious issues of our times, it becomes clear that it is the lucrative means behind a system of prison builders, police, and defense attorneys that motivates. Greed always before the well being of our fellow man. Simply draconian and despicable.
2
In his last film Michael Moore told the story of "stealing" the good ideas of the rest of the world to take back to the US. He featured Portugal & its sensible approach to ending drug use.. If we could EVAH stop our indefensible lie that we are "exceptional," mebbe the US could indeed become a global leader; instead, we build bulging prisons and transform our police into murderers.
1
The war on drugs is a profit making monster for the prison cartels, law enforcement, and the drug lords. Of course drugs should be legalized, but keep in mind there are people who are not buying what the NYTimes is pushing.
They like being stoned and will stay that way. They are not looking for a job or an eduction or shelter. They are looking for more drugs. Leave them alone and offer opportunity. Outcome you cannot guarantee.
"The lesson that Portugal offers the world is that while we can’t eradicate heroin, it’s possible to save the lives of drug users — if we’re willing to treat them not as criminals but as sick, suffering human beings who need helping hands, not handcuffs."
A lesson lost on our Republican party and its coalition of religious zealots, pseudo-libertarians, wealthy gamblers, gun-nuts, and Jeff Sessions' private prison investors.
2
Many countries have found at least partial solutions to the problems that plague the developed world: quality public education, free college, reducing rates of incarceration and recidivism, deaths due to opioid use, affordable housing, affordable health care, reducing homelessness and child poverty, income inequality, class mobility, reducing rates of gun violence, etc. Unfortunately, the US is not among them and does not seem to be able to learn from others' successes
1
In America, as with many of our problems, as long as the drug problem was seen as somebody else's problem - minorities, gays, woman, the poor - it was okay to lock them up at worst or ignore them at best. Today, as it has become a problem across nearly every community - white, middleclass, and the wealthy - we now hear it should be treated as a disease rather then a crime.
In the old days we talked about it in terms of heroin, cocaine, smack, Mexican drug lords, and junkies but today we renamed it all as "opioids" and lumped it all together with prescription pain killers, never mind that the number of people dying from legally prescribed and taken pain medication is a tiny portion of deaths compared to those dying from the other drugs illegally manufactured and sold.
And if we want to talk about the real killers and the real gateway "drugs" we only need look at the biggest selling drugs of all: alcohol, tobacco. and slow acting poisons disguised as food laced with highly addictive additives like sugar and salt marketed across the land with sophisticated brain washing like techniques that often target children. Can you say Kellogg's, McDonalds, Budweiser, Coke and just about the entire food and beverage industry?
Where is the political outrage over that epidemic which kills millions of people a year?
141
You cannot blame the industry.. You can blame the enablers. In Kg, we teachers told the little kids who brought sugar water and a candy bar for lunch, to put away their snack and have it later. You can blame the US Dept of HEW -- for their stupid food pyramid... and for pretending that fat kills...
There is plenty of outrage... and IMO morbidly obese people also need to be
locked up and sent for treatment.. however.. this is another situation where one size does not fit all.
PS Mike Bloomberg tried to ban sugary drinks. De Blasio wants to protect failing bars and clubs. (Let's vote him out... what a dud.)
A single MacDo hamburger w/ milk is not a bad lunch at all. Filling and healthy.. you can add a small apple for fiber if you must.
Mothers need to teach some children NOT to clean their plates and not to take more food than they will eat.
My type two diabetes is getting the better of me, so I have a solution: I am to stop eating, lose some weight, And then be diabetes type two free!
The "War on Drugs", like the "War on Terrorism", can never be won.
Such "wars" are a permanent feature of the human landscape. They can only be managed to reduce harm.
Meanwhile, the ONLY really important war, man's war on the environment that sustains us, is mentioned briefly and then dismissed because we all know that most humans just don't get it.
In fact, even on the nature-themed shows that run each Saturday morning, so that the networks can show they care about the planet, almost NEVER mention the root cause of species loss: Human-caused environmental destruction. It is just not politically correct to discuss the "War on the Environment" most of the time, and never in any depth.
91
Fact: 99% of all species that once were alive on Earth are extinct. Man did not appear until very late in the timeline, so your conclusion is false.
2
The two are related, I think. One reason we have so much drug addiction may be that our connection to nature and to the sensory world--through time spent in the natural world as well as through art, music, participatory sports, the making of things, the growing and preparing of food- -becomes ever weaker.
There is no war with the environment. Nature isn't fighting, doesn't care and always prevails. Same with drugs. The wars are man vs. himself.
I'm a conservative and generally resist the idea of wanton drug use, "robust social fabric and safety net" and rigid drug control. Having said that, at least by the criteria of drug use and (separately) drug deaths, Kristof does seem to have a point.
Isn't this a case study in why Justice Brandeis called states the "laboratories of Democracy". This is the idea that our fifty states appropriately have different views on the role of government. And per our 10th amendment, the states are supposed to be the ones to call the shots - at least on those matters other than the limited powers given to the federal government. "Seven states and the District of Columbia have adopted the most expansive laws legalizing marijuana for recreational use." Many of these states such as CA already provide extensive safety nets and fairly strict gun laws.
Doesn't it make sense to observe how these states fare - both generally and specifically regarding drug use and drug deaths - before expanding drug legalization on a grander scale ?
3
Congratulations to Portugal for its success in reducing drug addiction and limiting disease and death from it. Portugal designed and implemented a program based on compassion rather than profit or political power. Portugal may have saved taxpayers some money, too, but that clearly wasn't the goal.
And that is exactly why it can never happen here. Even since Bill Clinton "ended welfare as we know it" we have steadily chipped away at all social programs. Capitalism is our guiding principle, and it is no accident that we produced an edifice that extracts profits from drug addiction while doing little to help addicts.
5
It can happen here
I had the privilege of helping the Portugal design its evaluation of the decriminalization "experiment" before it was implemented (in 2001). Not only was it inspired leglslation, it was thoughtfully implemented and had a built-in evaluation system based on validated measurement. After five years, it was clear that decriminalization was working, and it has continued to work. No, the United States is not Portugal, but still, there are a number of lessons that could be learned from the Portuguese experiment, were we only open to observing.
24
Anne Case and Angus Deaton of Princeton University have chronicled the rise of “deaths of despair” and argue that opioid use in America in part reflects a long-term decline in well-paying jobs for those with a high school education or less.
I concur. I see anxiety all around me, even in young people with a 40 hour job and hopes for a promising career. Panic attacks are common among young men in their 20s. College graduates have been told they have the skills to be hired and retained in the new economy but they don't always believe it, and they have no panacea. Young and old citizens across America have been treated as cogs in a wheel, as if their value to an enterprise is the entirety of their lives. No wonder they want to escape! Give them intellectual and economic freedom to express their ideas and emotions in creative work. If I had to take work in a call center, I might look to opiods too.
12
Am I the only one that remembers when the Taliban banned opium production?
4
Not anymore. The Taliban have discovered the profit in the drug trade.
1
If only Jeff Sessions would read this. Fat chance.
19
Jeff Sessions is a member of the Executive branch. It is his job to ENFORCE the laws passed by Congress, not to make them. If people want logical laws like this, the onus is on Congress to pass them, not on the Attorney General to abdicate his duty to enforce.
2
Did Portugal's approach re: drugs only begin in 2017 after Trump was inaugurated? Is their a reason DEMOCRAT AG Holder or Lynch did nothing the prior 8 years? Or the DEMOCRAT AG of any blue state?
Not everything is political unless you want to make it so.
1
It would NOT matter at bit if he read it. His theory of law and order does not rest on facts, information or science, but on religion, faith, belief, etc. There are numerous law enforcement professionals trying to lower prison sentences and keep people out of prison. But he is old school-- spare the rod, spoil the child and how he interprets his religion.
1
Why does our government continue to follow a failed war on drugs. It may be that the private prison system and law enforcement are making money hunting down and putting addicts in jail. If so it is a disgrace that people are making money off the misery of others.
39
Maybe the same or a similar reason (insurance companies) we refuse to follow the leads of our wiser nation to the North and our much wiser European neighbors across the pond in regard to providing health coverage for all US citizens...add arrogance, greed and a dash of stupidity i.e. Republican Congress led by a leader with no future insight into what is best for Americans= needless suffering and premature death.
That's exactly what it is. I remember here in WA State they strengthened the penalties for DUI's a while back, and required drug & alcohol counseling was one of the punishments. What was the most profitable industry by margin percentage in WA State for the next 5 years? Required drug & alcohol treatment facilities. It is all about the money & keeping jobs and it's disgusting.
As a Portuguese i have to say that the best thing in our model is that the prison University is almost over.
Before, a guy just having fun in a weekend was caught with Cocaine would go to prison, there he would met other junkies, and is life of a small pleasure at the weekend become a day to day habit. Worst he will met other criminals, and a "good" man would learn the tricks of the killer, the robber, and so on.
If you are in your 20, it is easy to try things, if you are caught by police and you go to jail, you will pay for your use, but you will also know people that are bad, and you will, per say, have a ring of bad connections, that you will connect with your friends, thus having a biger and biger number of people going the road of hard drugs.
Today, that does not appen, so the connections are fewer, leading to less new droug aditics.
Sorry for my poor English.
107
I have been saying this for years. We did the biggest drug legalization experiment in the world when we reversed the stupidity of prohibition. People will never stop using "drugs" so making drug use a medical rather than a criminal issue works. Portugal is the proof of the concept. The problem is the vested interests, such as the drug dealers, the criminal justice system and the prisons for profit. Money to politicians blocks any rational solution. Maybe the legalization of marijuana will lead the way.
29
The alcohol-related rate morbidity and mortality plunged during prohibition. As did alcohol-related domestic violence and accidents. I know the party line was that it was a big failure and everybody was drinking bathtub gin and going blind and that's why prohibition was repealed, but it's actually not so. Look it up and do some actual research.
1
The Portuguese approach has been the obvious choice for decades.
1. Give the addicted the help they need.
2. Put the South American drug cartels out of business.
Is there another outcome that is any better?
16
And you can save 1/3 of the prissons, and 1/3 of all police force - think how much infrastructure or healtservice you can get from that.
