America, we have an opioid problem. Back in 2017, the Department of Health and Human Services declared the opioid epidemic a public health emergency. Five years and one pandemic later, the status of that declaration remains unchanged [i], and we are still in the midst of a rampant epidemic.

            Now, roughly 1 out of every 100 American adults—or 2.4 million people—have an opioid-use disorder.[ii] Among New York State residents in 2020, there were 84,283 admissions to OASAS[iii]-certified chemical dependence treatment programs for any opioid, including heroin.[iv] What’s worse, many people are dying prematurely from opioid-related overdoses every day.[v]

            So then, you’re probably wondering why is the author making a case for crack houses in the middle of an opioid epidemic.  The title of this article is obviously clickbait; no one is making a case for crack houses, at least not here; I only use the term because it happens to be casually thrown around in the U.S. Congress to refer to a piece of legislation authored by Joe Biden in the late ’90s, [vi] and I find it a bit absurd. Moving away from the clickbait of it all, I am, however, making the case for Safe Injection Facilities and for the decriminalization of low-level possession of all controlled substances. Now, before you call me crazy or furiously post a comment below about how I’m the problem with America today, hear me out. There’s a lot to learn about this topic, and by the end, you might even be surprised by your own thoughts and beliefs moving forward.

 

Let’s start with some helpful background:

            Supervised injection facilities (“SIFs”), for those unfamiliar with the term, are medically supervised facilities where intravenous (“IV”) drug users can go to safely inject illicit drugs under the supervision of trained professionals. On November 30, 2021, Mayor Bill de Blasio and the New York State Department of Health announced the first publicly recognized Safe Injection Centers in the nation would be operable in New York City. This is a big deal because until New York City passed this piece of legislation, it was not discussed in the American legislative landscape. However, Safe Injection Centers have been tried and repeated with very successful results in many other places around the world,[vii] and early results show that New York City’s SIFs are just as successful.  

           

1. Aren’t SIFs just places for addicts to get high? What’s the goal?

 

            Yes and no. Among health-intervention centers for intravenous drug users and addicts, SIFs are one public health strategy to reduce overdose deaths, infectious disease transmission, and public drug use.[viii] Their purpose is to reach high-risk users who typically fall through the cracks of standardized interventions and programs and provide support and connection to health and social services which help marginalized individuals take positive steps toward healthier lives.

            Essentially, these centers act as a fail-safe for people suffering from addiction who have no access to traditional healthcare resources and don’t have family or friends in their lives who might influence them to enter treatment. For those of you who have ever witnessed an unhoused person using intravenous drugs on the subway or in a public space, you can take comfort in knowing that these centers seek to directly address that problem. But the intervention doesn’t end there, research has shown that SIFs are 30% more likely to influence a person to enter into addiction treatment, and those same people are 100% less likely to die from an overdose while using drugs under the watchful eye of a healthcare professional.

            The ultimate goal of these centers is not to completely eradicate the problem of opioid addiction because, at the end of the day, any reasonable person understands that opioids and the people addicted to them are not going to disappear overnight. Instead, this is a harm reduction strategy aimed at reducing the amount of opioid-related overdose deaths and increasing the number of people likely to receive adequate treatment. It’s like the mother who knows her teenagers are going to consume alcohol whether she forbids them from doing so or not, so she allows them to drink at home, where she can keep an eye on them. Legislators can sanction and penalize opioid use all they want, but people are still going to use them regardless. Isn’t it better we keep an eye on folks, so they don’t die in the process?

 

  2. Shouldn’t this be a problem for the Police, not healthcare providers? What happened to the “tough on crime” and “war on drugs” approach?

 

            Looking at the number of drug-related deaths and overdoses in the last five years, it’s safe to assume that the War on Drugs and criminal penalties for drug use isn’t really an effective strategy for addressing the problem. Sure, people who are caught with drugs get arrested and go to jail, but then what? The tried-and-true American method of trying to prevent drug use by locking people up might just be doing more harm than good. The reality is the system can lock people up and penalize them with sanctions and fines, but no penalty is going to stop people from using drugs, especially if they are already addicted. In fact, despite all the knowledge and awareness that drugs are illegal, every 25 seconds, someone in America is arrested for drug possession.[ix] The number of Americans arrested for possession has tripled since 1980, reaching 1.3 million arrests per year in 2015—that is six times the number of arrests for drug sales.[x] This means that more people are going to jail for using drugs than they are for selling them. Let me repeat that; more people are going to jail for using drugs than they are for selling them.

            This is a problem for three reasons, a) Incarceration does more harm than good, b) incarceration is expensive, and c) Incarceration disproportionately harms non-white people.

