Public Health Casualties of the Drug War

How does the drug war contribute to the HIV/AIDS epidemic in the US?

Syringe sharing among injection drug users is associated with more than 250,000 HIV infections among American injection drug users, their sex partners, and their children - including the majority of all cases among children and women.(1) Yet the federal government refuses to lift its ban on funding for needle exchange programs, which remain underfunded and underavailable in many states and localities

• Nationwide implementation of syringe exchange in the late 1980s would have, by conservative estimate, saved 20,000 lives and $1.1 billion in health care costs by the year 2000.(2) Scientific consensus holds that had injection drug users had easier access to syringes, much of the disaster of AIDS in America would have been averted.(3)
  
• Every major medical, scientific, and legal body to study the issue concurs in the efficacy of improved access to sterile syringes, including the American Medical Association, the AIDS advisory commissions of both Presidents Bush and Clinton, the National Academy of Sciences, the American Public Health Association, the Center for Disease Control and Prevention, the American Bar Association, and the U.S. Conference of Mayors.(4)
  
• According to six government reports, needle exchange does NOT lead to more people using drugs. No reports contradict this finding.(5)

How does the drug war prevent doctors from prescribing needed medications?

Thousands of Americans who use marijuana to treat symptoms of AIDS, cancer, and multiple sclerosis potentially face arrest and imprisonment for violating state and federal laws. The federal government has threatened to revoke the license of physicians who even talk about medical marijuana with their patients.

• In the 1970s, following a court decision favorable to the rights of medical marijuana patients, the federal government established the Investigational New Drug (IND) "compassionate access" program. Though IND continues to provide government-grown medical marijuana to the eight surviving federally approved patients, it was grossly inadequate at helping the potentially millions of people who need medical marijuana, and has been closed to new applicants since early in the Bush Administration.
• In March 1999, the National Academy of Sciences' Institute of Medicine (IOM) released a report recognizing medical benefits of marijuana in limited circumstances and recommending that it be available to the seriously ill, until safer, effective delivery systems are devised.
• Since 1996, seven states and the District of Columbia have voted to make medical marijuana legally available. In opinion polls, more than 60% of the public consistently supports legal access to medical marijuana. Yet the federal government continues to ignore IOM's advice, the pleas of the sick, and the will of voters by threatening doctors, blocking effective distribution, and criminalizing needed medicine.

Methadone maintenance treatment (MMT) is the proven, most effective method of treating heroin addiction and reducing the death, disease crime and suffering associated with it. Yet methadone remains one of the most regulated, restricted, and underavailable medications in the U.S.(6) With few exceptions, methadone is distributed only at specialized methadone centers. Doctors cannot prescribe it, leaving thousands of patients with little or no access to treatment.

• MMT helps 90% of heroin addicts stop weekly or daily heroin use after just three months,(7) and has been shown to reduce both drug-offenses and predatory crime among patients.(8)
  
• The National Institutes of Health, National Institute on Drug Abuse, American Medical Association, National Academy of Sciences, and White House Office of National Drug Control Policy all endorse methadone treatment and have called for its expansion.(9)
• America treats fewer than 20% of the estimated 800,000 heroin-addicted people who could benefit from methadone.(10) By contrast, in many other countries - including Great Britain, Australia, Switzerland and Germany - most heroin addicts are successfully treated with methadone and other pharmacological treatments in physicians' offices and local pharmacies.

What does the drug war do to help people who are addicted to drugs?

By White House estimates, 57% of people who need drug treatment do not receive it,(11) in spite of its proven, superior cost effectiveness over criminal justice approaches in reducing drug abuse and related social costs. The 1999 federal drug war budget was just over 17 billion dollars. Of this, just $3.4 billion was targeted to treatment, while nearly two thirds was spent on law enforcement.(12)

• A study by the RAND Drug Policy Research Center found that treatment is 10 times more cost effective than interdiction in reducing the use of cocaine in the United States. The same study found that every additional dollar invested in substance abuse treatment saves taxpayers more than $7, and that additional domestic law enforcement costs 15 times as much as treatment to achieve the same reduction in drug abuse and related social costs.(13)

Has the drug war reduced fatal overdoses and other drug-related deaths?

No. Between 1990 and 1996, drug related deaths grew from 5,628 to 9,310, a 65% increase. During the same period, cocaine and heroin-related emergency room visits nearly doubled to more than 210,000.(14)

• Drug overdose deaths are an overlooked epidemic in the U.S. In the Orlando area, for example, heroin related deaths increased over 1000% between 1994 and 1995.(15) In Portland Oregon, New York City, San Diego, San Francisco, and Seattle, young men aged 20 to 54 are more likely to die by drug overdose than by car accident.(16)
  
• Despite these alarming statistics, federal surveillance of drug use patterns does not include accurate monitoring of overdose death rates. Only 20 states have accurate information that dates back to 1990. There are no federal programs or funds directed to overdose prevention.
  

