Public Health Approach

Partnership to End Addiction urges the use of a public health-based approach to address addiction.

Recognizing that addiction is a disease, and that harsh consequences are not an effective deterrent, we oppose the use of drug-induced homicide laws, excessive criminal penalties and other measures that seek to punish people for using substances.

Research evidence confirms that addiction is a complex brain disease, influenced by biological, genetic, psychological and socio-structural factors, best addressed with a public health-based approach. A public health approach requires delivering evidence-based interventions that span the continuum from prevention and early intervention to treatment, harm reduction, disease management and recovery supports. Such interventions include preventing substance use by addressing early risk and protective factors and utilizing a framework that promotes healthy youth development starting in early childhood; integrating addiction treatment into the mainstream health care system; utilizing evidence-based treatment interventions, including the use of FDA-approved medications; compassionately supporting individuals in recovery; and providing harm reduction services to individuals who use substances. Punishment has no place in the public health paradigm.

Punitive responses reflect our historically inaccurate framing of addiction as a moral failure, character defect or lack of individual willpower. There is no research evidence to support interventions based on the moral model of addiction. Research shows that increased rates of imprisonment for drug-related offenses have no impact on drug use or availability. Further, punitive policies exacerbate the stigma surrounding substance use disorders (SUD) and cause greater harm to individuals with SUD. For example, drug-induced homicide laws (i.e., laws that establish a criminal charge, such as murder or manslaughter, for individuals who sell or deliver drugs that cause another individually to overdose) create a fear of legal repercussions that does not deter use, but may discourage individuals from reporting overdoses or seeking medical help promptly when they occur. Not only are punitive “War on Drugs” policies ineffective in helping people with addiction or reducing drug-related problems, they also disproportionately harm Black, Hispanic and other communities of color.

Punitive policies, such as harsh criminal penalties, mandatory minimums and drug-induced homicide laws, are gaining more attention and focus as fentanyl (and other powerful synthetic substances) infiltrate the drug supply and contribute to staggering overdose rates. In this context, punitive policies refer to interventions that seek only to punish individuals for their substance use, rather than interventions that seek to create accountability or utilize incentives or leverage in motivating an individual to seek treatment. These interventions, which may come from family members, employers or even the criminal justice system, and may be compulsory at times, can be effective in motivating individuals to engage in treatment when such interventions are delivered compassionately and utilize evidence-based treatment interventions.

We recognize the unimaginable tragedy experienced by families who have lost loved ones and the grief and anger they experience. We understand that these families, together with policymakers and the public, want to take definitive action in the face of this unrelenting overdose crisis. Yet we believe that returning to failed strategies of the past, which included harsh criminal penalties, mandatory minimums and drug-induced homicide laws, is the wrong approach and will only serve to create greater harm in the future.

A renewed focus on criminalization threatens to undermine hard-fought gains to frame addiction as a public health issue requiring a public health, rather than a punitive, response. In recent years, there has been wider acceptance of the basic notion that addiction is a disease. Policymakers have provided greater financial support to address substance use and have been more receptive to public health interventions. While funding amounts have been historic, financial support has still been insufficient to adequately reach the enormous number of people in need and to facilitate the significant structural changes necessary to move addiction from the legal to medical domain. Most people with SUD continue to go without access to effective care, and financial resources have been woefully insufficient to combat a crisis in which the annual economic toll of opioid use disorder and opioid overdoses alone exceeds one trillion dollars. Further, fentanyl – and other synthetic drugs – are challenging existing public health efforts because of their potency and proliferation in the drug supply. Overdoses are preventable and SUDs are treatable, but it takes time to generate research and data on how to best utilize overdose prevention and treatment interventions in an ever-changing drug supply. The greatest challenge, however, is the pervasive stigma that undermines the political will to respond adequately and impedes meaningful action that matches more compassionate rhetoric.

The public health approach has not failed; rather, we have failed to sufficiently invest in the public health approach. The priority should be to allocate the limited available resources to evidence-based public health interventions that can address the systemic issues contributing to SUDs and aim to create sustainable solutions that positively impact individuals and communities affected by substance use. Given the documented harm caused by criminalization, we strongly oppose the use of punitive interventions to address the current fentanyl crisis. To effectively address addiction and ensure that resources are used most efficiently, reduce additional harm to those impacted by substance use and promote equity, we must remain steadfast in our commitment to align addiction policies with the research by fully committing to a public health approach.