Learning From Portugal

Over the past few years, American politicians have been (grudgingly) coming to terms with the fact that the nation’s much-touted “War on Drugs”–a war almost as massively expensive as those fought by the Pentagon–has consistently proven to be a failure.

Years of research that documented that failure have pointed to the fundamental flaw in American drug policy: a failure to properly categorize.

That failure wasn’t just the lumping of relatively harmless recreational marijuana in the ranks of  truly dangerous substances, although that was bad enough. (As pro-pot activists liked to point out, alcohol and cigarettes, both legal, account for far worse health problems– there have been zero deaths attributed to pot.)

By far the worst “category” problem was the decision to attack drug abuse as a criminal justice issue rather than a health issue.

Portugal doesn’t make that mistake, and as years of research have demonstrated, properly characterizing drug abuse as a medical problem has allowed that country to achieve far more success in managing it.

Decades ago, the United States and Portugal both struggled with illicit drugs and took decisive action — in diametrically opposite directions. The U.S. cracked down vigorously, spending billions of dollars incarcerating drug users. In contrast, Portugal undertook a monumental experiment: It decriminalized the use of all drugs in 2001, even heroin and cocaine, and unleashed a major public health campaign to tackle addiction. Ever since in Portugal, drug addiction has been treated more as a medical challenge than as a criminal justice issue.

After more than 15 years, it’s clear which approach worked better. The United States drug policy failed spectacularly, with about as many Americans dying last year of overdoses — around 64,000 — as were killed in the Vietnam, Afghanistan and Iraq Wars combined

In contrast, Portugal may be winning the war on drugs — by ending it. Today, the Health Ministry estimates that only about 25,000 Portuguese use heroin, down from 100,000 when the policy began.

The number of Portuguese dying from overdoses plunged more than 85 percent before rising a bit in the aftermath of the European economic crisis of recent years. Even so, Portugal’s drug mortality rate is the lowest in Western Europe — one-tenth the rate of Britain or Denmark — and about one-fiftieth the latest number for the U.S.

As the linked article notes, if the U.S. could meet Portugal’s death rate from drugs, that would equate to saving one life every 10 minutes. That’s almost as many lives as those that we lose now to guns and car accidents combined.

Many people are also coming to Portugal to explore what a smarter, health-driven approach might look like. Delegations from around the world are flying to Lisbon to study what is now referred to as the “Portuguese model.”

“This is the best thing to happen to this country,” Mario Oliveira, 53, a former typesetter who became hooked on heroin 30 years ago, told me as he sipped from a paper cup of methadone supplied by a mobile van. The vans, a crucial link in Portugal’s public health efforts, cruise Lisbon’s streets every day of the year and supply users with free methadone, an opioid substitute, to stabilize their lives and enable them to hold jobs.

Methadone and other drug treatment programs also exist in the U.S., but are often expensive or difficult to access. The result is that only 10 percent of Americans struggling with addiction get treatment; in Portugal, treatment is standard.

In the U.S., we don’t treat. We punish. And we aren’t deterred by the fact that punishment doesn’t work.

Many years ago, when I was Executive Director of Indiana’s ACLU, I made a speech to a large audience–I no longer recall what the event was–and included a critique of American drug policy. When an audience member suggested that we just weren’t being tough enough, I asked what seemed to me to be a very reasonable question: If there was a doctor who had performed 100 operations and every single one of his patients had died, would you agree that he just needed to do the same operation again? Would you go to that doctor?

What I call Americans’ “category problem” is influenced by our national inability to separate concepts of sin and crime. We saw that same confusion with prohibition–drunkenness is sinful, so we outlawed booze, making no distinction between social drinking and alcoholism. Drug addiction is sinful, so let’s not bother to distinguish between use and abuse, and let’s not look at evidence about cost-effective ways to address abuse…

The public health approach arises from an increasingly common view worldwide that addiction is a chronic disease, perhaps comparable to diabetes, and thus requires medical care rather than punishment. After all, we don’t just tell diabetics, Get over it

Portugal’s approach isn’t perfect. But it’s rational.

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What Portugal Can Teach Us About The Drug War

America’s policymakers evidently didn’t learn anything from the disaster that was alcohol prohibition. (Jeff Sessions clearly didn’t!)

