This article was originally published by The Crime Report.
Something was different about how representatives of the United States handled themselves at last month's United Nations summit on drug policy, said Diederik Lohman, associate director of Health and Human Rights division at Human Rights Watch.
Instead of sitting up front during the UN General Assembly's Special Session on Drugs, and corralling other countries into following its tougher-than-tough stance on drugs -- which is what the U.S. has done for decades -- Lohman said the U.S. stayed relatively quiet. While the U.S. delegates supported the "public health" emphasis to drug policy that was eventually included in the UN resolution, they weren't willing to embrace some of the more controversial drug reforms that other countries have championed, such as safe injection sites (SITs) in Canada or heroin-assisted treatment (HAT) in Switzerland.
"They were really putting themselves in the middle of the pack, with positions that most countries are comfortable with," Lohman said in a recent interview with The Crime Report.
"They seemed very happy just to sit there, in that middle position."
This transformation from cheerleader to bystander when discussing drug policy is a significant shift -- it parallels the way presidential candidates have been talking about drugs in recent months.
It's now become acceptable for mainstream elected officials and candidates, as well as members of U.S. law enforcement, to say we can't "arrest our way out" of the nation's drug problem. In October, President Barack Obama started to talk more about the opioid epidemic, releasing a memo on public health approaches to solving America's drug problem.
"For a long time I think treatment was seen as a second-class citizen to interdiction and arrest and incarceration. And that mindset needs to change," Obama said at a panel on drug policy in West Virginia.
"The good news is we are seeing that mindset changing and it is on a bi-partisan basis, which I think is really interesting. We're putting an end to the old politics on this."
According to Lohman, Obama's intervention has significantly changed the climate of discussion.
"Over the last year and a half or so, Obama has become much more engaged and outspoken -- and that has coincided with all the coverage of heroin overdoses and prescription painkiller overdoses that have affected white people as opposed to African Americans," he said.
"Combine that with Colorado and Washington voting to legalize marijuana, [and you find that] these changes in multiple areas have pretty significantly reshaped the environment in the U.S."
It's also become acceptable for public officials -- from police chiefs in major U.S. cities to presidential candidates from both major parties -- to say the decades-old "War on Drugs" has "failed." But while the rhetoric has clearly changed, decision-makers at the federal level have not embraced actual reforms aimed at ending that "war."
Instead, most seem content to sit on the sidelines and see how it all plays out.
Their wait-and-see approach, however, seems to have provided state and local governments the space to try out once-controversial ideas. For example, law enforcement in many cities are using naloxone, safe injection sites, drug courts and other alternatives to arrest and prosecution and programs that reduce the criminalization of drug use.
One such effort, Seattle's' Law Enforcement Assisted Diversion (LEAD) program, provides drug users and non-violent offenders with housing, job training and social services.
Opioids and Politics
Overdoses of heroin or painkillers, according to a recent speech by the president, now kill more people every year than motor vehicle accidents. In 2014, 47,000 Americans died of overdoses.
It's become harder for mainstream elected officials to ignore what the Centers for Disease Control has labeled an opioid "epidemic." Presidential candidates campaigning in New Hampshire and West Virginia have had to answer questions from people directly affected by overdoses. Former drug warriors like Hillary Clinton have been talking about alternatives to locking up drug users. Bernie Sanders supports marijuana legalization.
Donald Trump, who years ago said the only way to win the "War on Drugs" would be to legalize them, said legalization should be studied and that states should decide their own marijuana policies.
All three candidates, in fact, have said they support a state's right to legalize.
When Obama spoke about drugs in West Virginia in October, his administration released a memorandum addressing the nation's opioid epidemic. The announcement marked a clear shift away from the decades-old incarceration approach to drugs and toward an approach focused on treatment and public health.
And yet, the "War on Drugs" under Obama continues.
As Tim Dickinson points out in a recent Rolling Stone piece, "Despite strides toward a more sane national drug policy, the deeper infrastructure of the War on Drugs remains fundamentally unaltered under Obama."
"A lot of our drug policy approaches have been ingrained into the system over the last four decades," Lohman said. "They are not going to be undone just like that."
