HRC and Progressive Drug Policy

In Johann Hari’s great new book on drug addiction and the drug war, “Chasing the Scream”, he recounted a story about Switzerland’s first female president, Ruth Dreifuss:

The police officer who accompanied Ruth Dreifuss had tears in his eyes. He was taking the future president of Switzerland through an abandoned railway station in Zurich, down by the river. All the local drug addicts had been herded there, like infected cattle.

Ruth had been looking out over scenes like this for years now. A few years before, she had been to the park in Bern that played the same role there. There were girls being openly prostituted out and there were addicts staggering around, out of control, incoherent. There were people injecting themselves “in places you couldn’t imagine,” she says, because every other vein couldn’t be traced, as if it was trying to escape. Above the bustle, dealers were yelling their prices at the top of their voices. As she heard them, Ruth thought of Wall Street brokers, barking on the trading floor. The threat of violence hung over everything as dealers fought for customers.

Most Swiss people had never seen anything like this. The police were not just crying; they were afraid. This was Switzerland in the 1980s and 1990s, but it was an affront to everything the Swiss thought about themselves.

That was 20 years ago, and since then, Dreifuss went on to spearhead one of the most successful drug policy experiments in the modern world.

Earlier this month, Hillary Clinton released a proposal to deal with America’s growing heroin problem. In an editorial in the New Hampshire Union Leader, she wrote:

ON MY first trip to New Hampshire this spring, a retired doctor spoke up. I had just announced I was running for President, and I had traveled to Iowa and New Hampshire to hear from voters about their concerns, their hopes and their vision for the future. He said his biggest worry was the rising tide of heroin addiction in the state, following a wave of prescription drug abuse.

To be candid, I didn’t expect what came next. In state after state, this issue came up again and again — from so many people, from all walks of life, in small towns and big cities.

In Iowa, from Davenport to Council Bluffs, people talked about meth and prescription drugs. In South Carolina, a lawyer spoke movingly about the holes in the community left by generations of African American men imprisoned for nonviolent drug offenses, rather than getting the treatment they needed.

Writing at Vox, German Lopez finds a lot to like about Clinton’s proposal:

Clinton’s $10 billion Initiative to Combat America’s Deadly Epidemic of Drug and Alcohol Addiction is the most ambitious attempt of any presidential candidate to tackle America’s struggles with drug abuse. It’s an approach that public health and drug policy experts have demanded for years. But Clinton is the first candidate to dedicate such a large sum of money to the cause — and if approved by Congress, it could help combat what some public health officials and experts have called a drug overdose epidemic.

The big idea behind Clinton’s plan is to shift public policy on drug abuse and addiction from the criminal justice system to the health-care system. It would also help fill a big gap in health care: Nearly 90 percent of people who have a drug or alcohol abuse problem don’t get treatment, according to federal data.

The need to move away from our criminal justice approach to drug addiction has been urgent for awhile. On this point alone, Clinton deserves a lot of credit for getting with the times and rebuking the old approach. Her proposals for diverting addicts out of prison into treatment, to provide first responders with overdose prevention drugs, and to compel insurance companies to cover addiction treatment costs are all important and long overdue. Cracking down on doctors who prescribe opioids makes me a little nervous as this power has been greatly abused by prosecutors, but on the whole there’s more to like than dislike in this proposal.

Here in Seattle, for instance, the promising LEAD program is something that could ideally be expanded with this approach. LEAD’s four year experiment in Belltown diverting addicts to treatment instead of jail has been hugely successful at reducing subsequent arrests. But the funding for it isn’t a guarantee from year to year. Federal matching funds for this and similar programs around the country could reduce both local health care and criminal justice costs.

Funding those types of treatment programs would certainly be a great start, but there’s more we could do, and some of it is already being done elsewhere.

Up in Vancouver, the inSite safe injection facility is a place where addicts can safely use drugs without fear of arrest. Medical professionals are on hand to deal with medical emergencies and to counsel those trying to quit. The efficacy of this approach has been studied for years now, and the results are overwhelming. Allowing addicts to have safe place to use heroin has led to less crime and more addicts diverting into treatment. It has also lowered the rates of AIDS and Hepatitis cases and greatly reduced the amount of overdoses. It’s worked so well that despite pressure from an ideological Harper government, the Mayor of Montreal is willing to break the law to open one in his city.

Would Clinton’s proposal allow for a facility like inSite in the United States? The city of San Francisco tried to open one in 2007, but South Carolina Senator and noted federalist Jim DeMint used his position in the Senate to force the city to abandon its plans. It’s possible that even if Clinton became President and supported it, a Republican-led Congress would have the power and motivation to kill it once again.

But let’s go back to Switzerland, where they did something even more radical and progressive than that. Again from Hari’s book:

It had been discovered a few years before in Switzerland that there was a clause in Swiss law that allowed heroin to be given to citizens provided it was part of a scientific experiment. So far that had been done with only a tiny handful of people.

So Ruth said–Okay, we are going to have a really large experiment. We are going to make it much easier for any addict who wants it to get methadone, and for the people who can’t cope with that, we will prescribe them heroin. Switzerland has a political system built on consensus. No one official can drive a policy on her own. She needed to persuade her colleagues, and the cantons. So Ruth fought for it. This is an emergency, she explained, and in emergencies, you take dramatic steps.

Everything Americans have been conditioned to believe about drugs and drug addiction leads us to believe that this approach is completely nuts. We believe that anything but a cold turkey approach to drugs invites complacency and encourages more drug use. But much to the surprise of strict prohibitionists, the experiment worked, and Swiss voters overwhelmingly voted to keep it legal in 2008. The number of Swiss who regarded drug addiction as a serious problem plummeted from 64% to 12% between 1988 and 2002.

Many myths of heroin addiction and recovery were shattered by this experiment. Addicts did not continually demand higher and higher doses. They didn’t become complacent and give up on trying to kick their addictions. In fact, the opposite happened. The addicts receiving maintenance treatment became more likely to slowly wean themselves off the drug or to seek alternate treatments like methadone.

An approach like this remains explicitly illegal in the United States. Doctors are prohibited from prescribing heroin to anyone. Many of them are targeted by prosecutors simply for not being stingy enough when prescribing legal opioids to pain patients. Moving us in the opposite direction would require a lot of political courage. Could Clinton do it? Would she fight for it the way Ruth Dreifuss did?

The prohibitionist mindset tells us that the availability of drugs is the main determinant of drug use. But this is completely wrong. It’s certainly one determinant, but many other factors play into the equation, and have a far greater impact. After doing the research for his book, Hari came away believing that the presence of deep emotional scars was the predominant precursor for addition. People in that situation had to be helped to help themselves. But trying to enforce a prohibition by sending countless people through our criminal justice system tends to have the opposite effect, along with a whole host of unintended consequences.

This remains difficult for many Americans to accept and understand. We still tend to think of addicts as freeloaders, and the act of taking drugs as a form of rebellion that we shouldn’t give in to. This mindset only becomes shattered when someone we know and love falls victim to an addiction. Maybe the Swiss are more able to see the addicts in Needle Park as their brothers and sisters in ways that we here in America can’t. Or maybe we’re finally reaching that turning point in public understanding, just as we’ve reached a major turning point on pot prohibition in the past decade. However close we might be to a truly progressive drug policy, Hillary Clinton seems willing to move us closer to that point, and that might be good enough for now.