In fact, for a country whose citizens constantly assert a belief in individual liberty, we rank right up there on the forced prudery scale. As any historian or political scientist can confirm, America’s legal landscape is littered with religious moralism masquerading as public safety.

When it came to drug use, and our incredibly expensive and demonstrably ineffective drug war, moralism joined hands with racism, first against Asians and Opium, and then against African-Americans, as Michelle Alexander copiously documented in The New Jim Crow. 

Years of criminal justice research have confirmed the futility–and injustice–of America’s approach to drug prohibition, an approach that creates drug “schedules” unsupported by evidence of harm, fails to distinguish between use and abuse, treats drug use as a criminal justice issue rather than a public health problem, and requires massive wasteful public expenditures.

Those are mistakes Portugal no longer makes.

Portugal decriminalized the use of all drugs in 2001. Weed, cocaine, heroin, you name it — Portugal decided to treat possession and use of small quantities of these drugs as a public health issue, not a criminal one. The drugs were still illegal, of course. But now getting caught with them meant a small fine and maybe a referral to a treatment program — not jail time and a criminal record.

The reactions from so-called “experts” were predictable. And wrong.

Whenever we debate similar measures in the U.S. — marijuana decriminalization, for instance — many drug-policy makers predict dire consequences. “If you make any attractive commodity available at lower cost, you will have more users,” former Office of National Drug Control Policy deputy director Thomas McLellan once said of Portugal’s policies. Joseph Califano, founder of the Center for Addiction and Substance Abuse at Columbia University, once warned that decriminalization would “increase illegal drug availability and use among our children.”

But in Portugal, the numbers paint a different story. The prevalence of past-year and past-month drug use among young adults has fallen since 2001, according to statistics compiled by the Transform Drug Policy Foundation, which advocates on behalf of ending the war on drugs. Overall adult use is down slightly too. And new HIV cases among drug users are way down.

Now, numbers just released from the European Monitoring Centre for Drugs and Drug Addiction paint an even more vivid picture of life under decriminalization: drug overdose deaths in Portugal are the second-lowest in the European Union.

Portugal has now operated under decriminalization for fifteen years, a time period sufficient to allow us to draw some conclusions. At a minimum, we can conclude that the country hasn’t experienced the dire consequences that opponents of decriminalization predicted.  The Transform Drug Policy Institute, which has analyzed Portugal’s policy outcomes, says of  of Portugal’s drug laws,

The reality is that Portugal’s drug situation has improved significantly in several key areas. Most notably, HIV infections and drug-related deaths have decreased, while the dramatic rise in use feared by some has failed to materialise.

Of course, there are other aspects of Portuguese society that are important contributors to these salutary results. As an article from Vice points out,

Though often narrowly assessed in reference to its decriminalization law, Portugal’s experience over the last decade and a half speaks as much to its free public health system, extensive treatment programs, and the hard to quantify trickle down effects of the legislation. In a society where drugs are less stigmatized, problem users are more likely to seek out care.

So let’s see….a country that doesn’t stigmatize or criminalize personal drug use, and provides its population with an extensive “free public health system” seems to have solved–or at least significantly moderated–its drug problem.

And of course, Portugal–like every other industrialized country— spends far less per capita on medical care than the U.S. does.

We don’t learn from our own failures, and we refuse to learn from other countries’ successes. I think that’s what’s called American Exceptionalism.

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Behind the Statistics

Linda Greenhouse, an always insightful observer of law and courts, has written an excellent column for the New York Times about the Trump Administration’s reversal of Obama’s policy phasing out private prisons.

For Trump loyalist who keep pointing out that the stock market is doing well, she provides a “think about this” example of just what is fueling that optimism:

So the Trump administration is putting the welcome mat back out for private prisons, just as candidate Donald Trump said he would do, reversing the Obama administration’s policy of phasing them out for federal prisoners. It’s no wonder that shares in some of the nation’s biggest for-profit prison companies soared by double digits the day after the presidential election, making them among the biggest winners in the immediate postelection rally.

Greenhouse also provides us with a stark reminder of the “cost controls” that allow private prisons to make money. Her example comes from Indiana.