As the perceived problem shifts from blacks and crack to whites and opioids, so does talk shift from the war on drugs to a medical problem.
And we will never stop drugs from entering this country as long as there is a market.
We helped kill Pablo Esocbar in 1993 and the drugs keep coming.
It is a demand side problem.
11
A truly beneficial news story adding much to Kristof's personalized newsletters.
4
The old tale that drugs are bad for you has some substance. Some drugs are very bad for you (alcohol), while others are rather benign (cannabis).
Beyond the objective nature of the consequences of various drugs, our society layers in a variety of additional costs.
Surprisingly, for all we know about the consequences of alcohol and with the obvious exception of DUI, alcohol use is treated rather lightly and even encouraged by government (tax revenues, you know.) While generally recognized as less injurious than alcohol, mere possession of cannabis makes you a criminal in many states -- except those whose citizens finally demanded an end to the charade of its prohibition.
Whatever the drug, the policy consequences of illegality are claimed by politicians to fall upon the user, in order to protect both society and the user from the claimed harms. Problem is that this politician's pipe dream of raising the costs to the user and making them pay makes about as much sense as Trump's assertion he'll build a wall (that won't succeed in stopping illegal drug smuggling or immigration) while making the Mexicans pay for it (they won't and no rational person or nation would submit to such nonsense.)
Even assuming the wall is ever built, the US will pay for it. Just as we all pay the costs of the drug war. When there's a better, more effective and more economical way to address the problems of drugs, only political stupidity stands in the way of overcoming decades of failure.
13
If if we decriminalize drugs then Big Pharma and the prison industrial complex lose money. Our system is set up to create addicts and then criminalize them. It keeps the money flowing to the 1 percent, the only people that matter in our country. Lock up the addicts and throw away the key is our axiom here in the U.S.
18
What? Do you really think Big Pharma can't make a very large fortune from softening drug laws? Oh wait Methadone is off-patent.
1
Portugal, to its great benefit, wasn't founded by Puritans, as was the US. Today, their equivalents are evangelicals, who preach that shortcomings must be punished. We're a nation without empathy.
39
Thank you Mr Kristof. Disingenuous and/or ignorant politicians have for too long associated the concept of legalization with the idea that this would somehow be allowing criminals to get away with something, which, in the case of addiction, is just insanity. The numbers comparing Portugal to the US are staggering and cannot be ignored; yet they are being exactly that. Criminalizing addiction is like criminalizing overeating/obesity; should we just start throwing people who can't stop eating in prison? As crazy as that analogy sounds, that's exactly how too many old white men (e.g. guys like AG Jeff Sessions) view drug addiction...
12
If we stop criminalizing drug use, we'll lose a big reason for locking up black and brown people and, of course, we can't have that. So the "war" on drugs will continue to be waged and the poor white folks that get caught up in it will be considered collateral damage...like dolphins trapped in a tuna net.
It's really a shame that so many will have to needlessly suffer to maintain the current (dis)order.
17
It seems my somewhat emotional earlier comments did not make it past the censors despite not actually saying anything hateful.
I'll try to restate, without the emotion.
The cartels that provide hard drugs like heroin are among the most vicious and violent criminal groups on Earth. They also corrupt entire governments and police forces, with the result that the innocent populations entire countries like Colombia and Afghanistan are reduced to poverty.
How do they do this? By using the money given to them by drug addicts, to purchase arms, ammunition and pay for bribes and kickbacks.
The "non-violent" crime of drug use FINANCES the entire criminal operations of these organizations, including their rapes and murders.
The heroin flowing around Europe has its source in Afghanistan, and its purchasers are directly supporting groups like the Taliban with their cash.
I'm a pragmatist. If Portugal's approach will actually reduce drug dependency and cut the flow of funds to the cartels then I am all for it. But the notion that drug-use is a crime without victims other than the drug-user is totally FALSE. Yes, addicts are victims, with a medical condition. But they are also the financiers of rape, murder and institutionalized corruption. This includes, of course, those addicts in white shirts and neckties, who snort coke on the weekends and head to Wall Street during the work week, as well as single black mothers smoking crack.
I'm starting to get emotional so I'll stop writing.
12
Make drugs cheap and concentrate on persuading people not to use them, and the cartels will wither, become less violent, find other lines of business, and become your ordinary organized crime syndicate. It is the illegality of the drugs that keeps prices high. If we purchased the Afghan opium production we could really weaken the Taliban.
4
Let these addicts do themselves I'm
Tired of seeing money/ effort going to people that don't want it
3
By the time most people become addicts, we have already invested tens of thousands of dollars raising and educating each of them. If they do themselves in, this investment is lost. If we can find a way of making an additional investment that will turn some of them around, we rescue some of our original investment. Up to a certain amount of investment, it is a smart business decision. Beyond that point, it is an unwise business decision we may want to make on other grounds.
Aside from the humanitarian aspect, I think investing more money is throwing good money after bad. If you are trying to be economically rational, lways keep in mind the sunk cost fallacy.
Sounds too sensible and too close to socialism for Republicans to implement in the US.
9
The war on drugs was lost years ago.The d.e. a.'s budget is 25 BILLION dollars this year.The extra costs associated are hard to calculate,local police.state police.prison,border patrol-etc.etc.lives ruined/lost.-------The definition of insanity is doing the same thing over and over expecting different results.That's our national drug policy !--I've been an advocate for Portugal's approach for many years,it works far better than anything we have considered. vote
11
I've been waiting for the obvious, definition of 'insanity'!?!
So half the people in Portugal are impaired, non-productive, but a nurse monitors their dosage?
Sounds like a plan.
The problem is the US is heroin is too easy to get, and a whole lot cheaper than painkillers on the street. It's a lot easier to pay $10 for hit than go to rehab.
The liberal solution is to allow the free flow of drugs across the Southern border and help these folks shoot up. I don't know about Portugal, but we don't produce heroin in the US, unlike cannabis it just doesn't grow here very well.
Incredible. I guess the rest of us are all racists because we want a wall?
2
Seems hawk did not read the article too closely or he simply decided to ignore the evidence: the U.S. has both a higher user rate and drug related death rate than Portugal and both these rates have dramatically fallen there since the adoption of this policy whereas they have dramatically increased in the U.S. Some people just seem incapable of changing their preconceived ideas even when faced with evidence to the contrary and through some contorted reasoning relate that the the construction of an expensive but totally useless wall.
1
Where, oh where, did you come up with "half the people in Portugal are impaired, non-productive" and "The liberal solution is to allow the free flow of drugs across the Southern border" from Mr. Kristof's piece?
You should reread his entire opinion, which does include statistics to support it. Maybe then you will see that Portugal has actually reduced the number of heroin users since decriminalization, reduced overdose deaths, reduced drug-related HIV infections, and that it still does criminalize drug trafficking.
2
Demand drives supply, not the other way around, especially in drugs.
There are many ways over, under, around, and through walls, usually in an 18 wheeler, right through the gate, with big bribes to border police. Drug dealers have ships and planes and submarines.
If you interdict half of the drugs, the price more than doubles. Talking half of the supply makes the business even more profitable than it was before. This is proven in theory and data and history.
Big organized crime in this country was created by prohibition.
And no illegal immigrants would come here if nobody was willing to pay them to be here. It is the demand for illegal labor (because they have no rights) that brings the immigrants. Fight for immigrant rights to increase your own.
If I have you a tax cut to sell human excrement, would you go into the excrement business? Of course not. There is no demand.
2
Republicans demonize drug use and demand even tougher laws and sentences. (Looking at you AG Sessions.) As a result, as a nation, we spend about the same amount on failed enforcement as the drug lords make on sales in this country. That is a crazy policy.
Treatment, legalization of various classes of recreational drugs, and laws that focus on providers, not users wil have an impact, where we are having none now.
8
It is the job of Congress to make the laws. It is the job of the Justice Department, including Mr. Sessions, to enforce the laws Congress passes. I completely agree that the drug laws need to be changed, or in many cases eliminated entirely, but until they are changed, they need to be enforced.
1
Sounds nice, but America is not about helping or compassion.
We have a big police force all armed like seal team 6, and they do not want to loose their jobs.
So Portugal, you keep thinking about your citizens, we need to think about jobs.
Making criminals is priority number one in the USA.
16
Common sense does not work in America because it's in the public interest.
7
There is no great panacea when it comes to drug use. But this approach is way better than here. And it's backed up by the statistics. The grown up approach and I would go even further. Kristof is right. Now if he would only wise up about prostitution and the sex industry.
Orange, NJ
5
That's cute, Mr. Kristof.
You actually think we Americans can learn from other countries.
Here's the six-year-old article for those who are interested in Portugal's experience:
https://www.newyorker.com/magazine/2011/10/17/getting-a-fix
1
As only Nixon and the Rs could recognize Red China, so Trump and the Rs are the only ones who can end our destructive War on Drugs and adopt the Portuguese model. Sad.
1
Nixon and Kissinger didn't open up China to us. They opened us to China.
China is still closed and we are still open. Please I don't need any solutions to anything from Trump and his associates. It could only lead to disaster. A disaster that they will profit from, sniff then use as an excuse for more disasters.
It's called disaster capitalism.
Unbelievable that NYT would have sent any op-ed writer, Kristof in particular, to give us a believable take on the drug issue in Portugal.
Any fool already knows that a medical, not criminal, approach to drugs is the right way to go. NYT didn't need to send someone all the way to Portugal to discover this. We could learn a lot from Canada. But, if the paper was going to spring for a trip to Portugal, it could, at least, have chosen someone who knows the finer points of methadone, which is a far cry from the miracle cure that Nicholas "Babe In The Woods" Kristof describes here. Methadone is an awful drug--anyone with any knowledge, and that includes street-level addicts, knows this. Yet Kristof treats methadone as something good, a step forward. Straight from the Reader's Digest school of journalism.
Drugs and addiction are serious issues. We need reporters with expertise to flesh this out, not op-ed writers who know nothing beyond the subject save what they've read in the media and what they know about someone from high school who is now hooked.
Bad use of scarce resources, NYT.
