As the world gathers in Washington this week for the International AIDS Conference, it will be an excellent opportunity for the U.S. to engage in dialogue with the international community. Note that word: dialogue. It involves talking and listening. Hosting the conference for the first time in more than 20 years is a great first step, but the U.S. needs to take more than a first step – particularly when it comes to drug policy.
Why is it that U.S. legislators are so unwilling to consider successful policy initiatives from abroad? Why are Americans so determined to be “exceptional” at the expense of our own health and wellbeing?
While the U.S. has been mired in a failed drug war, much of the world has begun to move on. Over the past two decades, a number of countries have been quietly implementing evidence-based programs that deal with the harms associated with drug misuse, and importantly, the harms associated with drug prohibition. There are no perfect solutions to drug abuse and addiction, but it's time we put all options on the table.
The drug czar’s Office of National Drug Control Policy should be looking to the international community for ideas about what works. In particular, four evidence-based solutions have reduced disease, death, crime and suffering in other countries. U.S. policymakers should pay close attention to these solutions.
1. Sterile syringe access program
Let’s start with an easy one – sterile syringe access programs. We know from decades of research and implementation the world over that these programs prevent the spread of HIV/AIDS and hepatitis C among people who inject drugs. And yet our federal government still prohibits the use of federal HIV prevention funding for syringe access programs, citing erroneous drug war rhetoric about “encouraging drug use.” While we could consider all of the data from around the world, in the case of syringe access, we have plenty of evidence from locally funded programs here in the U.S. that have proven this scare-mongering to be untrue. Syringe access programs prevent the spread of HIV/AIDS and do not encourage or increase rates of drug use. Period. This has been proven from Bangkok to Bakersfield – so why is Washington dragging its feet?
2. Safe places to inject under supervision
Next up is another proven method of preventing HIV and other diseases. Safe injection facilities (SIFs) are places where people who inject drugs can do so under medical supervision. These facilities reduce overdose deaths and the spread of diseases such as HIV/AIDS and hepatitis C, and also to draw hard-to-reach users into treatment and rehabilitation. While the idea of facilitating intravenous drug use might raise eyebrows as syringe access once did, the results are incontrovertible. More than 90 facilities are serving clients -- and saving lives -- as we speak, in countries including Canada, Australia, the Netherlands, Spain and Switzerland. It’s time we started raising our eyebrows at a government willing to ignore the evidence in favor of drug war rhetoric.
3. Heroin-assisted treatment programs
This next innovative idea saves lives and is successfully treating opiate addiction in a number of European countries including Denmark, Germany, Switzerland and the U.K: heroin-assisted treatment. This treatment involves strictly regulated and controlled prescription of pharmaceutical heroin to help severely dependent heroin users who have not succeeded with other treatment options. The programs have been shown to significantly improve participants’ health, their housing and employment situations, and to dramatically decrease criminal behavior. Impressive results like these should have this idea on the tip of every legislator’s tongue.
And, finally, the success story that has dramatic implications for drug policy the world over: decriminalization. Ten years ago Portugal shifted its method of dealing with drug use and misuse from a punitive approach to a health-centered one by rapidly expanding access to treatment and decriminalizing drugs – all of them. Rates of overdose and HIV infection have dropped precipitously and none of the hysterical predictions of Lisbon becoming a drug tourism capital have materialized. In fact, following the introduction of decriminalization, Portugal has maintained drug use rates well below the European average – and far lower than the United States. Most importantly, youth drug use rates have dropped – a goal we can all agree on. It’s a bold experiment – but didn’t the U.S. used to be a place known for its bold experiments?
These four ideas have something interesting in common. The places implementing them are measuring their success through the health of their citizenry. Novel. Meanwhile the U.S. continues to measure its drug war progress in tons of drugs seized and number of citizens we put behind bars.
It's time to step back and ask ourselves what's the best way to solve the problem we're trying to solve – how to reduce drug abuse and addiction – and use the best available evidence to guide us. The United States has gained a reputation as an innovator in countless arenas, but perhaps the true measure of our exceptionalism will be our willingness to set aside our pride and learn from the successes of others.
July 23, 2012
Why Can't Americans Try New Ways to Reduce Drug-Related Disease ?