Research shows that decriminalization of drug possession, combined with other harm reduction efforts and treatment services, is an important component of efforts to improve public health and health equity.
It was early in medical school when I encountered the first of many patients who had spent years in jail or prison for drug possession. On this particular morning, I met a 42-year-old male who was recently released from prison… again. I listened as he described his tumultuous childhood, physical abuse, sexual trauma, untreated mental health conditions, and various suicide attempts. He recounted his many arrests, most of which were for possession of marijuana and cocaine—drugs he possessed for his own personal use… and he resented the fact that he was offered little support in his recovery from addiction while in jail and prison.
This patient’s story is all too common. In 2019, 45% of inmates in federal prisons were incarcerated for drug offenses, and nearly 80% of drug-related arrests were for drug possession. However, there is no research to demonstrate that incarceration is an effective means of deterring drug use. In fact, it is quite the opposite; data from various countries strongly support decriminalization. For example, Portugal [PDF] decriminalized drug possession for personal use of illicit drugs in 2001, and since that time, the country has experienced the following:
- reduction in drug use among certain vulnerable populations;
- increases in the numbers [of people] accessing treatment services;
- significant decreases in HIV transmission rates and new cases of AIDS [PDF] among people who use drugs; and
- significant reduction in drug-related deaths.
The President of the International Narcotics Control Board [PDF] in 2015 named Portugal’s decriminalization policy as “a model of best practices.” Another example is the Netherlands [PDF], which decriminalized drug possession in the 1970s and now has one of the lowest rates of IV drug use and opioid-related deaths in the world.
The Federal Bureau of Prisons does provide inmates the opportunity to participate in substance use treatment programs, but due to the exponential growth in incarceration for drug offenses, there are long waiting lists for inmates to be enrolled in these programs. In 2012, Roger Werholtz, former director of the Kansas Department of Corrections, said that “Until we re-evaluate policies on drug abuse, nothing changes… There needs to be a modified approach that includes treatment outside of prison and penalties that don’t make addicts and dealers career prisoners.” As demonstrated by research, drug use is best approached with a treatment rather than correctional lens.
Furthermore, the misguided drug laws and harsh sentencing requirements [PDF] that have led to such high incarceration rates disproportionately affect people of color, which further perpetuates systemic racism in the United States. It is well documented that people of color are more likely to be stopped, searched, arrested, convicted, and harshly sentenced [PDF] when compared to the Caucasian population, and this also bears out in regards to drug offenses. Black people make up 13% of the US population, and though they are documented to use illicit drugs at analogous rates to persons of other races, black people are arrested more frequently and comprise approximately 40% of persons incarcerated in state or federal prisons for drug offenses. Likewise, Latinx persons make up 18% of the US population but comprise 38% of persons incarcerated in state or federal prisons for drug offenses. Approximately 80% of those incarcerated in federal prisons [PDF] for drug offenses, and nearly 60% of those incarcerated in state prisons [PDF], are Black or Latinx.
Drug law violations are far-reaching, thereby impacting voting rights, employment, business loans, student aid, public housing, child custody, and more. When people are convicted for drug possession, it is not only ineffective at deterring future drug use, but also has huge impacts on their social, economic, and political lives [PDF].
The World Health Organization and United Nations issued a joint statement in 2017 that called for:
Reviewing and repealing punitive laws that have been proven to have negative health outcomes and that counter established public health evidence. These include laws that criminalize or otherwise prohibit gender expression, same-sex conduct, adultery and other sexual behaviors between consenting adults; adult consensual sex work; drug use or possession of drugs for personal use; sexual and reproductive health care services, including information; and overly broad criminalization of HIV non-disclosure, exposure or transmission.
Decriminalization must be combined [PDF] with other harm reduction efforts and treatment services in order to robustly address the opioid epidemic. Yet, decriminalization is a vital component, as it decreases stigma, reduces fear of prosecution, and eliminates laws that exclude people with history of arrest or incarceration from fundamental rights [PDF].
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