Totally agree. He is another angle on it -
Legal drugs in an Ecological Society?
http://www.ecohustler.co.uk/2014/06/11/is-decriminalising-drugs-a-step-t...
You will never eradicate drug abuse because it's not so much a disease as it is an aspect of human nature. The desire to get high is paramount is some of us. So our American war on drugs is doomed to fail. Given this if you refuse to accept the thinking that their approach is more humane and logical then from a cost benefit analysis alone the Portuguese model seems a better solution to the problem of drug abuse. It should be tried in our country because our current solution clearly is not working is it?
John~
American Net'Zen
3
We should be so ashamed.
5
You can always count on Americans to do the right thing - after they've tried everything else.
Safe to say more will die till we try a better way.
Health Care.
Climate Change.
Gun Control.
Education.
MIC
etc. etc. etc.
Sad and pathetic.
MAGA indeed.
Way to go Portugal.
3
"Portugal introduced targeted messaging to particular groups — prostitutes, Ukrainians, high school dropouts, and so on." I laughed out loud when I read this sentence. I wonder how my Ukrainian friends will react. Also thieves, Albanians, pederasts, and so on.
1
For the GOP, drugs are just a means for putting as many black and brown people in jail as they can. Any concern that the GOP shows for whites primarily in red states is just lip service: They could could care less about them. Spending money to treat them might prevent them from giving tax cuts to rich people. The rich are the only people that the GOP cares about.
3
Powerful article, convincing information.
2
Hypocritical Republicans would never allow a state the freedom to develop their own drug policies and programs which do not fit their idea of what is "right" , except of course it involves healthcare or protecting the state's environment, then it becomes a Federal matter.
I would love to see Portugal's approach used here but how are we going to get it past the knuckleheads in D.C. when it would put large swaths of the criminal justice system out of work?
4
Here's a thought, maybe you win it by not fighting it in the first place? Just sayin'...
3
Considering congress is poised to pass a law that will deny healthcare for the poor and people living in blue state...don't hold your breath for any Christian compassion any time soon.
1
The American system is designed to punish wrongs done to others. Steal, assault, or drive drunk, and the system mostly works.
I've been in the trenches for over 20 years in the legal system. I can't tell you how many times I've seen someone with a probation problem because of a dirty urine-how much time and money is wasted as Judge, Attorney, DA and probation officer go in circles to give XXX 'another chance' or put XXX in jail because 'they blew their chance'. The same logic the applies well to put a thief or abuser in jail doesn't apply the same way if all that was done was to find some THC metabolites in urine. Yes, the hairdresser likes cocaine. She got busted. Do we jail her for six months because she failed a drug test ?
I've lost clients during cases to overdose. Guess what ? The legal system didn't save them, and is the wrong tool. Many of these folks are truly lost, for whatever reason, and a hammer isn't going to fix them.
6
So why does Kristof dance all around whether net addiction is up or down?
Three guesses.
1
Delusional thinking won't solve it. Sessions speech in Boston on Thursday blamed the gangs but also children who came across the border from El Salvador. Small children as plants by gangs for expanding drug trade. Sessions needs to get out more.
1
The way that Portugal teats it's drug problems , like Norway treats it's criminal population is so different from the way the US treats theirs. We have a culture of punishment combine with profit motive( where would we be without GOP private prison building supporters) and a venal cabal in the White House that knows no shame.
3
Too bad we cannot have a change in our national drug policy. It would save lives. Anything is better than the expensive, mean spirited policy that we have in place from the Nixon era. Not at this time with that nasty little man Sessions as Attorney General and a buffoon as President.
3
Forget wasting resources on these "people". The Moslems and Philipine President Duterte have the best solution to the problem.
1
After 1st Bull Run many southerners thought the South was invincible. After WWII and Hiroshima many Americans had a similar conceit. But we came to see deep problems as solvable by War. Thus, the War on Cancer, the War on Drugs, the War on Terrorism.
As the Viet Minh soldier says in the first episode of Ken Burns latest effort, "Only people who have not been in wars think of them in terms of winners and losers. There are no winners in war. There are only losers."
Wars cannot solve medical problems. Addiction is a disease, and diseases should be treated by qualified medical people.
3
Portugals herion death rate is low, because Portugal doesnt invade Opium growing regions on idiotic unconstitutional premises, after scaring its population into surrendering all their freedoms.
Once the addiction to Keynsian Economic theory takes its grip, the Portugese will feel compelled to send their young men and women into make-believe war zones to televise "nation building" endlessly, and to harvest the Poppies....while the un-elected Witch of the west gazes into the crystal ball and cackles at the Success of her "War on Drugs".
This manufactured addiction to herion is a direct predictable result of our nonsensical invasion of a chaotic region(for the wrong reasons)......
ON 9-10, a rag-tag group of Taliban rebels was our "ally"......by 9-12, the same group of rebels was converted into a well trained and funded sinister band of terrorists. The criminal, BinLadin, went unpunished. Even today, there is no hard evidence that he was ever captured or killed(conveniently buried at sea with no photos....other than a Hollywood propaganda flick)..........A drugged population is compliant and apathetic with instructions from authorities. The non-drugged population is intimidated and distracted by the drug problem.
Meanwhile.....the war profits continue to roll in.
1
Great article, but here in the USA we must, and I mean must "hurt" people who break the rules..........
Addiction is something beyond comprehension at the moment, suffering, hurting is how we hander these things...its sounds horrible, because it is horrible, ignorant and crazy...
But, this is how police and the courts think, hurt people.....heck a county sheriff in a near by county here in SW Ohio refuses to let his officers carry Narcan......"they deserve to die", they did this to themselves...madness!
3
Read "Drugs, America's Holy War" by economist Arthur Benavie. America's war on drugs has been nothing but a complete and total failure. But, like the village idiot, U.S. policymakers keep doing the same thing, hoping it will magically work.
3
Yes.
1
This will never happen in the US. Because; handguns are tightly controlled in Portugal AND there isn't the absurd 17th century bible thumping puritanical streak running through half the politicians and population of the nation. We Americans are very good at telling people what "the Lord" wants for them and the punishment that will take place when they "sin". We are an ignorant backwater compared to Portugal. This program, no matter how wonderful and beneficial to addicts and the Portuguese people, will never happen here - we're too stupid.
1
thank you Nick-let's hope our attorney general reads the oracle of false news, the failing new york times.I'm not hopeful
Not a chance of this in the US, this is a solution that requires intellect and compassion neither of which Trump or the Republicans posses in the slightest. Sad but true if it won't fit on a stupid hat it's not solution they can wrap their heads around.
1
"keeping Mario alive..."
for what purpose exactly?
a drug addicted esistence is not a life,it is a
living hell where addicts prey on family
members and strangers,no matter what
nonsense is given out about rehabilitation.
and PLEASE stop calling a willful choice to
take drugs a disease!
cancer is a disease,
diabetes is a disease,
asthma is a disease...etc.
addicts make hideous choices and then expect
society to pay for them.
I am a Democrat and ,in general, a "liberal"
but I am bone weary of articles calling a
selfish,self destructive choice a disease.
Mario has been using drugs since he was
fourteen;he clearly enjoys it or he wouldn't
do it.
keeping him alive,God forgive me, is no mercy.
3
You need to focus on the disease of racism and how your endorsement of an honorable platform for the racism of the odious Charles Murray fuels it.
The Drug War was the worst thing that humans inflicted on other humans in the 20th Century. Not all their wars, their holocausts, their diseases came near impacting the lives of millions. And it has only gotten worse.
2
Whaaaattttt !!
And if Mario was dead, so.
There are a lot of parasitic junkies stealing stuff all over the country, injuring and killing, compassion can only go so far before it becomes encouragement instead of curing of the individual and protection for those who are preyed upon.
2
Wish the Times would direct more energy in this direction, not just how many are dying. The criminalization of drug use is the larger problem. Eventually as reprobates like Jeff Sessions fade from the scene and the addicted no longer have to live the addict lifestyle the crime associated with addiction will disappear. The mainstream attitude towards addiction is one of the primary forces that sustain it. Imagine no drug gangs, no petty larceny, no junkie culture!
Kristof writes "that while we can’t eradicate heroin" actually we could or at least come close. Western governments could buy it all up. We could also up the brain power of our foreign policy in Afghanistan, Mexico, and SE Asia. Though until we get Republicans like Sessions (read low IQ moron) out of the way this can't happen.
How to win the war on drugs should be a sustained focus of the Times. Just rename it.
1
Yesterday as I approached the Boston Medical Center, after getting off of the exit I saw groups of homeless people on the sides of the road and some in the road panhandling. Waiting at a stoplight, I observed a man defecating openly and another injecting himself with a hypodermic needle, standing within feet from one another.
I've been to Portugal and I have NEVER seen anything like this.
Our cities and country are in a 911 crisis. Obviously something needs to be done to help these destitute people. Whatever's being done here right now obviously is not working.
5
Anyone interested in learning more about this topic should read Johann Hari Chasing The Scream. The idea of treating addicts has actually been around for a long time. In the 1930's in the United States and in the 1990s in Liverpool, England, experiments were undertaken which revealed that addicts could be treated with opioids and they could lead somewhat normal lives under medical suprrvision.The program in the United States was shut down by the fledgling anti-drug government programs, and Christian do-gooders ceased the Liverpool experiment. Mr. Kristoff also failed to mention Switzerland, which has a similar program of treating opioid addicted individuals with treatment programs and ultimately with prescriptions for opiates to allow those individuals to stabilize their lives. Switzerland program has been effective in reducing HIV and homelessness among addicts. If we started treating this problem as a psychological and physical medical problem, we could go a long ways towards solving so many other problems such as inner-city violence which many times has its roots in the illicit drug trade. We've already spent billions of dollars since the 1930s when the federal government decided to turn its attention towards the use of drugs, and we are further away from its solution. Perhaps it's time to invest those billions in treating the problem as a medical problem rather than a criminal one.
10
Indeed. Another point made in Mr. Hari's writing is this: the US "war on drugs" was, at its foundation shortly after the end of alcohol prohibition, racist to its core. People were trained to believe that persons of color using marijuana or heroin were dangerous. Jazz singer Billie Holiday was hounded and prosecuted for her heroin addiction. Sen. Joseph McCarthy was not prosecuted for his.
