Top doctors agree: treatment, not jail, for nonviolent drug abusers

In deciding to bring back the heavy-handed “war on drugs”, Attorney General Jeff Sessions is ignoring the advice of the 148,000 physician and medical student members of the American College of Physicians, the largest physician specialty society and second-largest doctor membership group in the United States. 

Following an extensive review of available studies, reports and surveys on the prevention and treatment of substance use disorders (which includes users of illegal drugs, like heroin, as well as those misusing legal substances like alcohol and prescriptions, ACP concluded that it would be more effective to address the health consequences of drug misuse principally as a public health issue rather than a criminal justice one.  “Substance use disorders are treatable chronic medical conditions that should be addressed through expansion of evidence-based public and individual health initiatives to prevent, treat, and promote recovery” the doctors’ group wrote.

“Whereas previous generations incarcerated drug users, the embrace of the ‘addiction as chronic disease’ paradigm has helped to direct attention toward a therapeutic approach to tackling the problem. Treatment of substance use disorders is similar to the management of other complex chronic diseases and requires coordination among providers, navigation of care systems, and efforts to engage patients in self-management of their illness.”  ACP called for “implementation of treatment-focused programs as an alternative to incarceration or other criminal penalties for persons with substance use disorders found guilty of the sale or possession of illicit substances.”

Offering illicit drug users treatment rather than incarceration can save both dollars and lives.  The ACP paper cited a study by Philadelphia’s own Temple University and RTI International which found that placing people who use drugs in community-based treatment programs rather than the criminal justice system would save billions of dollars and reduce crime rates. The model determined that if 10% of eligible offenders were sent to community treatment-based programs rather than prison, nearly $5 billion would be saved compared with current practices.” 

ACP concluded by noting that “Substance use disorders have been regarded as a moral failing for centuries, a mindset that has helped establish a harmful and persistent stigma affecting how the medical community confronts addiction. We now know more about the nature of addiction and how it affects brain function, which has led to broader acceptance of the concept that substance use disorder is a disease, like diabetes, that can be treated. . . Physicians can help guide their patients toward recovery by becoming educated about substance use disorders, proper prescribing practices, consulting prescription drug monitoring programs to reduce opioid misuse, and assisting patients in their treatment. Policymakers can mitigate the effects of drug use by permitting harm reduction strategies, such as syringe exchange programs; supporting initiatives to increase the behavioral health workforce; testing evidence-based prevention and stigma-reduction programs; and encouraging treatment of substance use disorders among the incarcerated and diversion programs for those with nonviolent drug arrests.”

Regrettably, the Justice Department under Attorney General Jeff Session is not heeding the doctors’ advice.  Reversing the Obama administration’s policies to reduce long prison sentences for non-violent drug users, the department is “preparing a plan to prosecute more drug and gun cases and pursue mandatory minimum sentences . . . [returning to] the national crime strategy of the 1980s and '90s from the peak of the drug war, an approach that had fallen out of favor in recent years as minority communities grappled with the effects of mass incarceration.”  And, the GOP bill to repeal Obamacare would have eliminated the requirement that Medicaid and all private health insurance plans cover the costs of substance use treatment.

So let’s be clear: the Trump administration’s renewed “war on drugs” is really a war on the millions of non-violent persons who use illicit drugs, which the doctors know to be a treatable medical condition.  It’s a war on families, putting loved ones in jail (where they are unlikely to get any treatment for their disorder) instead of helping them to get well.  It’s a war on communities, especially minority ones, depriving them of persons who could be productive contributors if they were able to get treatment instead of being sent away to prison.  It’s also a colossal waste of money: the Drug Policy Alliance, a group that favors reforming laws to de-emphasize criminalization and focus instead on treatment, estimates that the United States over the past 40 years has spent over $1 trillion on the failed “war on drugs.” 

President Trump and Attorney General Sessions: the front-line doctors who see the impact that substance use disorders have on patients, their families, and their communities know better: Don’t jail  patients with substance use disorders, help them get the care they need to get better.