Drs. Kim Thorburn and Robert Wood: Physicians support refocused approach to substance use disorder
By Drs. Kim Thorburn and Robert Wood
This month, the National Center for Health Statistics reported that more than 100,000 Americans died of drug overdoses in 2021, a 14.9% upsurge from 2020. COVID-19 is believed to be part of the cause by fostering isolation and increasing barriers to already limited treatment and support services. Resources needed by persons with the disease of addiction, now termed substance use disorder, have long been severely lacking and criminalizing substance use disorder is just plain wrong.
People who use drugs are isolated and alienated by being treated like criminals. The threat of arrest drives people into the margins of society, placing them at greater risk of overdose and making it harder to connect with services. Further, criminal penalties imposed to discourage drug use impede recovery, including erecting barriers to education, housing and employment. Instead of treatment, criminalizing drug use simply punishes drug users.
We need to stop treating drug use as a crime and invest much more heavily in public health strategies to prevent, treat and assist recovery from substance use disorder. For these reasons, we support Initiative 1922 and encourage other physicians, public health professionals and all Washington voters to do the same.
One of us directed King County’s HIV/AIDS program during the height of the AIDS crisis, and the other worked in prison health systems in the late 1970s and 1980s as the “War on Drugs” was ramping up. Both of us have witnessed first-hand the disastrous consequences of treating drug use, a medical problem and public health concern, as a crime. During the 1980s, as politicians were increasing spending on the drug war and slashing federal funding for public health, housing and social services, we saw rates of HIV transmission through injection drug use and incarceration rates, especially of non-white Americans, soar to the highest levels among developed countries.
Incarcerating people with substance use disorder only causes harm. There are no individual or societal benefits to putting people behind bars for a medical condition. It is rare for people to overcome addiction while incarcerated, and they face a heightened risk of overdose death after release.
As we have seen with COVID-19, public health decisions need to be based on evidence, not hysteria. Drug overdose is a leading cause of preventable death. We need to apply the evidence-based solutions to the problem. Our country has spent over one trillion dollars on the “War on Drugs,” and it has not worked.
Outreach, engagement and recovery support services do work, and they need to be scaled up. Initiative 1922 directs $141 million every year from existing state cannabis revenues to local services statewide. It ends arrests for personal drug possession but still allows law enforcement to seize and test drugs so information about especially dangerous substances circulating in communities can be identified and reported to the public
Public health professionals are often first to see the collateral consequences of policies based on politics rather than science. We have been witnessing the damage caused by criminalization of drug use far too long. Washington should seize this opportunity to change course and replace the vicious strategy of punishing people who are struggling – a strategy that has helped fuel the opioid epidemic – with I-1922’s focus on public health responses.
Dr. Kim Thorburn, of Spokane, is a retired public health physician who worked for 20 years running prison health systems in California and Hawaii and served as Spokane’s public health officer for nearly 10 years. Dr. Robert Wood lives in Seattle, served as the director of the HIV/AIDS program for King County from 1986 to 2010, and is a retired Clinical Professor of Medicine at the University of Washington School of Medicine.