We, the population, have been conditioned by almost a century of this nonsense to think that addicted persons are evil. It's difficult conditioning to overcome.
The police in the USA depend on the war on drugs for their livelihood. Decriminalizing drugs will give them less to do. It will take away their ill-gotten revenue by eliminating the most important motivator for extrajudicial civil forfeiture of property. It will cause some of them to be laid off.
The police have the ear of the legislators. That's why, for example, the Massachusetts legislature is stalling on implementing the will of the people expressed in last year's legalization of marijuana.
It took a century to get us into this confused mess. It's going to take a while to get us out.
111
Carl Hart, a neuroscience researcher, wrote a book "High Price: A Neuroscientist's Journey of Self-Discovery That Challenges Everything You Know About Drugs and Society" about the racist aspects of the "war" on drugs and his personal experiences growing up. It's worth reading.
3
You might not think that addicted people are evil. But there is a good reason that anyone would think so.
It's because they ARE DANGEROUS.
So let's not pretend that isn't true, and the liability and costs to our society have been countless.
Yet another methodology that comes down to profit motive vs ethics. In our culture, there is neither the will nor the compassion for this problem, because it is a class struggle. Drug addiction is multi-layered, complicated and therefore costly to treat. So are ALL mental health/behavioral-based illnesses by the way. It can't be treated quickly with surgery or with a chemical triage so it somehow evolves into the fault of the individual sufferer's character. How very sad that our system favors incarceration and ultimate death of these individuals over life and any possibility of hope.
16
Good points. As Americans we expect that somehow a technological or medical fix will come along and make our decision-making easier, and so we don't have to think about the moral or ethical aspects of our problems.
Thank you for this article.. it speaks to many of the changes in mindset and administration that will be needed in the USA to help prevent deaths from heroin overdose like my oldest son, one year ago this weekend.
Fifteen years ago, when he was well, he worked in Harm Reduction, distributing health materials, needle exchange services, and HIV tests to addicts in a truck similar to the one shown in the article. This was targeting the HIV epidemic and it was effective in reducing the spread of HIV through at risk populations like IV drug users.
We learned that of the biggest obstacles to Harm Reduction was the moralizing that occurs at legislative levels where funds could be allocated - until this holier-than-thou, criminalizing mentality is effectively countered in the policy sphere the deaths in the USA will continue.
Understanding this epidemic as the devastating disease that it truly is is a critical first step.
4
It works, not perfectly, but it does work. Something the rest of the world cannot say.
We can cure a large proportion of addicts for a fraction of the cost of arresting, prosecuting, and locking them up. They are a lot less likely to mug or steal from us.
Win, win, win!
14
Portugal has a good approach. Add to it government-provided drugs for free (completely stops the drug gangs and distributors, as well as drug addict crime to pay for their habit) in return for addict registration and free medical treatment (gains monitored access to addicts), and you'd have an even better program. And for far less cost than our current war on drugs. Should have been done long ago, and one asks, "why not". Follow the money.
9
We need more PREVENTIVE EDUCATION here.
We need to start in the schools at a very young age.
We need more public education also, in all mass media.
Giving addicts methadone is addiction maintenance - which does not work for most drugs.
Preventive education does work, we must do it now.
1
I love this comment, because it's probably the best solution in the long term
The Portuguese culture is different in other respects. Less street crime (could this drug situation have anything to do with ?). People are known for their friendliness and helpful ways. Great fresh food. All's not perfect, high unemployment, less middle-class, wait, I can't think of any thing else to list....
3
I find it persuasive but some of your statistics are confusing. Portugal is spending $10 per citizen per year compared to the U .S. spending $10,000 per household per decade? So I am supposed to assume there are 4 citizens per household in Portugal x 10 years = $400 compared to $10,000? Still a bargain.
3
So many people have the view that addiction is not a disease in the traditional sense. They claim it is physical, moral, and spiritual weakness. Yes and no.
The tendency to addiction has many complex causes. While the world spends billions on the war on drugs, I don't notice much work being done to find out who these addicts are and what factors lead to addiction.
I doubt that a small team (say 1 social worker, 1 nurse and 1 psychiatrist) could get funding to spend 3 months interviewing addicts at Ground Zero of the opioid crisis and another 3 months writing up their report from any source today. It seems we'd rather not hear that part of the story as it's more satisfying to condemn the moral weakness of others.
I do recall reading a quote from one long-term heroin addict many years ago that stuck with me. His described heroin by saying, "If God made anything better, he kept it for himself." Therein lies the seductive evil of opiates, etc; they produce a short term sense of well-being so powerful that it destroys our ability to control our lives.
Addiction programs seem to focus on the miseries of addiction; very little is done to reduce, or even understand, the factors that create the initial hunger for the escape that opioids provide, if only for a few hours.
Kudos to Mr Kristoff for drawing the successful Portugese program to Americas attention. You can also find good videos on youtube describing the program.
14
One day society will look back at this era where drug addicts were treated with scorn rather than as sick people with a medical problem like cancer, and we'll wonder why so much hatred was heaped on people who were already struggling and suffering with almost unimaginable pain every day of their lives.
12
Thank you. I believe the same.
1
You can't "win a war on drugs" any more than you can win a war against sadness. Some people have always and will always wish to use mind-altering substances from alcohol to cocaine to fentanyl to whatever. Some can control it and others can't.
Prohibition has never worked. The United States' War on (Some) Drugs is a complete failure that has wasted billions of dollars and ruined countless lives. But it persists because of a combination of powerful interest groups that profit from it and the opportunity it provides for politicians to grandstand.
Portugal has the correct approach; decriminalization and medical treatment for those who need it. But maybe there's hope for the US; the author tells us that the issue resonates for him because his "hometown in rural Oregon has been devastated by methamphetamines and, more recently, by opioids. " You can read between the lines of that statement and understand what he really means.
8
I highly recommend the book "Chasing the Scream" by Johann Hari who chronicles the start and long history of the "war on drugs" and other options, like this one in Portugal. It changed everything I thought I knew about addiction. This article and Hari's book could help change the policies about it too. We definitely need a better way - our current policies certainly aren't working.
7
Thank you for this. Of course there is no magic bullet for these complex issues as the source of the problem with addiction is almost always a reaction to some kind of trauma...deprivation, abuse, neglect...and on and on.
Dr. Gabor Mate, who lives and practices in Canada, wrote a book called, "In the Realm of Hungry Ghosts" that addresses the dilimma of treating those with addiction with compassion, support and a the sober view that it is not a crime.
Making addicts into criminals for using only costs us money to house them in jails, punishes people for victimless crimes and does nothing at all to help them move beyond the source of this deadly spin cycle.
7
The additional tragedies related to American drug policy are not just American. It's the untold death and destruction around the world including Mexico, Columbia, Afghanistan, etc. When an addictive substance is criminalized it becomes extremely profitable and disputes between individuals and organizations are not handled in civil court. As Pablo Escobar demanded it was "plata o plomo" (a silver bribe or a lead bullet). If America were to implement a program like Portugal's virtually all of that violence and corruption would go away. Drug lords love to be illegal. It makes them rich.
17
This is an fine article that summarizes a chapter in Johan Hari's essential 2015 book, "Chasing the Scream." I am surprised that Hari's book was not referenced, as Mr. Kristof must be aware of it. For anyone who is concerned with this topic "Chasing the Scream" is a "must read."
A wall along the southern border, or at least better border security, would also help keep out the flood of heroin from Mexico. Just a thought! It makes little sense to address the demand factor without also considering the supply factor. Progressives tend to respond to the border issue by saying something along the lines of "yeah but it's Americans' fault for demanding the drugs" but if we're going to employ the sympathetic attitude expressed in Mr. Kristof's article this doesn't seem very sympathetic to addicts.
3
Wall or no, as long as the demand is there, drugs will continue to find their way in. Where there's money to be made and lots of it, a wall is just another cost of doing business.
2
As long as the drugs are illegal, they will get into your country whether there is a wall or not. It is the illegality that keeps it profitable. Drug addiction should be a medical problem, not a legal problem.
2
There are no good pain meds. The pills make life miserable but weed helps, PTSD, pain and my general ability to socialize peacefully as well. Head injuries cause a lot of problems and weed helps. If people would mind their own business and stop running big pharmaceutical "War" on their profits.
1
Minimal Pain and Maximum Support
Give users the choice of a criminal process or immediate non-criminal diversion.
Lock em up until the physical addiction is gone (and facing "Mike Tyson" is no longer an issue). Let them out as soon as they have a reasonable plan to stop buying illegal drugs (with or without methadone). Don't let them go back to the same friends and community environment that makes them fail (at least until reasonable sobriety has been achieved). Expect them to identify others they get high with and their drug dealers (and agree to testify against them) as a condition of release.
2
Yet another graph showing the United States LAST in a list of nations on a life-or-death issue. The only thing American Exceptionalism stands for any more is being exceptionally BAD at any number of things involving the well being of its citizens.
Did we really help win WWII and lead the world for several decades and put men on the moon - or was it ALL done with smoke, mirrors and trick photography?? Yes, denying historic facts is lunacy, but so are the political positions taken by the right wing since the 80's - all the while waving a flag and brandishing a crucifix with a holier-than-you attitude.
The United States of America is like Dr. Jekyll and Mr. Hyde or a deeply manic-depressive person, exhibiting in spades two wildly divergent personalities - one reasonably sane, the other apparently bent on total self-destruction. Out approach to drugs is simply yet another example of the latter - let's look at what works best... and then do the complete opposite!
6
This approach not only reduces prison use because drug use is seen as a medical problem, not a criminal problem, it also reduces the number of people arrested for petty theft who are stealing to get money for drugs. Police, prison keepers and some lawyers will have to find other forms of employment... not to mention those in organized crime. Makes you wonder where all the support for criminalization of drugs has come from over all those years......
3
Where is alcohol in this article?? All drugs/alcohol are the same as far as addiction & destruction of lives are concerned. The insidious nature of alcohol gets ignored because opioids are the PRESENT problem. Ask any doctor or cop about what they see daily regarding the effects drinking has on their jobs.