NOTES:

1. Centers for Disease Control and Prevention. HIV/AIDS Surveillance Report, 11(No2); 1999
2. Lurie P, Drucker E. "An Opportunity Lost: HIV Infections Associated with Lack of a Needle Exchange Programme in the USA." Lancet 1997; 349:604-608.
3. Lurie P, Drucker E. "An Opportunity Lost: HIV Infections Associated with Lack of a Needle Exchange Programme in the USA." Lancet 1997; 349:604-608.
4. U.S. Conference of Mayors, Needle Exchange: Moving Beyond the Controversy, Washington, DC, 1997. Lurie P, Reingold A. The Public Health Impact of Needle Exchange Programs in the United States and Abroad (prepared for the Centers for Disease Control and Prevention). Berkeley, CA: University of California, School of Public Health, and San Francisco, CA: University of California, Institute for Health Policy Studies; 1993. National Institutes of Health Consensus Panel. Interventions to Prevent HIV Risk Behaviors. Washington, DC: National Institutes of health; 1997 American Medical Association 6/97 Statement on Syringe Exchange. US Conference of Mayors. Needle exchange: Moving Beyond the Controversy. Washington, DC: US Conference of Mayors; 1997
5. Normand J, Vlahov D, Moses LE, eds. Preventing HIV Transmission: The Role of Sterile Needles and Bleach. Washington, DC: National Academy Press; 1995:224-226, 248-250. Paone D, Des Jarlais DC, Gangloff R, Milliken J, Friedman SR. Syringe Exchange: HIV prevention, key findings, and future directions. International Journal of the Addictions. 1995; 30:1647-1683. Watters JK, Estilo MJ, Clark GL, Lorvick J. Syringe and Needle Exchange as HIV/AIDS Prevention for Injection Drug Users. JAMA 1994; 271: 15-120
The six reports are: *National Commission on Acquired Immune Deficiency Syndrome, The Twin Epidemics of Substance Use and HIV, Washington, DC: National Commission on Acquired Immune Deficiency Syndrome; 1991. * US General Accounting Office, Needle Exchange Programs: Research Suggests Promise as an AIDS Prevention Strategy, Washington, DC: US General Accounting Office; 1993. * Lurie P, Reingold A. The Public Health Impact of Needle Exchange Programs in the United States and Abroad (prepared for the Centers for Disease Control and Prevention) Berkeley, CA: University of California, School of Public Health, and San Francisco, CA: University of California, Institute for Health Policy Studies; 1993. * Drug Policy Foundation, comp. The Clinton Administration's Internal Review of Research on Needle Exchange Programs: Previously Unreleased Documents Plus background Material. Washington, DC: Drug Policy Foundation; 1993. *
Office of Technology Assessment. The effectiveness of AIDS Prevention Efforts. Washington, DC: Office of technology Assessment; 1995
National Research Council and Institute of Medicine. * Proceedings, Workshop on Needle Exchange and Bleach Distribution Programs. Washington, DC: National Academy Press; 1994.
6. Institute of Medicine - Medical Use of Marijuana: Assessment of the Scientific Base
Institute of Medicine. Treating Drug Problems, vol 1: A study of the Evolution, Effectiveness, and Financing of Public and Private Drug Treatment Systems. Washington, DC: National Academy Press; 1990:187.
7. Hubbard RL, Rachal JV, Craddock SG, Cvanaugh ER. "Treatment Outcome Prospective Study (TOPS): Client Characteristics and Behaviors Before, During, and After Treatment. In Tims FM, Ludford JP eds. Drug Abuse Treatment Evaluation: Strategies, Progress, and and Prospects. NIDA Research Monograph 51. Rockville, MD: US Department of Health and Human Services; 1984:42-68. Hubbard RL, Rachal JV, Craddock SG, Cvanaugh ER. "Treatment Outcome Prospective Study (TOPS): Client Characteristics and Behaviors Before, During, and After Treatment. In Tims FM, Ludford JP eds. Drug Abuse Treatment Evaluation: Strategies, Progress, and and Prospects. NIDA Research Monograph 51. Rockville, MD: US Department of Health and Human Services; 1984:42-68.
8. Ball JC, Ross A. The Effectiveness of Methadone Maintenance Treatment. New York: Springer-Verlag; 1991: 195-211.
9. Consultation Document on Opioid Agonist Treatment, Office of National Drug Control Policy, 1998; Policy Compendium, Polices: 20.966, 95.964, American Medical Association; NIH Consensus Statement: Effective Medical Treatment of Opioid Addiction, National Institutes of Heath, 1997; The Drug Abuse Treatment Outcome Study, National Institute on Drug Abuse.
10. Consultation Document on Opioid Agonist Treatment, Office of National Drug Control Policy, 1998.
11. National Drug Control Policy Strategy Report 2000, Office of National Drug Control Policy
12. Office of National Drug Control Policy. National Drug Control Strategy: 1999
13. Rydell, C.P. & Everingham, S.S., Controlling Cocaine, Prepared for Office of National Drug Control Policy, RAND (1994), p.xvi.
14. Office of National Drug Control Policy. National Drug Control Strategy: 1999
15. "Heroin Toxicity Deaths in Florida in 1998" Issued by the Staff of Medical Examiners Commission Florida Department of Law Enforcement. Tallahassee, Florida March 16, 1999.
16. CDC wonder mortality data. Accessible at wonder.cdc.gov
17. CDC wonder mortality data. Accessible at wonder.cdc.gov