NYU public health experts applaud decriminalization as a public health victory—and call for continued reform.
While November’s election revealed a divided country, American voters agreed on one issue: the need to reform the nation’s drug policies. In every state where a measure to loosen restrictions on drugs was on the ballot, it won.
Four states—Arizona, Montana, New Jersey, and South Dakota—voted to legalize recreational cannabis, and Mississippi and South Dakota legalized its medical use. Both the District of Columbia and Oregon eased restrictions on psychedelic drugs: DC decriminalized psychedelic plants, including psilocybin—the psychedelic compound in “magic mushrooms”—and Oregon legalized the use of psilocybin in mental health treatment. (Research, including studies at NYU Grossman School of Medicine and Johns Hopkins University, shows that psychedelics may be a promising treatment for anxiety, depression, and substance use disorders.)
The most significant drug policy reform also came from Oregon, which became the first state to decriminalize small amounts of all drugs, including heroin, cocaine, and methamphetamine. Now, instead of facing arrest and prison time, a person found with drugs will be required to pay a $100 fine or undergo a health assessment with an addiction specialist—a policy that treats drug use as a public health issue, not a criminal justice issue. Using funds from taxes on cannabis sales, Oregon will also increase access to drug treatment services.
The election “was a banner day for drug policy advocates,” said Danielle Ompad, associate professor of epidemiology at NYU School of Global Public Health (GPH) and deputy director of the Center for Drug Use and HIV/HCV Research (CDUHR).
Ompad and fellow CDUHR substance use researcher and GPH Opioid Overdose Prevention Program director Alex Bennett shared their key takeaways about the new, more humane and health-centered drug policies—and about what additional changes they hope to see in the future.
New state policies may have a national effect.
Cannabis is still classified as a Schedule I drug by the Drug Enforcement Administration, which states that it has no medical use and a high potential for abuse. Yet more than half the country—34 states, DC, and four US territories—has legalized medical cannabis, and November’s vote added Arizona, Montana, New Jersey, and South Dakota to a growing list of states that have legalized it for recreational use. Ompad and Bennett said we’re witnessing a domino effect, thanks to a growing appreciation of the drug’s therapeutic benefits.
“Americans in more states have spoken, and it is just a matter of time before the federal government follows suit,” said Bennett. “The passage of these new laws reflects the growing support among many Americans for a more rational, balanced approach to drug policy that moves away from a law enforcement-driven model and towards a public health-driven model.”
This week may be a test of the impact of state actions on national policies, as Congress is expected to vote on the Marijuana Opportunity Reinvestment and Expungement (MORE) Act of 2019.
“The MORE Act would decriminalize marijuana at the federal level and remove it from the list of controlled substances,” explained Ompad. “Removing cannabis from Schedule I—and from the drug schedule all together—is a high priority for drug policy advocates.”
Decriminalizing drug use is a victory for public health.
By legalizing or decriminalizing drugs, governments can regulate them, gaining control over quality and safety, and eliminating black markets. This reduces the risk that the drug supply will be adulterated—such as by adding fentanyl, a synthetic opioid, to other drugs, which is causing a surge in overdoses.
Public health experts are also eager to see a decline in drug-related incarceration.
“Simply put, incarceration is bad for public health, bad for people, bad for communities,” said Bennett. “Research has shown that even a short, three-day stint in jail can significantly increase a person’s risk for opioid-related overdose upon release.”
Moreover, states that have legalized recreational cannabis can generate income from taxes on sales, which can be used to expand drug treatment and other social services.
The “war on drugs” has disproportionately hurt communities of color.
In 1971, President Nixon declared a “war on drugs,” leading to millions of arrests for drug violations and “mass and inequitable incarceration of Black and Brown people,” said Ompad.
Research shows that, rather than working to address social problems rooted in long-term economic and structural inequalities, punitive drug policies have been instrumental in deflecting political attention away from underlying issues.
“It has been easier to incarcerate already marginalized groups than to address systemic racism, poverty, and inadequate health care and education,” said Bennett. “Criminalizing drug use has devastated communities, eliminating thousands upon thousands of people of color from the competitive labor market while simultaneously creating an industry to maintain their oppression, with resources directed to policing and corrections to perpetuate this cycle.”
Bennett cautioned that the harms—to individuals, families, and communities—brought about by the “war on drugs” should not be erased from public policy discussions now that criminalization approaches are being replaced by more therapeutic ones.
“The harms created by drug prohibition will be here for decades to come, as children who visited their mothers and fathers and grandfathers in prison deal daily with the trauma related to the imprisonment and how it has impacted their communities,” he said.
We need to do more than decriminalize drugs.
Bennett and Ompad note that thousands of people remain in prison for minor drug offenses, including actions that would no longer be punishable with incarceration under new policies.
“Decriminalization does not return the many years of life lost by people arrested and imprisoned for non-violent drug crimes. We need to make decriminalization retroactive, throw out convictions for non-violent drug offenses, and compensate those who were incarcerated for the years of life lost,” said Bennett.
“Seventeen states have already passed expungement policies so that past marijuana convictions can be expunged, vacated, set aside, or sealed from public view,” said Ompad.
Increasing access to drug treatment is still needed.
Oregon is creating new drug treatment centers to meet the state’s growing need for treating rather than punishing people who use drugs. But CDUHR experts say more should be done nationwide to ensure people have access to evidence-based treatment.
“The stigma and judgement associated with drug treatment continue to harm people who use drugs and to hinder them from accessing it,” said Bennett. “Barriers need to be taken down so that people can access treatment in a safe environment.”
Bennett points to one area with room for improvement: medications for opioid use disorder, specifically the unequal systems for dispensing methadone and buprenorphine. While both medications can help people get off and stay off opioids, methadone requires daily visits to federally regulated clinics and is often targeted at lower income communities. Buprenorphine, on the other hand, can be given in private doctors’ offices, which are more often visited by white, more affluent people. Researchers say that policies should work to promote buprenorphine use in lower income communities to ensure they have access to this evidence-based treatment.
All eyes are on Oregon.
As substance use researchers, Ompad and Bennett will be closely following the outcomes of Oregon’s decision to decriminalize all drugs.
“As these new policies are being implemented, we will start to look for metrics of success,” said Bennett. “For example, is there a decrease in the jail and prison population that is drug-related? Is there an increase in the utilization of social services? Do more people seek medications for opioid use disorder? Do we see an increase in the policing of other types of crimes? Does drug use go up? Is there an increase or decrease in drug-related deaths or infections?”
Bennett said it will be important to monitor how the new drug policies are enforced, and to ensure that vulnerable groups—including people of color and those without stable housing—are not disproportionately burdened with fines or health assessments.