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Addiction Medicine Speaker Focuses on Downside of Criminalizing Drug Use - Yale School of Medicine

Every 23 seconds, someone is arrested for drug possession in the United States. The drastic consequences can follow that individual for life.

The war on drugs has funneled over a trillion dollars into extensive policing that disproportionally affects Black and brown communities. To address the widespread consequences of the “war on drugs,” as well as the potential public health benefits of decriminalization, the Yale Program in Addiction Medicine invited Maritza Perez, JD, director of the Office of National Affairs of the Drug Policy Alliance in Washington, DC, to speak virtually to the Yale community on July 13. The presentation served as part of the program’s larger Finding Solutions for the Opioid Crisis speaker series in concert with the Sandgaard Foundation.

“Perez is an extremely knowledgeable, well-trained person who is able to articulate the various facets of the impact of criminalization of substance use on the lives of a variety of individuals, including those who are minorities,” says David A. Fiellin, MD, professor of medicine (general medicine), of emergency medicine, and of public health, and director of the Yale Program in Addiction Medicine. Not only that, he continues, but she also understands that important work needs to be done at a federal level to advocate for changes that improve the quality of life of U.S. citizens and reduce opioid-related deaths.

The Nixon administration declared the war on drugs, which has continued to surge with each subsequent presidential administration. During her webinar, Perez revealed harrowing statistics. A Black man in the U.S., she said, faces a one in three chance of becoming incarcerated, while a Hispanic man has a one in six chance. Even though Black and white communities use cannabis at similar rates, Black Americans are four times more likely to be arrested. Similarly, despite equal substance-use rates, Black Americans are six times more likely than white Americans to face jail time for drug-related offenses. And nearly 80% of those incarcerated for drug-related offenses are Black or Latino.

“Targeted drug enforcement and over-policing in communities of color have led to severe consequences to Black and brown populations,” said Perez. “I’m not just talking about high-level trafficking. I’m talking about severe consequences for simple use and possession.”

The drug war also targets non-citizens, including green card holders, asylum seekers and DREAMers, and low-level drug offenses can put them at risk of immigration detention and deportation, she said. In fact, drug offenses are one of the most common causes of deportation, second only to illegal entry.

“The drug war is also at the center of our deportation machine,” said Perez. In 2019, for example, Immigration and Customs Enforcement (ICE) arrested more than 67,000 non-citizens for minor drug violations.

Despite heavy policing, the rate of drug use has not declined in the U.S. Perez called for a new path forward, which includes drug decriminalization in combination with other public health efforts. While decriminalizing drugs may seem radical to some, she said it can lead to numerous benefits and has been implemented successfully in other nations. Portugal, for example, decriminalized drugs in 2001. As a result, the country saw large reductions in drug overdoses and HIV infections, as well as a growing number of people voluntarily seeking treatment. The nation’s leaders also invested in public health services.

“Research tells us that every dollar spent on treatment saves more than a dollar on crime reduction,” said Perez.

This year, Oregon became the first state to decriminalize drug possession and is funding treatment services with its cannabis tax revenue. Perez hopes that Oregon’s decision will encourage other states to follow suit.

“This victory in Oregon is really a landmark declaration that the time has come to stop criminalizing people for all drugs regardless of type,” she said.

Yale has traditionally been very involved in identifying strategies and interventions to treat addiction, especially opioid addiction. It has also been at the forefront of demonstrating the effectiveness of certain harm reduction strategies. For example, it offered one of the earliest syringe exchange programs and conducted much of the science that showed their effectiveness in decreasing the transmission of viral infections such as HIV. Yale also has a strong history of advocating for policies to make medications that treat opioid overdose such as naloxone more readily available.

More innovation is needed now, according to Jeanette Tetrault, MD, professor of medicine (general medicine) and public health, and associate director of training and education of the Yale Program in Addiction Medicine. “Recent statistics show that there were 93,000 overdose deaths in the last year. This is a 30% increase from the year before,” she says “The status quo isn’t working.”

Yale faculty members have also recently established the SEICHE Center for Health and Justice, where experts in medicine, public health, and law come together to work for those ensnared in the criminal legal system as a result of substance-related sentences.

Yale Program in Addiction Medicine’s speaker series is continuing to elevate work related to the overdose crisis in the US. A full calendar of events can be viewed here.

Submitted by Robert Forman on July 26, 2021