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    a. It does more harm than good

            If you were previously under the impression that the state is doing someone a favor by locking them up and forcing them to go “cold turkey,” that is a misguided assumption. The numbers show that the leading cause of death among recently released individuals arrested for drug possession is from a drug overdose.[xi] In fact, in that first two-week period after release, such individuals are 129% more likely to die from an overdose than the general public.[xii] By arresting someone and forcing them through the criminal justice system, their future prospects of successful recovery are severely limited once they are released from prison. This is especially true considering the fact that their criminal record will make them less likely to obtain living-wage employment, less eligible for housing, and more likely to end up homeless and looking for drugs. It is a vicious cycle, and criminalization of addiction only reinforces the cycle rather than interrupting it.

 

     b. Incarceration is expensive

            Second, the criminalization of drugs and the incarceration of low-level drug offenders is extremely expensive.  Since 1971, the war on drugs has cost the United States an estimated $1 trillion. In 2015, the federal government spent an estimated $9.2 million every day to incarcerate people charged with drug-related offenses—that’s more than $3.3 billion annually.[xiii] Using data gathered from the Vera institute, New York city spent upwards of $200,000,000 (two hundred million) incarcerating individuals convicted of drug-related crimes just in the last year. That’s two hundred million a year in New York City alone, so imagine what that number looks like when you expand it across the entire state.[xiv] This number does not include costs associated with prosecuting individuals, so the cost of criminalization is likely costing New York state anywhere between $500,000,000 dollars (five hundred million) on the lower end and closer to $1,000,000,000 (one billion) on the higher end.[xv] That’s a lot of hard-earned tax dollars spent on a practice that will only get more expensive as it continues.

 

   c. Rates of Incarceration are disproportionate among races (i.e., structurally racist)

            Third, the War on Drugs approach has a disproportionate impact on Black Americans. Black Americans are nearly six times more likely to be incarcerated for drug-related offenses than their white counterparts, despite equal substance usage rates.[xvi] In state prisons, people of color make up 60% of those serving time for drug charges.[xvii] Further, Prosecutors are twice as likely to pursue a mandatory minimum sentence for a Black defendant than a white defendant charged with the same offense, and Black defendants are less likely to receive relief from mandatory minimums.[xviii]

            Now I’m not saying anything about individual people being individually racist towards Black Americans. But the numbers do reflect a disproportionate effect across races, and for me, that’s enough reason to reexamine the system we have in place and make some changes.

 

  3. If you decriminalize low-level possession of controlled substances, aren’t you making it easier for people to do drugs?

 

             I’ll admit the idea sounds a bit radical, or perhaps like it supports drug use. However, that is not the goal. In other places around the world where this strategy has been implemented, it has proven to reduce the amount of drug use and addiction.[xix] In Portugal, a country that was suffering from a serious addiction crisis in the nineties, they implemented a similar strategy, and since then, drug-related deaths have remained below the EU average since 2001, the proportion of prisoners sentenced for drugs has fallen from 40% to 15%, and rates of drug use have remained consistently below the EU average.[xx] The success is too hard to ignore.

            In fact, the piece of legislation that is currently making its way through the assembly and senate[xxi] does a lot more than just reduce a misdemeanor to a violation. It encourages the person charged with the violation to submit to a needs assessment which allows a trained professional to meet with the individual and recommend treatment and provide them access to helpful resources based on their needs. It also sets up a Drug Policy task force composed of experts and appointed politicians who would focus on the current opioid epidemic, the carceral system, and the health system and figure out the best possible harm reduction strategies moving forward.

             If you have read this article so far and are ok with this vicious cycle of addiction repeating and getting worse, and you don’t think there is a need for anything to change, then you probably do not support this bill. However, if, instead, you understand that there is obviously something that needs to change so that our state can heal from this rampant epidemic, then supporting decriminalization makes sense. It has been proven to work.

 

4. Decriminalization and SIFs sound counterintuitive, but both are more likely to be effective than what we are doing now. Especially in New York.

           

            As someone who grew up in Staten Island, I am acutely aware of how this proposal sounds to a staunch conservative. I believe Congresswoman Nicole Malliotakis (R-NY) called Safe Injection Centers an “egregious abuse of taxpayer dollars”[xxii]. In addition to Safe Injection Centers, to propose legislation that would decriminalize low-level possession of all controlled substances probably sounds equally, if not more, outlandish. Understand that I am aware of how this sounds on first blush. But, if you look at the facts I have provided and try to put compassion before your disdain and judgment, you might find yourself in a different position.

