Persistence and Prosecution

**IMPORTANT: This article contains mentions of drug use and overdose. If you feel uncomfortable with these topics, please refrain from reading.

The “War on Drugs”, a term coined by President Richard Nixon in 1971, represents the persistent and ongoing efforts by the United States government to reduce illegal drug trafficking and use throughout the nation. In a message to Congress, Nixon declared drug abuse to be “public enemy number one” and since then, the US has poured over $1 trillion dollars on efforts to combat drug use. (1, 2) 

However, the “war” appears to have taken a long downturn; a Commonwealth Fund study finds that overdose deaths in 2020 exceeded 90 thousand and with a federal budget for drug abuse prevention and control of $34.6 billion. What happened to the so-called War on Drugs and is there a better solution?

It comes as no surprise after reading the framing of my introduction that overdose deaths in the US are rising. (3) With the US Government spending more and more money fighting drug proliferation, it is clear based on the hard data that that money could be better spent. But the War on Drugs has caused other problems as well. 

The federal government has incarcerated individuals for possessing, creating, or selling controlled substances, jailing roughly 1.16 million Americans every year. (4, 5) This war also disproportionately affects low-income communities and communities of color, home to marginalized individuals predisposed to incarceration.

The issue with this policy is simple. The War on Drugs policy agenda is punitive, putting the threat of incarceration upon individuals who produce, use, or sell drugs in an attempt to discourage them from doing so. While this may have seemed like a viable solution fifty years ago, this policy has yielded no significant benefits and has resulted in the economic and social displacement of millions, particularly marginalized individuals. Additionally, policymakers in the 1970s did not realize that the drugs they were so intent on criminalizing: heroin, marijuana, etc. are addictive. Incarcerating drug users will not prevent those individuals from using those drugs again. Thus, the Federal Government continues spending money to criminalize individuals without achieving significant results.

Former New Jersey Governor and Chair of the Opioid and Drug Abuse Commission, Chris Christie proposed a new policy agenda: “What we need to come to grips with is addiction is a disease and no life is disposable… It can happen to anyone and so we need to start treating people in this country, not jailing them.”

The trillion dollars the US Federal Government has spent over the long war may seem like a drop in the bucket; however, if spent on treatment programs and on implementing drug safety measures, the number of overdose deaths in the US may drastically decrease. I argue that the War on Drugs policy should be one of treatment rather than incarceration. There are many research-driven approaches that may be effective in reducing drug overdoses in the US. In this article, I will focus on syringe service programs. 

What are syringe service programs? Syringe service programs (SSPs) are community-based and community-led programs that provide individuals who use drugs with access to clean syringes along with a means to dispose of used syringes. (6)

You might be wondering: but how does this stop people from using drugs? Well, on its face, it doesn’t. Syringe service programs are designed to promote healthy practices amongst individuals who use drugs, specifically by ensuring that those individuals are using clean syringes. This is an aspect of harm reduction, essentially reducing the negative consequences of an activity without prohibiting or stopping that activity itself. In this way, SSPs are designed to reduce the risk of HIV infection, viral hepatitis, and blood-borne infections amongst individuals who consume drugs. (7)

SSPs however are not simply syringe exchange centers; typically, these programs include vaccination and disease testing centers; pathways to seek care for infectious disease, mental illness, and substance use disorders; and overdose and infectious disease prevention education. Clearly, syringe service programs are focused on mitigating the issues secondary to drug use, not ending the so-called War on Drugs but reducing mortality nonetheless. 

A CDC study finds that SSP participants are 5 times more likely to enter drug treatment programs and 3.5 times more likely to stop injecting drugs. The same study finds that on average, over 90% of syringes provided by SSPs are returned at a later date. (8)

Syringe Service Programs, while not originating in the US, began in the late 1980s during the HIV/AIDS epidemic. Reused syringes often carry small quantities of blood which may contain blood-borne pathogens like HIV and Hepatitis; research at the time suggested the use of syringe exchanges to reduce HIV cases and mortality. And, in fact, the adoption of SSPs in 2008 showed some promise in reducing HIV cases. (9)

Over the past few decades, the North American Syringe Exchange Network (NASEN) was developed supporting individuals around the US. (10) Since the HIV epidemic, as more research supports the use of syringe service programs, SSPs have proliferated throughout the US with locations even in Alaska, Hawaii, and Puerto Rico. Below, I provide a current map of NASEN. (11) 

UNC’s Student Health Action Coalition has recently implemented a syringe service program. The Student Health Action Coalition (SHAC) brings together medical students, public health students, pharmacy students, dental students, social work students, nursing students, and physical therapy students in forming a free clinic to support local communities. 

SHAC’s syringe service program facilitates the transfer of clean, unused syringes for used ones, preventing the likelihood that an individual shares a syringe with someone else and that a syringe is used more than once. However, SHAC provides a variety of other services to supplement the SSP; free STI and HIV testing along with mental health services ensure individuals who seek care for drug use are treated comprehensively. (12, 13) Furthermore, SHAC also provides patients with bandages, antibiotics, and Narcan (a drug used to reverse opioid overdoses); thus, by developing a variety of treatment options for patients, UNC’s SHAC is able to achieve the best results in the community. (14)

In 2021, the US experienced a record 322 drug overdose deaths per 1 million individuals. (15) By any account, the ongoing “war” on drugs is going poorly. A policy paradigm shift from criminalization to support will not only bring an end to this crisis but also reduce the fallout faced by marginalized communities across the nation.