The head of a top federal drug agency is criticizing the ongoing policy of criminalizing people for drug use and is suggesting that the government should instead consider a policy of decriminalization.
Nora Volkow, director of the National Institute on Drug Abuse (NIDA), penned an essay for the journal Health Affairs that’s titled “Addiction Should Be Treated, Not Penalized.” It lays out the case against incarcerating people over low-level drug offenses and looking at the issue as a public health matter.
While it stops short of explicitly endorsing decriminalization, Volkow says that the current system leads to disproportionate enforcement against communities of color and can actually increase the risk of overdose deaths.
“Drug use continues to be penalized, despite the fact that punishment does not ameliorate substance use disorders or related problems,” she said. “Imprisonment, whether for drug or other offenses, actually leads to much higher risk of drug overdose upon release.”
“We have known for decades that addiction is a medical condition—a treatable brain disorder—not a character flaw or a form of social deviance,” Volkow continued in the essay, which was first published by Health Affairs late last month and republished on NIDA’s website on Friday. “Yet, despite the overwhelming evidence supporting that position, drug addiction continues to be criminalized. The US must take a public health approach to drug addiction now, in the interest of both population well-being and health equity.”
In @Health_Affairs blog, Dr. Volkow makes the evidence-based case on how drug #criminalization disproportionately harms Black communities & exacerbates health disparities. A public health approach to #addiction is needed. https://t.co/6w1awINIRb pic.twitter.com/ty9GfrlWtg
— NIDAnews (@NIDAnews) April 27, 2021
The NIDA head pointed out how people of color have been “disproportionately harmed by decades of addressing drug use as a crime rather than as a matter of public health.” Citing disparities in how opioid criminalization has been enforced and laws punishing crack more harshly than powder cocaine, Volkow said these are examples of “racial discrimination that have long been associated with drug laws and their policing.”
What makes these admissions notable is the source from which they’re coming. While NIDA is known among advocates as a source of resistance to reforms such as ending marijuana prohibition, its director sides with them on the fundamental principle that substance misuse should not be criminalized.
“The damaging impacts of punishment for drug possession that disproportionately impact Black lives are wide ranging. Imprisonment leads to isolation, an exacerbating factor for drug misuse, addiction, and relapse,” the director said. “It also raises the risk of early death from a wide variety of causes.”
Volkow also said that beyond incarceration, merely being arrested for marijuana possession “can leave the individual with a criminal record that severely limits their future opportunities such as higher education and employment.” And that enforcement trend hurts black people more than white people despite comparable rates of consumption.
“This burden reinforces poverty by limiting upward mobility through impeded access to employment, housing, higher education, and eligibility to vote,” she said. “It also harms the health of the incarcerated, their non-incarcerated family members, and their communities.”
These statements ostensibly lend themselves to a harm reduction policy position in favor of decriminalization, but Volkow doesn’t specifically say that’s the route lawmakers should take. Instead, she says that research “is urgently needed to establish the effectiveness and impact of public health–based alternatives to criminalization, ranging from drug courts and other diversion programs to policies decriminalizing drug possession.”
To that end, NIDA is “redoubling its focus on vulnerabilities and progression of substance use and addiction in minority populations,” she said. “We are exploring research partnerships with state and local agencies and private health systems to develop ways to eliminate systemic barriers to addiction care.”
The agency is “also funding research on the effects of alternative models of regulating and decriminalizing drugs in parts of the world where such natural experiments are already occurring,” Volkow said, presumably referencing countries such as Portugal that have stopped criminalizing people over simple possession.
“People with substance use disorders need treatment, not punishment, and drug use disorders should be approached with a demand for high-quality care and with compassion for those affected,” she said. “With a will to achieve racial equity in delivering compassionate treatment and the ability to use science to guide us toward more equitable models of addressing addiction, I believe such a goal is achievable.”
While NIDA might not be widely considered a champion of progressive drug policy, its director has previously conceded that existing federal drug laws aren’t working.
In 2019, for example, she acknowledged that the Schedule I status of marijuana and other drugs makes it “very difficult” for researchers to study the benefits and risks of those substances.
“Indeed, the moment that a drug gets a Schedule I, which is done in order to protect the public so that they don’t get exposed to it, it makes research much harder,” Volkow said during a House Appropriations subcommittee hearing. “This is because [researchers] actually have to through a registration process that is actually lengthy and cumbersome.”
She also discussed the potential benefits and risks of cannabis at a congressional hearing last year.
NIDA is also one of the main agencies behind a new development in federally sanctioned marijuana research. After requesting public input last year on a standard THC unit for cannabis studies, it announced last week that it had reached a determination to set the standard at five milligrams of THC per dosage.