A decision on Feb. 21 by the federal appeals court in Chicago came just in time to remind us that privatization is a really bad idea. The United States Court of Appeals for the Seventh Circuit reversed a federal district judge’s dismissal and sent back for trial a case with the most appalling facts, brought by a dead prisoner’s mother against the company to which the Indiana Department of Corrections had outsourced its inmates’ medical care.

The opening paragraph of the opinion by Chief Judge Diane P. Wood tells the story: “Nicholas Glisson entered the custody of the Indiana Department of Corrections on September 3, 2010, upon being sentenced for dealing in a controlled substance (selling one prescription pill to a friend who turned out to be a confidential informant). Thirty-seven days later, he was dead from starvation, acute renal failure, and associated conditions.”

After reciting the facts of this particular, egregious example, Greenhouse notes that she has two reasons for her focus on the Indiana case.

The first is to show the recklessness of President Trump’s wave-of-the-hand decision to retain the private prisons that a Justice Department study last year concluded “do not maintain the same level of safety and security” as those operated by the Bureau of Prisons. Sally Q. Yates, the holdover deputy attorney general whom President Trump fired last month for refusing to defend his travel ban, relied on that conclusion in announcing that private prison contracts would not be renewed and that the 22,000 federal inmates housed in those prisons would be cut to 14,700 by May 2017 and eventually to zero.

Greenhouse’s second reason was to highlight the stark differences between the judge’s opinion upholding the right of the mother to sue and the original decision, by a different judge, dismissing the suit. As she pointed out, the choice of the people who render judgment in our system–the judges nominated by the President  and confirmed by the Senate–is important. Those choices matter.

When I read about this case, and the absolutely unnecessary death of a “felon” whose crime consisted of the sale of one prescription pill, it reminded me of something else that matters:  the harm done by policies rooted in nothing other than social disapproval –what the Founders called “the passions of the majority.” Greenhouse has provided us with one example–drug laws that sweep far too widely and impose penalties wildly disproportionate to the offenses. The Trump Administration is in the process of providing us with another–the indiscriminate deportation of people whose only “crime” is coming to our communities without documentation.

Everyone disapproves of drug abuse, but not everyone agrees on the difference between “use” and “abuse”–or even the difference between harmful and harmless substances.

Similarly, everyone disapproves of illegal entry into the country in the abstract, but when we fail to distinguish between people who were brought here as young children by their parents,  people who have been longtime assets to their communities or who have served in America’s armed forces, and the “bad hombres” of Trump’s rash rhetoric, we aren’t just being inhumane, we are supporting measures that are both costly and stupid.

It matters who our judges are. It really matters who the President is.

 

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Smoking and Drinking

Have you ever wondered about the disparity in the way the law treats alcohol, tobacco and marijuana?

As any police officer will attest, a nasty drunk is far more dangerous than someone zoned out on “weed.” As the scientific literature will confirm, tobacco is many times more harmful than marijuana. Not only has the belief that marijuana is a “gateway drug” proved bogus, but for adults, it is less harmful than either smoking or excessive ingestion of alcohol. (No one has ever died of a marijuana overdose, although if your preferred method of indulging is brownies, I suppose the resulting obesity might get you.)

People with addictive personalities will abuse whatever is at hand–alcohol, drugs, even glue. Should we outlaw glue?

The history of America’s war on drugs is too labyrinthian and too racist to recount here, and there are plenty of books and articles on the subject if you are interested in the whole sordid story. Suffice it to say that our mindless war on weed has made the once-profitable cultivation of hemp illegal, prevented study of marijuana’s medicinal value, and not-so-incidentally ruined countless lives (mostly African-American; black people are almost four times more likely to be arrested for marijuana possession than whites, even though both groups use the drug at roughly the same rate.).

But attitudes are finally changing.

In 1969, according to the Pew Research Center, 84 percent of Americans thought the drug should be illegal; by 2015, that number had fallen to 44 percent.

After Colorado became the first state to legalize marijuana, policymakers began to seriously consider a number of issues–especially pot’s potential to generate tax revenue.