Please let's talk about ALL of these killers & how treatment is the only answer. Having been thru treatment 35 years ago ( and still sober), I can say these things with first-hand knowledge.
2
Great work here, and you deserve everyone's thanks.
The "war on drugs" infrastructure has built itself a lucrative industry which fails, day after day- at the expense of the tax payer- the sick, the homeless and the inconvenient dead.
We now have the largest incarcerated population in the world, served increasingly by lucrative private prison systems, bloated, often racist law enforcement, profitable confiscation laws associated with drug distribution arrests, and no end in sight.
It's just another symptom or our public insanity, for which the cure has been sold to the dying as worse than the disease.
6
These people are Victims. It is a failure of the medicine health industry. Why do people take the drug in the first place? Once they take the drug the first time, since these drugs are designed to create addictive need, they continue to need the drug. Besides addictive need, they create pain, so you need more in order to get rid of the pain. ---- Plus, these drugs are of course not made very well, so the idea that you are getting "pure" is most likely not true.... these drugs are very risky. Of course, what I have just said, has been said before. So, probably people will say, Duh, as a response. Thus, the real issue is why this problem is still continuing, when it can be solved. There are so many things that are junk that are currently allowed to be legally on the Market. Until junk is taken off of the Market, this problem will continue. ---- Also, people still today do not have their Human Rights, so The World Court needs to start enforcing Individual Human Rights around the World.
Alcohol addiction is treated as a disease. It makes sense to do the same for addiction to other drugs. Addiction destroys individuals' lives, and it can destroy the lives of people they love. Treating drug use as a crime completely ignores the psychological factors and interpersonal dynamics that are part of the cycle of addiction. Policies and programs informed by empathy, not control and coercion, are the way to go.
1
FDR declared War on Drugs in 1934, 20 years after Congress passed the first drug control law. That means that the US has tried to outlaw drugs for over 103 years. A logical conclusion is that the War on Drugs is a failure. When you realize that what you have been doing does not work its time change.
The simplest way is legalization.
Yep, regulate and tax drugs. But, don't be so harsh as to make illegal drugs cheaper and simpler. We want to make legal drugs cheaper than illicit drugs.
That would drive the criminal production and distribution systems out of the market.
Would it work. Well it did in the 19th Century when doctors prescribed maintenance doses from addicts. It has worked reasonably well with alcohol. Restrictions on tobacco advertising and marketing plus "education" (anti-tobacco advertising) has reduced tobacco usage.
3
In my experience the majority of US people look inward, and thus tend to lose the opportunity to learn from other cultures. This results in always having to learn things the hard way from scratch.... guns do not make you safer, middle East wars can not be won, triple costs for health care do not give a better outcome, lowering taxes does not generate economic activity, privatizing does not improve efficiency.... and the list goes on and on forever. The central problem with this US approach is being unable to break out of unrecognized bias. You are doomed to repeat and repeat until real learning takes place. Yes, Portugal's approach to drug use is not perfect but humane and produces an amazingly better outcome than other countries.
3
Way way way too much money is being made by both sides to ever stop the war on drugs. If it makes sense- we can't use it.
1
The best solution on how to deal with a drug/dangerous object is simple.
Legalization, regulation, responsibility and non promotion.
The formula is simple, the implementation is extremely difficult because various factions of society do not like some part of the formula.
We were most successful using the formula with cig. smoking from a high of app. 40% yrs ago to to a low of app. 15% today.
We are least successful with the abuse of the gun, leading our peer countries by light yrs re death and injury.
4
Many years ago - long beyond the statute of limitations - I. like many others in the 60's and 70's, dabbled in the sale of marijuana to a small group of friends. No drug czar, no violence, certainly no guns involved.
But even back them. brushing at the very fringes of the illegal drug culture, the one thing that struck fear into the hearts of the suppliers was "legalization".
Any efforts made to make the drug they handled more difficult to obtain and import were ineffective and served to raise prices - chalked off to the cost of doing business and passed on to the consumer.
The only got politically involved when questions of legalization and regulation came up and then they used their vast wealth and connections to lobby against any such proposals, making for some odd bedfellows indeed, even though the general public was unaware.
There is only one way to stop the supply of illegal drugs, and that is to stop the demand. You can only do that by treating the addict, not criminalizing them. Doh.
We all know that old definition of insanity - trying the same thing over and over and expecting a different result. That has been U.S. policy for decades and we continue to lose the "war". Drug lords and drug addled addicts continue to beat us every time.
Change the language - not a war, a movement. Not criminals - victims. Eliminate the profit and you eliminate the suppliers. Bold? Perhaps, but sometimes strategies need to be changed boldly when you are losing.
4
Have you ever met a happy, fulfilled person who became a drug addict or alcoholic? I haven't.
They all seem to be self-medicating for some sort of deep emotional pain, even if their lives look fine on the surface. Dig deeper, and you find a horror story.
I'm reminded of a long-ago fellow student, an emigre from the Soviet Union, who said that when he lived in Moscow, he used to consume incredible quantities of vodka, but since moving to the U.S., where his non-conforming ways were more socially acceptable, he had not felt that impulse and was able to control his drinking.
I strongly suspect that today's opioid epidemic in the Rust Belt is a symptom of mental and physical pain. People who believe in the American Dream and have done everything right according to the myth are stuck in low-paying, unpleasant, dead-end jobs and can see no way out. They know that they are doing worse than their parents. They may be working at heavy labor past the age when their bodies can heal from injuries easily, so they suffer from chronic physical pain as well.
The high rate of drug abuse and suicide in that demographic is completely unsurprising.
4
Neuroscience has taught us that all substance addictions, legal (alcohol, nicotine) and illegal (narcotics, amphetamines etc), operate via a common pathway modulated by the neurotransmitter dopamine, often referred to as the chemical of pleasure. Dopamine is also involved in pain relief/reduction by opioid receptors. Both functions of dopamine underlie addictions, starting with experiencing pleasure and, with opiates, requiring higher and higher doses to get the same 'high'. As the disease progresses, avoidance of pain and other symptoms of withdrawal becomes paramount. Pleasure seeking and withdrawal avoidance become a vicious cycle in which addicts are trapped, leading to all sorts of aberrant behaviors and crimes. Our brains are not equally easily addictable and young brains are more addictable than older ones. It takes time to become addicted, which is why dealers often give drugs away as a way of increasing their customer base.
In my neurology practice I treat a number of chronic pain patients with narcotics, the majority having undergone failed low back surgeries, are unresponsive to non-narcotic meds and injections and whose insurance pays for limited or no PT or psychotherapy. All are told at the outset that the goal is to make them more functional not pain free. An abiding worry is that increasing restrictions on prescription narcotics will lead to some of them to hit the streets, where heroin is the cheapest narcotic.
5
Thanks for a great article on an important subject.
It's interesting isn't it, that the three countries that are worst on deaths per million are the US, Sweden and Norway. Not coincidentally all take very conservative approaches to drugs and drug use. Meanwhile the most open minded approaches seem to get the best results in terms of saving lives.
2
Portugal seems to have the right attitude to this public health crisis. Also, there must be a reason why so many turn to drugs. Scientist should find out if poor nutrition - not the right nutrients - is a factor. Maybe our sugar highs and lows contribute to addiction. The body may be crying out for help before the person turns to drugs, and drugs dull the lack of well being. It is more than just the drugs.
It is really a very strait forward thing to curtail drug abuse. First, doctors who prescribe the drug should be investigated for reasons why to prescribe this addictive drug and not other less predictive. Second, the pharmaceutical companies should be liable (like tobacco companies) for producing this addictive drug. If the doctors are mindful & pharmacy companies careful, we should drastically reduce the accidents of drug addictions & abuses.
Drug addiction should be considered a disease rather than a crime in society?
Considering drug addiction a disease is an improvement over considering it a crime, but it is an odd improvement. Take the generally understood relationship between being sick and pharmaceuticals: A person has an illness from this or that cause (genetic, bacteriological, viral, etc.) and is treated with drugs. But drug addiction as a disease is essentially saying the person is sick because of taking drugs, the taking of a drug is a sickness the person needs to be cured of.
I tend not to like that explanation. I much prefer to seek the reason for drug addiction in the very same areas that we generally look for sickness, which is say there is something genetic affecting the person and/or some sort of environmental influence and the taking of the drug, the drug abuse, is just a symptom of some yet unidentified sickness as say taking cold medicine is a symptom that the person probably has a cold.
In short, the problem with the drug addict is not that the addict is abusing drugs but that something internal and/or external is affecting the person which results in an attempt at a cure and this cure tends to be settled as a drug abuse regimen. I recollect as a teenager having drug and alcohol problems. I still like drugs such as opioids and amphetamines. I would say most of my pain is of suffering an existence in a quite hostile environment to being a sensitive, highly intellectual and artistic person.
1
I agree with Mr. Kristoff, but what I'd add is that the government should not only decriminalize the possession and use of hard drugs, it should become a supplier of "safe" hard drugs for free, so drug dealers would be put out of business - as a heroin/opioid addict would only have to go into a government clinic to get their score - no stealing required.
But people who are often high or drunk will inevitably commit crimes (as being on them makes you do irresponsible things). This is where the law comes in to force you to attend treatment or go to prison. The criminal aspect will be about behavior (as it should be), not on the addiction, though there will be enticement to beat the addiction.
1
Prohibition only benefits criminals. Those who want to use drugs will use them regardless of whether they are legal or not. Our war on drugs has been a collosal failure.
We should legalize but regulate drug use. Right now our drug policies are responsible for the drug cartels plaguing our neighboring countries. Countless lives have been lost and countries have been destabilized so that Americans can get their fix.
Here in Oregon we've legalized and regulated marijuana. Prices have dropped, dealers have been put out of business, and those like my cousin who have used it whether it's legal or not no longer have to worry about being arrested for something they're going to do regardless. We treat marijuana like alcohol and the same laws apply for driving or committing criminal behavior while under the influence.
Locking people up is a waste of money and lives. If the Portugal model works we should set aside our biases and adopt their policy.
