Top Federal Drug Official Says Criminalization Creates Stigma And Harms Health Of Consumers

The director of the federal government’s top agency on drugs and health says ending harsh penalties around use would reduce harm and facilitate access to treatment.

“Societal norms surrounding drug use and addiction continue to be informed by myths and misconceptions,” Nora Volkow, director of the National Institute on Drug Abuse (NIDA), wrote in an opinion piece for the health news website STAT last week. “Among the most harmful of these is the scientifically unfounded belief that compulsive drug-taking by individuals with addiction reflects deliberate antisocial or deviant choices. This belief contributes to the continued criminalization of drug use and addiction.”

NIDA Director Dr. Nora Volkow shares how punitive policies around drugs contribute to the overwhelming #stigma against people with #addiction, in @statnews and on her blog. In English and Spanish:https://t.co/4Q3m4FubNZ

— NIDAnews (@NIDAnews) August 9, 2021

“Many people intersect with the criminal justice system as a direct or indirect result of their substance use disorders, and the experience may worsen their addiction and their physical and mental health,” Volkow writes. “Imprisonment itself not only increases the likelihood of dying prematurely but also negatively impacts mental health and social adjustment via the stigma of having been incarcerated. And it has radiating effects: Incarceration of a parent increases their children’s risk of drug use, for example.”

The NIDA official’s column further argues that stigma caused by criminalization and prejudice against drug users have “major negative impacts on health and well-being,” which “helps explain why only 18 percent of people with drug use disorders receive treatment for their addiction.”

“While attitudes around drug use, particularly use of substances like cannabis, have significantly changed in recent decades, the use and possession of most drugs continue to be penalized,” she writes. “Punitive policies around drugs mark people who use them as criminals, and so contribute to the overwhelming stigma against people contending with an often debilitating and sometimes fatal disorder—and even against the medical treatments that can effectively address it.”

“They are often treated in a demeaning and dehumanizing way.”

The fear of criminal consequences—or even the perception of stigma—”reduces the quality of care” people who need treatment can receive and leads to other health effects when they conceal their use from health care professionals, the top federal drug official wrote. Those same factors also prevent people who use drugs from participating in public conversations about how to effectively address substance misuse problems.

“But while a growing number of people in recovery are speaking openly about their past use and their current struggles to keep sober, people who use drugs actively—either because of an untreated addiction or during a period of relapse or even simply as a matter of personal choice outside the context of a use disorder—are not free to do so without fear of legal consequences.”

“An effective public health response to substance use and substance use disorders must consider the policy landscape of criminalizing substance use,” she argues, “which constitutes a major socially sanctioned form of stigma.”

Volkow has expressed similar sentiments in the past, publishing another essay critical of the drug war in May in the journal Health Affairs. While she doesn’t explicitly endorse decriminalization or legalization of drugs in the new piece, titled “Punishing Drug Use Heightens the Stigma of Addiction,” it’s among among her sharpest indictments yet of the drug war—notable given that NIDA, part of the National Institutes of Health, is widely seen as a key piece of the nation’s drug-control apparatus.

Going forward, the official says that “research on the positive and possible negative outcomes associated with alternative policy models that move to prioritize treatment over punishment are also urgently needed, as such models could remove a major linchpin of the stigma around drug use and addiction and improve the health of millions of Americans.”

Volkow has received pressure from advocates to publicly discount the war on drugs as a failure, with the group NORML urging her last year to declare that criminalization causes more harm than marijuana itself.

But Volkow has also acknowledged that cannabis can carry risks. Last year, she told a congressional panel that legalization could bring benefits but also raise concerns. She described it as “an area where there’s been major changes in the perception of the American public that we have a drug that is benign and, as a result of that, we’re seeing a very dramatic increase in the number of people that are consuming marijuana.”

Last month, Volkow stressed to members of Congress that prohibition carries its own concerns, particularly around racial justice. “Abundant data show that Black people and other communities of color have been disproportionately harmed by decades of addressing drug use as a crime rather than as a matter of public health,” she said.

At last month’s hearing Volkow also responded to a question from Sen. John Cornyn (R-TX) on the need to investigate the impact of “high concentrations of THC on people with perhaps mental health challenges or on the developing juvenile brain.”

“Do you agree that it’s important before we legalize marijuana at the federal level—should Congress decide to do so that—we get this kind of research performed so we actually know what we’re doing?” he asked, implicitly recognizing that efforts to end federal cannabis prohibition are gaining momentum.

“I think it’s 100 percent necessary that we actually have an understanding of the consequences of legalizing marijuana are going to have into the children and adolescent brain and what are the consequences,” Volkow replied. “We owe it to the public to actually provide that information.”

