Why U.S. Presidents Can't Win The War On Drugs

While the decriminalization effort Measure 110 failed to fully meet the mark, the Health Justice Recovery Alliance joined forces with local law enforcement to create a pilot program that helped locals struggling with addiction. Through the program, police can contact an outreach worker who will come to the scene and connect the person struggling with addiction to support services such as detox care and housing, helping lead them toward long-term recovery. So far, the pilot program has helped over 200 people.

In less than three and a half years, Safeworks, the only supervised drug-use site in Calgary, saved thousands of people from opioid-overdose deaths and helped users for whom abstinence-based treatment didn't work. The government of Alberta deemed the site a scene of "chaos" and ordered it closed once two new sites open. Safeworks supporters oppose the disruption in harm-reduction work that move would bring, considering how critical personal relationships built on trust are to this kind of service.

Supervised injection sites in Canada have prevented hundreds of heroin overdose deaths. Now, New York City is looking to follow Canada's lead with a city-wide initiative to establish safe injection sites. While the Trump Administration is not in support of such sites, experts believe that it is unlikely that the federal government would interfere with a site if a city is in support of it.

In the 20 years since Portugal decriminalized possession of personal amounts of all drugs, deaths from HIV and overdoses declined and more people take advantage of expanded drug treatment programs. Treating the country's addiction-related problems as a health concern rather than a crime has been embraced domestically and copied by other places, including most recently in the U.S. by Oregon. Portugal's experience serves in part as a cautionary tale about tailoring policies to local conditions and following through on ideals with clear, measurable approaches. Copying the program outright is not simple.

Rules changes designed to prevent the spread of COVID-19 at drug-treatment clinics had the benefit of improving access to treatment, which experts say has saved thousands of lives. Although overdose deaths have increased during the pandemic, they would be far higher but for emergency rules allowing for telehealth consultations with medical professionals, fewer restrictions on the use and storage of long-term supplies of methadone, and insurance coverage of addiction medications. Though not everyone prefers telephone consults over in-person visits, enough do that advocates want to make the changes permanent.

Since introducing both the decriminalization of a range of substances like heroin and cocaine and new harm-reduction strategies in 2001, Portugal has seen success in driving down HIV cases, overdoses, and needle sharing. The country attributes their progress to treating the issue of drug use as a human rights issue rather than a criminal one, because they consider external factors that contribute to addiction like gender, class, or race.

In 2001, facing a 20-year opioid epidemic, Portugal decriminalized all personal drug use, meaning people carrying drugs for personal use could no longer face prosecution or jail. The approach, met with public support, offered people access to services like safe injection sites and counseling and showed demonstrable success in declining opioid related deaths, the spread of infectious diseases, and drug use all together. As the rest of the world faces a similar crisis, Portugal could be a model response.

Rather than treat opioid users like criminals, Vancouver has deemed it a public health crisis. The city, especially its downtown east side, witnessed 1,500 deaths in just one year from opioid use. Its approach is unique and multi-pronged – making Narcan, an overdose antidote, available to everyone, opening safe injection sites, and having a police presence – without arrests – on blocks where using remains high.

In New Hampshire, many actors are participating to coordinate solutions to the opioid crisis. Among the most effective solutions are training physicians to help patients manage pain without opiates, helping patients wean off opiates, and maintaining rapid response teams to respond to potential overdoses.

Doctors at Johns Hopkins and Rutgers New Jersey Medical School are striving to establish new guidelines that are specific to surgical procedure and patient circumstance for prescribing opioids. The general consensus is this: every patient's needs must be assessed individually, alternatives to opiates should always be considered first, and no patients with acute pain should ever be sent home with more than a few days' worth of opiates.