2
Another compassionate response to drug addiction with absolutely no attempt to understand and potentially treat the root-causes of substance abuse.
Centuries ago any affliction was blamed as a moral failure and both shame and shunning were considered to be the most effective treatment along with telling the sick person that they needed to repent and build a better life. That is pretty much where drug treatment is today. While we understand a lot of biological and psychological diseases, we haven’t done the research to explain why one person becomes addicted to drugs and another doesn’t. Until we launch the research we will, at best, be like Portugal and manage the problem.
Why don’t we fund the research? Because we still see this as a moral-failure and refuse to spend research dollars on understanding the bio-chemical-psychological basis which predisposes a person to drug addiction. While 12-Step programs do a great deal of good, they still cannot explain or predict the actual onset of drug addiction. It is past time for some serious research and serious spending.
1
(1) I would like the article to have included some analysis of the situation in France, Italy and elsewhere in Europe which the chart showed to have rates almost as low as Portugal. Do they do anything different? N Kristof please follow up.
(2) Where are the US philanthropies? I'll bet one of them could convince a US state to trial something similar to this and it could be a great demo.
3
I am a drug and alcohol counselor and I agree with you that treating addiction as a medical problems rather than a criminal problem is by far the best approach to take. One issue I have with your article though, is that the graphic pictures can be destabilizing triggers for anyone in recovery or who is struggling to quit their own use. Pictures of injecting drugs or of the blood or even just the paraphernalia can cause cravings which can lead to relapse.
1
I disagree with Kristof on almost everything -- until this.
And, while we're at it, let's ends the Federal reefer madness and remove cannabis entirely from the Controlled Substances Act.
If Obamacare can be turned over to the states, so can cannabis regulation.
7
I thought this closing sentence explained Portugal's commitment and success: "Yet for all his suffering, Brito lives, because he’s Portuguese." - I'm trying to relate this to what it means to "be American." I don't see comparable bedrock, and that troubles me more than the thought of decriminalization and expanding social services, much more.
There are lots of good reasons to reform the criminal justice system. We have read about deficient jails and prisons, racist police, capital punishment, rape, and bail among other areas of deficiency. And the arguments we read are convincing. But they uniformly omit the subject of cost, which tends to be astronomical.
Proportionately Portugal's government budget is 33% larger than ours. That buys universal health care, other benefits, and 50% more law enforcement personnel. Because Portugal has many drug users on the streets, it needs lots need lots of police. To match Portugal's police force, proportionately, the US would have to hire another 500,000 police at an estimated cost of $75 billion. Getting better police officers, reforming the bail system, improving our prisons, improving police training and raising our paltry level of rape prosecutions are all big-ticket items. I shouldn't have to be the one telling you the cost of Mr. Kristof's proposed changes. Discussing any reform without stating the approximate cost is not a sufficient discussion by me.
1
What about drug related violent crime, Mr Kristof? What did it do? It had to have gone done dramatically (I hope). Not much was said on this matter but I am really curious to know what the numbers say.
The problem, Mr. Kristof, is that with our Calvinist/Social Darwinist mindset over here in the good old USA, we don't want to have the approach or outcomes of a policy that treats drug addiction as a public health problem rather than as a discrete set of individual moral failings. Our ethos, generally, is that the people you write about in this column are losers, not worthy of respect or compassion, and should be encouraged to die as quickly as possible so as to stop soaking up precious resources that rightly belong to the morally upright Elect--the Elect having shown their virtue and deserving status through having amassed riches and resources through their hard work and moral righteousness.
I write about this a lot, but it bears repeating--so much of what passes for policy discussion in the US starts from a Calvinist/Social Darwinist world view, and a survival of the fittest mentality is incompatible with programs based in compassion. As long as this mentality prevails, we're unlikely to have programs similar to Portugal's drug policy, or universal health care, or any sort of extensive safety net.
7
Love this. Addicts around the country thank you Mr. Kristof.
There is a reason that the US comprises not quite 5% of the world's population and consumes over 75% of it's prescription drugs. We have direct-to-consumer marketing ("ask your doctor if this pill is right for you!"), an over-burdened treatment delivery system where only 10% of people with a substance use disorder get the help they need, and the false belief that SUD is a moral weakness and people just need to quit. Shame and stigma keep people from asking for help and we have criminalized drug use in black and brown communities. Until we change our basic beliefs and the social norms surrounding alcohol and drug use, misuse and addiction, people will keep dying and individuals, families and communities will suffer.
2
We have plenty of drug treatment in the US. There are clinics and "treatment centers" all across the USA. The only problem is, treatment doesn't work. The addicts stay addicted. Maybe some stop using, temporarily or permanently, but they stay addicted.
Admittedly, drug use is illegal in the US so addicts live in an underworld, and many of them die of it as a result. In Portugal, use is legal and supported, so they don't die. But they stay addicted. In both cases, addicts are lost to their families, themselves, and the country.
One thing we have never tried is shaming drug use. We shamed smoking, a legal practice, and smoking is greatly diminished. We shamed eating fat, and dietary fat, a legal and necessary part of a healthy diet, disappeared all across our dietary spectrum, replaced by non-food chemicals.
We don't shame drug use.
It's "cool." It's funny. Our young laugh at our warnings about it. And after all, they're immortal. Nothing can hurt them, even as it kills them.
Shaming would work.
But only if we meant it.
1
The war on drugs isn't about drugs: it's about power and control.
It all comes down to that.
4
This is what you get when you have a government that views its people with compassion, empathy and reasonability. In the US we still hue to some "spare the rod, spoil the child" mentality that supposes we can instill desirable qualities in the disadvantaged and addicted through punishment. It would be a farce but for the hundreds of thousands of unnecessary deaths it causes.
3
I read all the 27 comments (only 27 comments on a life and cultural peril?) and nobody even mentioned prevention and the underlying cause of this enormous problem. How can anybody not see that the graph on the drug related deaths not see that this is a deep-seated cultural issue related to a very deep seeded anxiety which over the last 10 or 15 years has festered because of us versus them. Blame anybody but ourselves for a busted educational system, an infrastucture falling apart, a tax system which favors the greedy very rich, a health system which has exponentially increasing
costs, incredible disparity of income, racism gone amuck, and representatives with single digit approval. The youth withdraw into drugs to escape the absolute insane society they live in. 50 years ago they rebelled by turning on and tuning out. No amount of money, treatments programs, jail arrests, for medications can possibly turn this problem around. The denial of a deep societal problem must come to a stop. Everything wrong with this society is linked to the drug problem.
1
You win a war on drugs, by not treating it like a war anymore.
1. Legalize all drugs.
2. Tax all.
3. Treat addiction ( all ) as a disease.
4. Educate
5. Socialize health care ~ Single Payer
The steps ( easy ) are right there and could be achieved through political will, but that would take all of us accepting that we are complicit. We need to get involved and vote in the people that will do what is necessary.
Until then, the plague expands and the narcos propagate.
8
Everywhere else does everything better. An old song, never too catchy.
There is no reason not to offer both rehabilitation and punishment. Rehabilitation to aid the addict in recovering his or her life, and punishment to atone for the harms done to others, by means of theft, emotional abuse, or the ordinary consequences of intoxication, such as vehicular homicide.
Yes, but this approach is based on facts, logic and data-driven outcomes.
US public policy is based on superstition, dogma and violent emotion.
Until we unshackle ourselves from these toddler policy-makers, progress is unlikely at a national level.
Too many Americans in gerrymandered districts enjoy the debasement of others. They would never allow for something that works if it did not include shame, retribution and punishment...until they do it.
2
The US has built a prison industry without compare in the western world, whose vested interests continue to support a war on drugs that is completely useless. On the other hand, now that white people in the US are dying in unprecedented numbers and at shockingly young ages, there may be an opening to modify policy. As long as this was considered a problem mainly affecting minorities (though that was always untrue), nothing was likely to change.
4
To discuss drugs in this way is indecent. When the war on drugs was about African Americans, and in my county American Indians, it was all about incarceration. Now, that we have a white drug epidemic, we need to treat it with love and treatment. This is ultimate hypocrisy. Because I am watching "Vietnam" it recalls a nation that said it was okay to send poor and minority people to fight, but when it came to middle class white kids, we got all frightful. Nevertheless, this has always been the correct way to fight drugs. So, will we have two systems, one for crack cocaine and one for heroin, one for black and one for white? This from a community that has lost some good kids, two I coached in soccer. This approach, if used in the US, will have to go deeper into families and systemic mental health issues, which are often at the core of drug use. But good luck. I am not convinced we can win this war any more than we could win in Vietnam or that building a wall will stop illegal immigration.
134
We are living in a country that has small minds and small ideas. We are stuck with a corrupt political and judicial system. So until that changes we will never move forward with the proper treatment of drug users.
3
You always needed to treat it with love and treatment. Sure, the American "war on drugs" has been to a large extent a war on non-whites, but if a rational approach is hypocritical, so much the better for hypocrisy. It is, after all, in Oscar Wilde's immortal words, the tribute that Vice pays to Virtue.
1
I'm sick of much smaller countries with a virtually homogenous population being compared to the US.
We are a nation with the highest rates of obesity. With the highest rates of gun violence, with each person naming their rights.
But not their responsibility.
Addiction, is at once preventable, because it's predictable.
So let's make drugs legal, or remove the criminal consequences of possession of drugs or their sale.
You still have a social liability that's led to overdoses, homelessness and mental illness, the endangerment and deaths of children from having addict parents.
The exponential crimes that come from addiction is a clear and present danger.
What to do about it?
This country tends to never multitask when it comes to slaying a Hydra. You have to cut off ALL the heads to finally kill it!
2
Irrational drug prohibition policies have devastated our society and spread death and destruction throughout the world, at a cost of billions to US taxpayers. The politicians responsible for diverting these taxpayer dollars from more productive activities, including appropriate medical and therapeutic approaches to addiction, should be held accountable.
4
This topic is covered in my book "Federal Nacotics Laws and the War on Drugs" (2006) where I point out that treatment works but incarceration and interdiction don't. Putting people in jail does nothing for the cravings, and interdiction (cutting off the drug flow) has never worked anywhere. Profits are too high. But labeling addiction a disease, while pointing in the right direction, has its own problems.