Cracking down has not stopped drugs from getting into the country. In 2010, Americans spent about $100 billion annually on cocaine, heroin, marijuana and meth, according to the Office of Drug Control Policy.
Obama has made some small changes. In 2010, he narrowed the sentence disparity between crack cocaine and powder cocaine from 100-to-1 to 18-to-1. In March, he granted early release to 61 prisoners convicted of low-level drug crimes.
And while his administration has increased funding aimed for programs at reducing the demand for drugs, it's also increased funding for enforcement.
In recent years, the federal government has increased funding aimed at reducing demand for drugs -- meaning drug abuse treatment, drug abuse prevention and research -- up from about $5 billion in 2008 to almost $15 billion in 2016. But the amount the feds spend on supply reduction -- meaning domestic law enforcement and international drug control -- has also increased, from about $8 billion in 2008 to almost $16 billion in 2016.
Earlier this year, Obama proposed spending more on reducing drug demand than on efforts to reduce drug supply -- which includes everything from fighting drug cartels to arresting and prosecuting drug users and dealers -- an about-face from nearly three decades of federal policy.
His proposal includes increasing the federal spending by about $1.1 billion for addiction treatment.
Congress is also starting to get in on the action. In March, the Senate passed the Comprehensive Addiction and Recovery Act of 2016 with a nearly unanimous vote -- and last week the House passed 18 bills related to opioids. The legislation, which The New York Times says will be reconciled in a conference committee, aims to shift the country's drug policy away from incarceration and toward treatment.
While the feds have been slow to address the crisis, change is already happening on the ground. And reformers say the changes in how elected officials, candidates and the media are talking about the drug war have given local governments the space to try new approaches and collect new evidence to see what works.
"We're seeing more nuanced discussions in the media on safe injection sites," Lohman said. "It's no longer this idea that was way out there that only these crazy Dutch people would consider."
A Boston nonprofit, Boston Health Care for the Homeless Program (BHCHP), is trying to help reduce overdose deaths in Massachusetts. In March, BHCHP opened its first of many planned "safe spaces" for heroin users to ride out their high under medical supervision. Users aren't allowed to inject in the space, but other places around the country are trying to create spaces where people can do just that.
As the Associated Press noted in a recent article, state lawmakers in New York, Maryland and California, as well as government officials in Seattle, San Francisco and Ithaca, New York have been exploring the idea of safe injection sites, sometimes called safe injection facilities (SIFs).
Basically, these are government-sanctioned locations where drug users can inject under the supervision of a doctor or nurse. Other countries like Canada, Switzerland, the Netherlands, and Australia have operated these types of facilities. Reformers say they will reduce deaths.
Grassroots advocacy groups are pushing these more-radical approaches as well.
"Nearly 100 SIFs exist around the world. They have been rigorously evaluated and shown to steeply reduce overdose deaths, HIV and viral hepatitis infections, and public disorder, and to increase access to drug treatment and other healthcare," reads a statement from grassroots organization Vocal New York.
There are detractors, of course. Critics call them "shooting galleries" and say they will do more harm than good.
"These strategies give the message that society has given up on the addict, condones their drug use, and condemns them to a life of drug dependence," reads a statement from the International Task Force on Strategic Drug Policy, a group that advocates for "sound drug policy around the world" and includes former Obama administration drug policy advisor Kevin Sabet.
"We oppose so-called `harm reduction´ strategies as endpoints that promote the false notion that there are safe or responsible ways to use drugs," the statement continues.
Other grass roots programs that local governments are implementing include the "Gloucester Angel Initiative," a program in Gloucester, MA, that offers amnesty to a drug user who wants access to treatment.
Leo Beletsky, an associate professor of Law and Health Sciences at Northeastern University, recently noted that innovation is increasingly coming from the bottom up. In a column for The Crime Report, he described the police officers' growing use of naloxone, a drug used to treat overdoses and commonly referred to by its brand name Narcan, many major law enforcement organizations support its use
"A closer understanding of drug misuse, its root causes, and evidence-based prevention and treatment tools can empower criminal justice professionals and institutions to achieve better results," Beletsky wrote. "At the same time, a shift in police attitudes towards addiction can increase trust and communication with drug users and their families, as well as in the community at large."