Legalization raises a number of questions with policy implications. For example, how can it be taxed? In 2015, Colorado raised $135 million in taxes and fees from legal sales. Another important question: Will states that stop arresting people for selling or having marijuana save money on policing and reduce their incarceration rates? Some 620,000 people were arrested for marijuana possession in 2014, according to the FBI; young minority men were disproportionately targeted. Will more children take to smoking weed? As laws relax and the stigma associated with marijuana recedes, people may use more.

A study from Australia suggests some answers to those questions. The authors looked at what consequences we might expect if marijuana were regulated like alcohol and sold to people above the age of 21. They extrapolated their analysis to include the United States, a country with similar cultural behaviors and economies. Here are some of their findings:

  • The U.S. could raise between $4 billion and $12 billion annually by taxing legal marijuana. These numbers are based on a tax levy of about 25 percent, which is what the state of Colorado charges.
  • When people have more access to marijuana (through legal and illegal means) more people use it.
  • Currently, 17 percent of Australians say they do not use cannabis for fear of legal repercussions; 90 percent of those say that access is not the reason.

Access is evidently not a problem for people in either country; several years ago, an American study found that teenagers in Maryland could obtain illegal marijuana (and other drugs) much more easily than they could obtain legal but regulated alcohol. Legalization and regulation similar to that currently in place for liquor stores would probably reduce today’s easy availability.

The authors determined that a tax rate of 25% wasn’t high enough to incentivize a black market. One of the (many) negative consequences of drug prohibition is the fact that it makes an illegal market profitable.

In the U.S., tobacco and alcohol interests have powerful lobbies, so those substances are legal even though they do far more harm than marijuana.

Just to be clear, I don’t advocate prohibition for any of these; we’ve seen how well that works. Substance abuse is a public health problem; it shouldn’t be a matter for the criminal justice system.

Wouldn’t it be nice if we based public policy on evidence and analysis, rather than moralism and money?

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Why Prisons Should Never Be Privatized

There are some things that government–not the private sector–simply must do.

As I have written many times before, whether it makes sense to “contract out” the provision of government services is not an either-or question. The decision will depend upon a number of considerations: is this a core government responsibility? is it important to maintain institutional competence? does the government agency have the ability to adequately monitor contractors?

And especially–what are the negative consequences we might anticipate from a decision to grant governmental authority to private, for-profit enterprises?

The Justice Policy Institute has just released a report confirming a major concern voiced by critics of private prisons: the likelihood that those who profit from incarceration will lobby for harsher criminal justice penalties and seek to derail needed justice system reforms.

According to the report,  private prison companies actively engage in lobbying intended to protect and grow their profits, by working for harsh policies and longer sentences.

The authors report that while the total number of people in prison increased less than 16 percent, the number of people held in private federal and state facilities increased by 120 and 33 percent, respectively. As ThinkProgress reports,

Government spending on corrections has soared since 1997 by 72 percent, up to $74 billion in 2007. And the private prison industry has raked in tremendous profits. Last year the two largest private prison companies — Corrections Corporation of America (CCA) and GEO Group — made over $2.9 billion in revenue.

JPI claims the private industry hasn’t merely responded to the nation’s incarceration woes, it has actively sought to create the market conditions (ie. more prisoners) necessary to expand its business.

According to JPI, the private prison industry uses three strategies to influence public policy: lobbying, direct campaign contributions, and networking. The three main companies have contributed $835,514 to federal candidates and over $6 million to state politicians. They have also spent hundreds of thousands of dollars on direct lobbying efforts. CCA has spent over $900,000 on federal lobbying and GEO spent anywhere from $120,000 to $199,992 in Florida alone during a short three-month span this year. Meanwhile, “the relationship between government officials and private prison companies has been part of the fabric of the industry from the start,” notes the report. The cofounder of CCA himself used to be the chairman of the Tennessee Republican Party.

One of the primary reasons governments exist is to provide for the public safety. Decisions about the most effective ways to accomplish that should be made on the basis of evidence, by disinterested policymakers carefully considering what the research tells us about the efficacy of various approaches.

The private prison industry is spending millions of dollars opposing efforts to reform the nation’s drug laws–reforms based upon years of research demonstrating that the Drug War has been a costly failure, and that imprisoning thousands of low-level offenders has been counter-productive.

Americans spend millions of dollars on the criminal justice system. Those dollars are supposed to make us safer–not make private interests richer.

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