Addiction is neither willful misbehavior nor a disease like an infection; it is its own special category of problem. One of the problems of using the disease model is that people expect that if you have one, or maybe two, chances at treatment the problem should be gone. In reality, you typically need three or more rounds of treatment to significantly impact the recidivism rate. In the end, those treatments wind up saving both lives and money, but somehow its hard to get the political will to pay for adequate treatment.
Until we recognize what is needed to actually address this problem we will continue to be saddled with an unending tragedy.
3
Here in the US the war on drugs seems to be spurred on more by the profit motive than by any real desire to save people from a lifetime of drug addiction. Money flows to all facets of the illegal drug trade. From the drug kingpins to the DEA to private prisons to the street seller who is willing to become involved in probably the the most dangerous occupation there is.
I view the fight against the legalization of marijuana in the same way. The profits from it being illegal probably are far greater than the taxes collected were it to be made legal.
1
One need not be comfortable with drug use to want to mitigate its worst effects. America's war on drugs has been a decades-long effort in futility. It is long since time to look reality in the eye and find a smarter approach.
Drug use is not going to stop. But there are measures to reduce overdoses, reduce the spread of blood-borne pathogens including HIV, reduce criminal activity around drug use, stop castigating drug users into law breakers without futures, and to use our legal system for more dire matters.
The war on drugs has failed. Let's find a new mission with better prospects.
12
Mr. Kristof oversimplifies a complex issue.
There are two parts two the opioid epidemic in this country. One is illicit use which includes heroin and the illicit forms of fentanyl (it is very hard to overdose on the prescription forms of fentanyl available in this country). The other is over prescription of opioids by physicians. The first is the one where we have to decide the proper balance between law and medicine. The second is essentially an issue of medicine.
I am a pain management physician and every study of which I am aware has cited physician education on the management of pain including the prescription of opioids as being woefully inadequate. Anyone who doubts should consider that although for years we have known that the use of opioids and benzodiazepines together is contraindicated and that last year the FDA finally added its toughest warning against this, the number of patients being prescribed opioids and benzodiazepines has risen.
Finally, Mr. Kristof indicates that making methadone more readily available is one easily achievable goal to address the opioid epidemic. I would like to ask him one question: if this is true than why isn't methadone considered the first line opioid for the management of pain that opioids may be required for? It's at least as good and possibly even a better analgesic than the other opioids.
5
Dr Steve, as a physician, can you answer your question for us? 'Why isn't methadone considered the first line opioid for the management of pain that opioids may be required for?' Are you asserting that it would not be, in fact, easily achievable to make methadone more readily available?
1
bill,
When used as an analgesic, methadone has the same restrictions as any other opioid. It is only when used for opioid detoxification are there additional restrictions on its use (only licensed drug treatment facilities can administer it for this).
As to why it isn't considered the first line opioid, the only answer anybody has ever given me is that it is a great drug but most physicians don't know how to correctly prescribe it.
Certainly if it is the answer to opioid addiction, then it would make sense that it and buprenorphine. which is another opioid also used for treatment of addiction, to be the opioids we should first use for pain because if patients became addicted to them then we would already also be giving the drugs to treat the addiction (I am only being half-way facetious as the problem is that there are no study showing that the proper treatment for people who take opioids for legitimate pain complaints and become addicted to them is methadone or buprenorphine).
1
If you are a pain management physician then I am the first cosmonaut to circle the earth. You can't OD on prescription fentanyl? Are you kidding me! The next thing you will say is OxyContin is non addicting. It's your cohorts in the AMA who hand out a hundred oxy or norco, along with a hundred xanabars , a bottle of adderal and soma every month. That's not pain management, that's being a narco trafficker. Everybody has ADD and is in chronic pain, business is good.
There can be no doubt that the current system in the US leads to high costs across many dimensions. Something has to give. I worry however, that Portuguese society is very different; the population is far small and less heterogeneous than in the US. Switching to the Portuguese model would take meticulous planning and enormous up-front costs. Even so, something has to give.
2
What worked in Portugal might or might not work in the US.
It takes serious (expensive) short and long term research to find out what really works. Does the NIH really want to fund such work? As opposed to the latest high tech medicine for the 1%? I don't see the will to do so.
2
I agree with the first statement but not the second. While there is no way to predict that, if adopted in the US, Portugal's model will yield similar results; however, there is voluminous research that proves 1. Portugal's approach works and, 2. Ours does not. Requiring more research to prove what is already known is folly. This would be akin to Elon Musk's disregarding 100 years of automotive engineering before founding Tesla.
As a substance abuse counselor and recovering addict/alcoholic, I can say that we know what works for harm-reduction, treatment, and sustained recovery. If there is research to be done, it should be directed at access to and delivery of services.
"Meanwhile, the U.S. has spent some $10,000 per household (more than $1 trillion) over the decades on a failed drug policy that results in more than 1,000 deaths each week."
U.S. drug policy is not a failure. Drug laws provide the bread and butter for America's justice system. Without draconian drug laws, America's police would have almost nothing to do, and the prison-industrial complex would collapse. Small town economies that depend on a local prison for employment would collapse. Not only that, falling prices for cocaine and heroin would undermine the flow of drug money that helps to finance America's war in Afghanistan.
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Thank you for the attention to such a serious issue. Such a complicated subject. The privatization our criminal justice system, the cheap political points score by politicians , in the enormous amount of money made by selling opioids all contribute to the horrendous situation in America today. As one whose life has been dramatically effected by drug and alcohol abuse, I can say unless and until we decriminalize and educate and do what we can To disincentivize businesses from making a profit, the sooner we can help our loved ones and save lives.
11
I am so sad to think of the country we could be. Yet we never seem to get there, and the status quoted is horrifying.
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Thanks Republicans
What makes you think we 'could be' that country? Pure speculation is easy. Also, a general categorization of 'horrifying' is, well, you're entitled to your opinions. Don't lose track of all the good which is also all around us.
Yes, America has not yet been great. I nurture a hope that we may, in the future, be a country in which we understand the great boon that diversity has been for us, in which we value every citizen and all benefit from working for every person to meet his or her potential.
Preventing sharing means less needle-associated diseases show up in Labor and delivery / newborn hospital units all over the world.
20
As far as I am concerned addiction is not a disease in the traditional sense; it is physical, moral, and spiritual weakness. The addiction lacks these qualities. When faced by challenging circumstances, the would be addict turns to drugs, usually marijuana initially, to create a temporary feeling of escape. The feeling of escape or "high" provides temporary relief, which must be repeated by ever stronger drugs. The circumstance that initially challenged the addict, that lead the attack to demise, must be addressed. Simply providing the addict more drugs and clean delivery devices does not cure or prevent the problem, only prolongs it, leading to a broader failure of society. Thank you.
6
I respect your position and understand where you are coming from. Certainly the underlying social and personal ailments that lead individuals to use mind-altering substances to escape should be addressed. In the meantime though it would be, to use your words, a moral and spiritual weakness for society to not do everything in its power to mitigate the risk of death and spread of disease that drug addiction poses. I disagree with your statement that by doing so we are "leading to a broader failure of society". Is taking the path of compassion weakening to a culture? Has the war on drugs created a more inclusive and strong society? Again, I agree with you that decriminalizing access to drugs is not enough in the long run, but it seems to be the first step in building a humane and compassionate approach to the issue of addiction. Thanks for your time.
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@ Southern Boy,
If you consider addicts to have a spiritual/moral "weakness", how would you deal with them?
What approach do you know of that "strengthens" such a "weakness"?
Do you have any data on successful "spiritual strengthening" programs?
I am unaware of any and would be interested.
Lacking that, the two approaches I have heard of are 1) punitive or 2) treat as a disease/disorder. (Substance abuse in general is listed as a category of psychiatric disorder.)
It seems that a disease model is much cheaper and more effective than a punitive one.
17
In response to Southern Boy: In our society, do we not help those who are born with debilitating physical weaknesses? And even if you were correct, that addiction can simply be attributed to moral and spiritual weakness (in addition to the physical weakness), don't we as a society want to help these people who are born with these weaknesses, rather than just criminalize them? You also speak of the "would-be addict"; what about the would-be alcoholic or would-be cigarette addict; why don't we throw them in jail for seeking substances that "create a temporary feeling of escape". And what if we cannot address, in time, the "circumstance that initially challenged the addict"? Because this often occurs when people are young, adolescent and dealing with all sorts of life issues...And no one who is a serious advocate of legalization as a better means of dealing with addiction than criminalization believes, as you state, that "simply providing the addict more drugs and clean delivery" is the answer.
You grossly misstate the case for legalization by stating it this way.
Ignorance ( of, for example, the evidence laid out in this article, which is contrary to your "as far as I'm concerned" opinions) and mistreatment of humans who are born with "weaknesses" are far more powerful causes that lead to the "broader failure of society" than addiction treatments that begin with a decriminalization approach.0
13
Our drug laws remain mired in money just as our alternate energy policies. There are too many companies making too much money locking people up. The energy companies make too much money to care that the future isn’t in oil and gas. As long as we have great wealth controlling our government there’s not only no incentive for them to push for logical solutions to terrible problems, or to pursue logical solutions for economic growth, there in fact is great incentive for them to leave things just the way they are.
Combine that with a Government stuck in the 1950’s and you get 1950’s solutions to 21st century challenges.
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Great article. Portugal's approach to the drug issue is an example of "Harm Reduction". Harm Reduction like needle exchanges can and do work to reduce the impact of addiction on the society. And it works, it saves lives and taxpayers money and it can undermine the power of the criminals to thrive in the illicit drug markets. We cannot stop all drug activity but we can reduce addiction's drag on our country.
The "War on Drugs" is an expensive failure. If we have not won it in 40 years why does Jeff Sessions think it can be won now? This war should be scrapped like Prohibition and we should take measures, as Portugal did, to reduce the impact on our world.
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Mr Sessions probably feels each minor pot-puffer thrown in a county jail is a meaningful victory in the War on Drugs. This is our AG. Yikes.