Although there have been reports of local police departments refusing to use naloxone, the International Association of Chiefs of Police supports equipping first responders with Narcan to prevent overdoses. Saving a drug user's life after they've already used a drug seems to be where they draw the line, however. The organization does not support any programs -- like safe injection sites-- that they argue convey an "acceptance of harmful drug use."
"The IACP believes that these programs exacerbate an already alarming drug abuse problem and transmits a contradictory and harmful message to the public," reads IACP's 2015 to 2017 legislative agenda. "IACP believes that public and private funding best serves the public when directed towards drug prevention, treatment, and rehabilitation."
U.S. federal law actually prohibits some of these radical approaches, including safe injection sites. Just as the current president has had a hands-off approach to marijuana when states voted to legalize it, the next president will likely have to decide whether or not to intervene when local governments or states try these controversial approaches like safe injection sites.
Sometimes inaction is significant.
The Obama administration has not intervened following the legalization of marijuana for recreational use in four states, Washington, Oregon, Colorado and Alaska. Marijuana is still federally classified as a Schedule 1 drug, a classification reserved for drugs considered to have no medical value. This presidential election, however, almost every candidate has said he or she would do what Obama has done, which is let states decide their own marijuana policies (Gov. Chris Christie was the exception).
The three remaining major-party candidates, Sanders, Clinton and Trump, at this writing, all say they would continue Obama's hands-off approach and not interfere in a state's decision to legalize marijuana.
The Crime Report couldn't find any comments by candidates in this primary season in favor or against safe injection sites.
Like the U.S. at the United Nations last month, Clinton and Sanders say we have to end the drug war by focusing more on treatment. Clinton proposed a $10 billion plan to combat addiction, including $7.5 billion in new federal-state partnerships to support treatment programs.
Sanders, who maintains the epidemic calls for "radical" change in how America approaches addiction, has focused on doctors overprescribing painkillers, saying that drug companies deserve some of the blame for the opioid epidemic. He said the health care community needs "to get its act together" when prescribing opioids.
Both Clinton and Sanders have called addiction a disease rather than a crime. Donald Trump, when asked about the opioid epidemic, talks more like the old-school drug warriors. In New Hampshire, when asked how he'd address heroin addiction, he said his wall would, in addition to blocking undocumented immigrants, stop heroin from getting to the U.S.
"We're going to end it at the southern border," Trump said. "We're going to work like hell to take care of the situation."
The other big question for the next president stems from that.
Battling the Drug Cartels
Will the next administration continue spending more on fighting the supply side? Will combating drug traffickers and dealers continue to be a priority? Federal spending on fighting demand for drugs has increased significantly in the past decade, but funding aimed at reducing supply has also gone up.
Critics of the drug war argue that enforcement hasn't stopped drug use.
"After decades of the war on drugs, it is clear that purely punitive approaches to drug crime are counterproductive. Drug use has not declined, controlled substances are now cheaper and more widely available than ever before, and the death rate from drug overdoses continues to rise," Michelle Alexander wrote in a Los Angeles Times op-ed earlier this month.
Grassroots advocates have been pressing the would-be presidents to take heed.
Judy Rummler's son Steve died of an accidental opioid overdose in 2011 after he became addicted to prescription painkillers. After his death, the Minneapolis mother started the Steve Rummler Hope Foundation and is currently the chair of the FED UP! Coalition, a national policy advocacy group comprised if people who have lost family members to overdoses.
In a recent interview with The Crime Report, Rummler said she just wants the candidates to talk about the opioid epidemic more because, as she put it, the way to bring about change is awareness. She compared Obama's recent comments on the opioid epidemic to when Ronald Reagan finally talked about AIDS near the end of his second term, which she says helped to bring about major change in reducing the number of AIDS deaths.
"At this point now, there are as many people dying from the opioid epidemic as there was AIDS," she said. "In New Hampshire, it was talked about because people were showing up and asking the candidates about it."
Nowhere has the issue been discussed more than in New Hampshire, and since it's likely to be a swing state in the general election, it will likely come up again.
"It will be interesting to see how this plays out," she said. "We need to have this discussion at the national level."
"We have over-incarcerated people who have been affected by drugs. They don't need to be incarcerated; they need to be treated. It would save a lot of money--and a lot of lives."