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Biden Budget Keeps Medical Marijuana Protections But Would Block D.C. From Legalizing Recreational Sales

President Joe Biden wants to maintain a long-standing policy that’s protected state medical marijuana laws from Justice Department interference as part of his fiscal year 2022 budget proposal—a notable administration decision given that previous presidents from both parties have called for its elimination in their annual plans.

But Biden wants to continue to block Washington, D.C. from using its own tax dollars to legalize adult-use marijuana sales, declining to recommend that current language barring such activity be eliminated.

The budget approach is raising questions about whether the president is drawing a line in the sand by supporting medical cannabis states but denying D.C. the right to implement sales as the mayor and local legislators want. If so, it would reflect his overall marijuana policy position: yes to medical cannabis, no to recreational marijuana.

The medical cannabis rider, which has been renewed in appropriations legislation every year since 2014, stipulates the the Justice Department can’t use its funds to prevent states or territories “from implementing their own laws that authorize the use, distribution, possession, or cultivation of medical marijuana.”

Past administrations—both Democratic and Republican—have proposed scrapping that language. President Donald Trump and President Barack Obama each called for ending the policy as part of their budget proposals. But Congress has consistently upheld it regardless.

During the 2019 appropriations season, the House approved an even more expansive amendment that would have provided protections for all state and territory marijuana programs, rather than just medical cannabis systems. But the Senate did not follow suit and the provision was not included in final spending bill sent to Trump’s desk.

When Trump signed that large-scale spending legislation in 2019, he attached a statement that said he is empowered to ignore the congressionally approved medical cannabis rider, stating that the administration “will treat this provision consistent with the President’s constitutional responsibility to faithfully execute the laws of the United States.”

Advocates were optimistic that Biden would propose removing the other long-standing rider, which has blocked D.C. from using local tax dollars to legalize marijuana sales—but that did not pan out. And that’s in spite of the fact that he did push to remove separate, D.C.-specific language blocking the city from using its funds to provide abortion services.

“It’s seriously concerning that the will of District of Columbia residents who voted to legalize cannabis years ago continues to be ignored, despite immense support in the city,” Queen Adesuyi, policy manager for the Drug Policy Alliance’s (DPA) Office of National Affairs, told Marijuana Moment, adding that local officials should be allowed to “deliver on the promises of equity and justice for those disproportionately impacted by racially-biased enforcement of cannabis laws in the District.”

The inconsistency with which Biden’s budget approaches D.C. is all the more interesting given that while the president has said repeatedly that states should be empowered to make their own decisions regarding adult-use legalization—and he also supports statehood status for the District—he wants to prevent it from having that same right.

“The president’s budget is simultaneously positive and concerning. On one hand, unlike his predecessors from both parties, he is the first sitting president to call for continued protections for medical cannabis programs,” NORML Political Director Justin Strekal told Marijuana Moment. “But on the other hand, unlike President Obama, this budget denies the right of self-determination to D.C. citizens when it comes to the overwhelming desire of the public and local government to regulate cannabis for adults.”

Mayor Muriel Bowser (D) said in April that local officials are prepared to move forward with implementing a legal system of recreational cannabis sales in the nation’s capital just as soon as they can get over the final “hurdle” of congressional interference.

The ongoing blockade is the result of an amendment that was first added by Rep. Andy Harris (R-MD) when Republicans controlled the House and has since been continued in annual appropriations legislation.

“It is incompatible to support D.C. statehood and simultaneously support the reauthorization of the Harris Amendment,” Mike Liszewski, principal with the Enact Group and a policy advisor to Students for Sensible Drug Policy, told Marijuana Moment. “President Biden’s decision to reinclude this provision in his budget is a slap in the face of every District resident. D.C. voters should not have to beg the federal government to allow us to set up our own marijuana regulatory system.”

The Biden administration is being closely watched by advocates when it comes to any marijuana policy development—especially since the president has maintained an opposition to adult-use legalization even as multiple bills to end federal prohibition are being drafted and introduced.

Perhaps unsurprisingly, Biden did not propose gutting the Office of National Drug Control Policy (ONDCP) as Trump did. The former president called for a roughly 90 percent cut in the agency’s budget in his proposals, but Congress did not follow suit. Biden, meanwhile, helped establish the drug czar’s office during his time in the Senate.

BREAKING: The Biden-Harris FY22 Budget request calls for historic levels of funding to prevent and treat #addiction and #overdose. Full details: https://t.co/jCgN4ug0F8

— ONDCP (@ONDCP) May 28, 2021

Biden’s budget also includes $17 million in funding to support industrial hemp production.

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Head Of Top Federal Drug Agency Says It’s Time To Consider Decriminalization

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/6w1awINIRbpic.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.

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