1
Don't believe it. This overstates the importance of the legal regime and understates (doesn't mention) cultural differences. The US has an entrenched drug culture; also a culture of pill-poppping which is why there is such powerful demand for painkillers; the US public just won't accept European-style restrictions on painkillers. The US of 65 years ago looked much like Portugal today with respect to drug use, albeit under a different legal regime.
By Kristof's logic SIngapore, with its draconian punishments for drug trafficking - and low rate of overdose deaths - could also be held up as proof that cracking down really does work. The common element with Portugal is really that it also does not have a US-style drug culture taking root (or not yet anyway).
Proponents of decriminalization might also want to consider Russia and alcohol. Yes, they haven't filled the prisons with traffickers, but legal alcohol causes enormous damage in Russia, because of the culture of drinking, which is the root issue.
This is not to say that criminalization works either. But decrimininalization will not turn the US into Portugal, because the underlying social and cultural dysfunction runs deeper.
5
Obviously no law turns one country into another country, ra.
However, the three choices are:
a) criminalization,
b) decriminalization, or
c) legalization.
a) costs a fortune and doesn't benefit anyone but the prison industry and does irreparable harm not just to the prisoner but to everyone around her or him.
b) reduces the cost to taxpayers by letting the problem continue (in Portugal, however, drug addiction has not increased), and recognizes that incarceration does more harm than good to most prisoners and reduces overdose deaths.
c) can generate huge revenue streams. But this encourages more usage, which leads to its own problems, as is the case of alcohol.
So which path should we follow?
22
The argument that legalization simply leads to more usage is not sound...and is far too general. To begin to address the issue, the US must first start by acknowledging that cannabis is not the same (in terms of addictive qualities or damage) as any other currently "illegal" drug ("drug", btw predominantly meaning "medicine".)
As someone else wrote above, the US needs to stop treating a 21st century issue with early/mid-20th century solutions. That do not work. For anybody.
3
Did Prohibition work for alcohol?
I can see that these programs seem to be working and that is good that lives are being saved. But to merely call addiction a disease is missing so much. Addiction is very different in its manifestations.
8
@ Mona,
What do you think is important not to miss about addiction?
1
You haven't said anything. Every disease is different from every other disease. If you want to claim that addiction is not a disease you are going to have come up with something better than "different".
1
The graphs say more than any picture or prose can. Portugal's program is successful in lowering deaths & improving public health.
Over 40 years ago, while I was involved in the USMC Human Relations program, drug use among Marines was one of the issues it dealt with as well as emerging issues of feminism & racial bigotry.
A few of us advocated a program of education & information to more effectively deal with Marines' drug use, but most unit commanders had no use for being "soft" on the "junkies".
The American drug problem has been exacerbated over the decades by the counter-intuitive lumping of all substances in the same Schedule 1 category. Any psychopharmacologist can explain how cannabis products are not the same as psychedelics which are not the same as opioids.
If any of our alleged "authorities" regarding drug use still think marijuana is a "gateway drug' leading to harder drugs, perhaps they should investigate how many users originally smoked tobacco, the original "gateway drug for many.
It's obvious the criminality paradigm of coping with drug use problems has failed for as long as it has been in use. It's time we followed other nations, such as Portugal & Spain in more effectively handle drug problems.
I used to tell Marines that education & factual information about drugs were the most effective way to deal with the problem. I would now add medical treatment & compassion to that equation.
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Strange, that calls for a sensible approach to drug addiction started appearing in mainstream Americans publications only when the victims were and are predominately white, as in the current opioid crisis.
In a country which loves of punishment (of other people), it will still likely prove next to impossible to de-criminalize drug use. Then again, we did succeed, even the 1980s, through sentencing and enforcement disparities, to criminalize the drug use of some, and not others. So there's probably hope. For some.
5
Did it work with another drug before? Alcohol was decriminalized. Prohibition ended. Prohibition was a failure.
2
Non-deep-south whites, at that.
Most Congressional politicians from both parties, most of whom are white, most of whom are between the ages of 70 and 80 years, support the status quo. Drugs are bad. End of story. No need to discuss it.
Because we now have a better understanding of basic neurobiological processes, as well as the molecular and genetic components that impinge on behavioral abnormalities, we are in a position to treat a wide variety of mental diseases and return those afflicted to happy and productive lives. Although we have not yet cured any of these diseases, we have, through research and enlightened treatment, made great strides in managing them. The same result could be achieved if we instituted a similar approach to the problem of addiction.
For good or ill, our government often chooses to influence or regulate the personal behavior of its citizens. But irrespective of one’s philosophical view on this matter, the first dictum should always be, first do no harm. As we have recognized that it is better to treat, rather than lock up, people with epilepsy, schizophrenia, or manic depressive illness, it would be far more productive to treat, rather than lock up, those individuals unfortunate enough to be addicted to substances such as nicotine, cocaine, alcohol or heroin. In short, sick people’s illnesses, whether it is diabetes, cancer, epilepsy, or addiction, should be treated, not criminalized.
41
PORTUGAL Sets a fine example for other nations to follow in the treatment of substance abuse. Imagine if the rate of new HIV cases could be slashed by 95% in the US by needle exchanges. And if the medical aspects of substance abuse could be treated medically instead of going through the criminal justice system. But that would curtail the profits for the privately owned US prisons.
26
Excellent article, very true. This is the only way to win such a war. Interesting that in Portugal they tried a "partial legalization". It might have less resistance that way.
4
Our AG Jeff Sessions is moving in the other direction, despite clear evidence that decriminalization works. We need new leadership on this issue at the federal level, but in the meantime it is up to our cities and states to adopt programs that treat addiction rather than punish it.
93
Prisons make money. Privatize and profit. The GOP way.
1
An idea worth exploring. Even a partial victory would be a marked improvement over the status quo, which is worsening daily.
30
As a parent who lost their only child to addiction, I came to the conclusion years ago that the only real way to solve it was legalization. When I say that, people are surprised. I think it’s because the imperative of justice is retribution. As soon as it is no longer a crime or moral failing and becomes a disease, compassion finds a way.
353
The problem with legalization as the answer is that its effectiveness as the answer to drug addiction in this country flies in the face of history.
During the last half of the 20th century opium products and cocaine were both completely legal and as easily obtainable as aspirin is today. The reason laws finally restricting access to them were instituted was because of the huge drug addiction problem in this country.
4
The article is clear in stating that legalization (or even decriminalization) alone is not an answer to drug addiction. The point is that criminalizing recreational drug use actually increases the societal costs of addictive behavior and does not address addiction at all.
Furthermore, cocaine and opiates were not completely legal during the last half of the 20th Century.
Finally, restricting access to useful but potentially harmful substances is achieved by requiring a prescription, and the effectiveness of this restriction does not rely on or equate with criminalizing drug use.
1
I'm very sorry for your loss, Jeffrey.
2
One of our country's significant deficiencies is that we have always favored "toughness" over compassion, mistaking the latter for weakness.
The other is our quest for simple answers and outcomes, failing to admit that even the best results will never be perfect.
Thank you, Mr. Kristof, for showing how compassion and acceptance of inevitable imperfections can go a long way in improving people's lives.
271
The problem in the United States is that there is a societal impulse to turn virtually everything into a moral problem, rather than seeing it as a practical matter. I suspect this is rooted in the nation's Puritanical roots.
Sadly, perpetual moralizing makes it all but impossible to enact sound, pragmatic social policy.
39
I have a hard time not seeing this as a moral issue. You nailed it right on the head! It HAS to be dealt with as a practical issue.
Another critical difference is that the treatment model in Portugal hasn't been "monetized" within a fee-for-service medical practice model (or insured program) that uses proprietary, expensive and restricted "medications" or "services" The public health model is freestanding, "opeh source" and parallel to the disease/medical practice model. I'ts simple Public Health Practice.
In the case of opioid addiction, the commerce of medical/disease care (and criminal justice systems) in many ways has corrupted our view. As the Portuguese here show us, there's a far more effective public health approach that's not in a Doctors office, courtroom or police van.
216
Does that mean the Docs are also impaired?
I have a loved one who nearly died of drugs. It seemed foregone for awhile.
She was saved by a counselor. She is now a counselor herself with a masters degree. She's amazingly smart and tough.
I knew another, a client, who ended in prison for drug use. Just use, small quantities. He is an amazingly gentle soul, and means well. Everyone seems to like him, even the cop who busted him. The cop was worried he'd freeze to death in the parking garage where he was arrested. He just drifted, and acted foolishly.
These are the type of person we lose when we lose so very many people to drugs. I fear too many Americans considering this as a political question just write off these people as worthless. They're not worthless. The waste of human potential is a loss to all of us, and a crime against humanity.
324
The loss of human potential is irrelevant in a world with 7.4B people and country with 324M. We don't need to judge from either extreme -- they're worthless bums or free-of-guilt sufferers of congenital disease. Let people make their own choices and stop the real war, which is on society and not on drugs. Give them all they want on an electronic card like EBT.
2
Does the gentle soul realize that the money he paid for his drugs went straight into the pockets of drug cartels, who use that very same money, his money, to buy arms and ammunition, to rape and murder, to corrupt government officials and buy off police?
4
J Jencks -- "Does the gentle soul realize that the money he paid for his drugs went straight into the pockets of drug cartels"
And why is that? Do those who keep drugs illegal not realize that their laws don't stop drugs. Their laws create the criminal cartels that violate those laws.
Prohibition created the organized crime of the Rum Runners. The crime ended with Prohibition, not with all Americans giving up on drinking. I don't defend drinking, but I don't defend Prohibition either.
2
Thank you again, Nick; this is it! This Portugal plan is exactly how to treat addiction as a disease and all your stats. and econ. info. are correct. I work with opioid/heroin/meth/weed/alcohol (whatever their DOC (Drug of Choice happens to be) addicted every day and the approach works - with, and this is critical - a good recovery program. I believe in the 12 Steps and AA but other programs may work too. Anyhow, there's a program called LEAD (I think that's it) in Seattle, WA that's small but doing the same thing as Portugal - check it out. We have similar programs starting in the U.S. - let's do whatever we can to encourage them!
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Link to LEAD in Seattle.... http://www.addictionpolicy.org/single-post/2017/02/07/LEAD