Read original article in the Financial Times
The news that Johnson & Johnson has been ordered to pay $572m by the state of Oklahoma over its contribution to the US opioid crisis is just the latest skirmish in a seemingly never-ending war on drugs.
The drug war never ends because the strategy is always backwards. In the US, the fight began in the Nixon administration. Richard Nixon saw the devastation being caused by drug addiction and responded by trying to restrict supply. That has been the strategy ever since.
I remember one incident when I was director of the Office of Management and Budget. Daniel Patrick Moynihan, then counsellor to the president, and I were heading to Camp David, where I was to make a presentation.
Pat was in a state of great exuberance: “Don’t you realise?” he said: “We just had the biggest drug bust in history! We confiscated 50 tons of cocaine!”
I congratulated him. “Great work,” I said. Pat replied: “This was in Marseille. We’ve broken the French Connection.” Then he added: “I suppose you think that as long as there is a big and profitable demand for drugs in this country, there will be a supply.” I looked at him. “Moynihan, there’s hope for you,” I said.
Nearly half a century later, there is still no dearth of supply. The opioid crisis shows how addiction often begins with a prescription. New technologies will only make drugs more plentiful and potent. One shipping container of synthetic fentanyl could supply the entire US illicit opioid market for a full year, according to a recent Foreign Affairs report. Marijuana is four times more potent per dollar than it was in the 1990s — now a $40bn market. In California it can be ordered to your front door by iPhone. And nearly half of prime age American men who do not work now take daily pain medication, prescription or otherwise.
Many people in the US are in jail for drug use. According to the Department of Justice, one-third of all federal arrests and one-quarter of all state and local law enforcement arrests are illicit drug-related. Four-fifths of these drug abuse violations are for possession alone.
Let’s face it: the supply-oriented war on drugs has failed.
If we look around the world for solutions, we can see that in Portugal drug use and possession are still illegal but the offence was decriminalised in 2001. Police issue citations to users, leading to a mandatory but non-adversarial drug commission hearing, within 72 hours, that focuses on situation-specific rehabilitation and treatment rather than jail time. Drug users can find help at treatment centres without fear of arrest.
Evidence shows some degree of success with young drug users — school-aged drug use in Portugal decreased for almost every illicit drug over the first decade of the programme. Success is more limited with older addicts, but the number of people seeking treatment at centres has doubled. If other countries adopted this strategy while maintaining efforts to restrict supply, the result would be a gradual shrinking of demand for illegal drugs and a decline in violence in supplier countries.
In the US, some states and localities are trying. Hawaii’s Hope programme, for example, which has now been replicated elsewhere, takes a similar approach to Portugal’s on drug offences committed by those on parole. Positive drug tests among participants in a trial programme fell by four-fifths versus other parolees, along with a halving in rearrests. Across the country today, 15,000 rehab centres already provide drug and alcohol treatment at varying levels of expertise and efficacy, at an annual cost of over $30bn.
To place demand reduction at the centre of our anti-drug strategy, though, we need to measure what works. A 2018 study of hundreds of anti-drug educational programmes asked this question by estimating their benefits and costs. Results ranged from $0.62 social benefit per dollar spent — that is, not cost-effective — to as high as $64 per dollar. There’s a good investment.
The opioid crisis underlines the fact that a harmful substance can be manufactured domestically and is as likely to come from a pharmacy as a street corner. The medical profession needs to wake up and warn anyone who gets a prescription about the dangers of addiction, and anyone who overdoses should be immediately assigned to a treatment centre.
Decades ago, the surgeon general of the US issued a powerful statement about the health hazards of cigarettes. A vigorous anti-smoking campaign was launched to confront the tobacco industry. The result of that campaign was a dramatic decrease in cigarette smoking, from 43 per cent of Americans in 1964 to just 15 per cent today. The trend in the UK is nearly identical.
Let’s wage a winning war on legal and illegal drugs by highlighting their dangers while decriminalising possession and providing treatment, without stigma, to ultimately reduce demand.