            I also think it’s important to note that this is not a solution that would work on a national scale, mainly because most states do not have the infrastructure in place that would allow for an effective change. New York is the ideal state for this piece of legislation for several reasons, but mainly because we have already made the first step in the creation of SIFs, and therefore the legislation only requires an expansion of an already existing program. Additionally, New York has always been at the forefront of social issues and prides itself on being ahead of the curve compared to other states.  If we can make this legislation work in New York and prove its success, it could serve as a significant first step in changing the minds of Americans about effective strategies for addressing this issue. To decriminalize in New York while expanding access to SIFs would be a major change, and of course, it would involve some transitional growing pains. However, if we stick to our convictions and can provide other states with a viable model for implementing this legislation, there is a strong chance we could put an end to the national opioid crisis over time while also lessening the harms of the criminal legal system on vulnerable communities. It is a long and challenging road ahead, but well worth the payoff in the end. It’s up to you, New York. Are you ready to join the fight against addiction? Let your local representatives know that you care, show up for your fellow New Yorkers, and as always, vote.

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ENDNOTES:

[i] https://aspr.hhs.gov/legal/PHE/Pages/Opioid-4Apr22.aspx

[ii] The Council of Economic Advisers, The Underestimated Cost of the Opioid Crisis (2017), available at https://www.whitehouse.gov/sites/whitehouse.gov/files/images/The%20Underestimated%20Cost%20of%20the%20Opioid%20Crisis.pdf.

[iii] Office of Addiction Services and Supports.

[iv]CDC Wonder: New York Office of Alcoholism and Substance Abuse Services  http://health.ny.gov/statistics/opioid/

[v] “On average, 136 people die daily from an opioid overdose.” Understanding the Opioid Epidemic, CDC, 2021, https://www.cdc.gov/opioids/basics/epidemic.html

[vi] 21 U.S. Code § 856 - Maintaining drug-involved premises (Crack house Statute) See, https://www.law.cornell.edu/uscode/text/21/856

[vii] “At least 100 supervised injection sites operate around the world, mainly in Europe, Canada and Australia."  Elana Gordon, What’s The Evidence Supervised Injection Sites Save Lives?, Public Health, NPR (September 7, 2018)  https://www.npr.org/sections/health-shots/2018/09/07/645609248/whats-the-evidence-that-supervised-drug-injection-sites-save-lives

[viii] Overdose Prevention in New York City: Supervised Injection as a Strategy to Reduce Opioid Overdose and Public Injection, NYC Health, 2021, https://www1.nyc.gov/assets/doh/downloads/pdf/public/supervised-injection-report.pdf

[ix] Human Rights Watch and ACLU, “Every 25 Seconds: The Human Toll of Criminalizing Drug Use in the United States” (2016), available at https://www.hrw.org/report/2016/10/12/every-25-seconds/human-toll-criminalizing-drug-use-united-states.

[x] Peter Wagner and Wendy Sawyer, “Mass Incarceration: The Whole Pie 2018” (Northampton, MA: Prison Policy Initiative, 2018), available at https://www.prisonpolicy.org/reports/pie2018.html.

[xi] Vera Institute of Justice, “The State of Opioids,” available at https://www.vera.org/state-of-justice-reform/2017/the-state-of-opioids (last accessed May 2018).

[xii] Id.

[xiii] In fiscal year 2015, the average cost of incarceration per federal inmate was $31,977.65 ($87.61 per day). In calendar year 2015, 105,000 individuals were incarcerated in Federal prisons for drug related offenses. For cost estimates, see: Bureau of Prisons, Annual Determination of Average Cost of Incarceration, 81 Fed. Reg. 46957 (US Department of Justice, 2016), p. 46957, document 2016-17040. For estimates of federal inmates, see: Peter Wagner and Bernadette Rabuy, “Mass Incarceration: The Whole Pie 2015” (Northampton, MA: Prison Policy Initiative, 2015), available at https://www.prisonpolicy.org/reports/pie2015.html.

[xiv] “In February of 2022, the recorded amount of people incarcerated for a drug violation in New York City was 3,140, combined with the cost of incarcerating an individual for one year which is estimated at $70,000.”  https://www.vera.org/empire-state-of-incarceration-2021#people-in-prison-in-new-york-state

[xv] Id.

[xvi]  NAACP, “Criminal Justice Fact Sheet,” available at http://www.naacp.org/criminal-justice-fact-sheet/ (last accessed May 2018).

[xvii] Id.

[xviii] U.S. Sentencing Commission, “Quick Facts: Mandatory Minimum Penalties” (2017), available at https://www.ussc.gov/sites/default/files/pdf/research-and-publications/quick-facts/Quick_Facts_Mand_Mins_FY17.pdf.

[xix] In Portugal, this type of approach has proven an effective strategy at reducing the harm caused by drug use and addiction over a period of just a few years. https://transformdrugs.org/blog/drug-decriminalisation-in-portugal-setting-the-record-straight

[xx] Id.

[xxi] https://www.nysenate.gov/legislation/bills/2021/s1284

[xxii] https://malliotakis.house.gov/media/press-releases/malliotakis-leads-new-york-republican-delegation-introducing-bill-defund