Law enforcement officers who fight drugs need to better understand how addictions work and help users get the best treatment. That’s the view of Regina LaBelle, former White House director of drug enforcement. For her, this conduct will bring more benefits to society than arresting users en masse.
“The more law enforcement understands how addictions work, the more lives they will save. The most important thing is to make sure law enforcement officers understand the public health aspect of the issue and act to prevent people from reaching the criminal justice system.” “, he defends.
“If you spend $1 on harm reduction, $1 on recovery support, how many dollars do you save that would be spent on incarceration?”
LaBelle was director of the National Office of Drug Control Policy at the White House under Joe Biden from January to November 2021. She has researched and worked on the topic since the 1990s, when she was a Seattle City Councilor. The city has faced drug use problems for decades in certain areas, such as Cracolândia, in São Paulo.
Currently, LaBelle is the director of the master’s degree in addiction policy at Georgetown University in Washington. “We’re training the next generation of people who are going to work with addiction policy to understand how science works. Science and compassion drive our policies,” she says.
Below, read excerpts from her conversation with the Sheet.
What governments should do, and not do, to combat drug use on public roads? The first thing is to have a national public health strategy related to drug use, or at least a municipal strategy, which is also important.
For that, you need to find out what the main problems are, what substances are being used and how they are being used. This needs research. And as far as I know, the latest research done in Brazil [sobre drogas] it’s from a decade ago.
You need research to understand the size of the problem and strategize. In my understanding, cocaine use is a bigger problem. And there is an effective treatment, contingency management [redução de danos]. We’re doing more of that in the United States.
The Biden administration has expanded the use of contingency management. which is an effective way to treat overuse of stimulants. Once you do that research, you create the strategy and delve into the types of treatments with evidence of what works.
And the other part, which is much bigger and long-term, is looking at the social conditions that are leading to substance use and homelessness. Look at poverty, unemployment, housing conditions.
There is a much greater focus in the US on these social determinants of health. They can lead to problematic substance use and addiction. These issues can include incarceration and trauma that people experienced when they were young. The social conditions part is very broad, and long-term, but it also needs to be addressed.
We have traditionally looked at drug abuse with a punitive approach. And our research clearly shows that punishment is not the way to improve conditions or prevent people from getting into substance use problems. We really need to reduce the harm associated with substance use, as well as lead people to healthier lives.
how to do this in practice? Drug use needs to be approached from a non-political, non-partisan public health perspective. Everyone has some family member affected by this, and it shouldn’t be a political issue where you do something to get points. And we have to make sure we’re treating people with compassion.
At Georgetown, I created a master’s program in addiction policy. The purpose is to ensure that we’re training the next generation of people who are going to work on addiction policy so they understand how the science works. Science and compassion guide our policies.
If I were to give one piece of advice, it would be to make sure that we are looking at all sides of the issue, but that there is no one-size-fits-all solution. And we need to make sure we’re thinking about the people most affected by the problem first.
How do you see the progress of policies to reduce damage? Last year, under the Biden administration, we released our priorities. For the first time, we’ve included a specific emphasis on harm reduction. Stigma towards people who use drugs pulls them away from the traditional health care system in a way that magnifies the harm associated with substance use.
Harm reduction also means treating people who use drugs with respect, and not thinking that if you punish them enough they will solve the problems they face, or that you will reduce the harm associated with drug use if you just punish them. Combating stigma and reducing harm is certainly an effort that needs to be made.
How to use police operations effectively? First of all is to make sure the police are aware of what kind of addiction you are dealing with. There are programs in the US where security officers work with health care social workers to prevent people from falling into the criminal justice system.
So it’s not the policeman who decides whether or not a person deserves treatment — and the person’s needs can go further, to include housing, employment, other social services.
I don’t think Brazil has as big a problem with opioid use as we have in the United States, with heroin and fentanyl, but US security forces have taken Naloxone for operations, a drug capable of reversing overdose. It’s a way to help security forces get involved on the public health side.
The more they understand how addictions work, the more lives they will save. The most important thing is to make sure that they understand the public health aspect and that they work together with the public health sector to prevent people from getting into the criminal justice system.
User treatments tend to be long and costly, at a time when there is no money for public spending. How to deal with this issue? Reducing the harms associated with drug use actually incurs the costs [do governo] down. Over time, this reduces expenses that would otherwise be spent on healthcare or the criminal justice system. The other part is to increase recovery support services such as jobs and housing.
From a policy standpoint, if you spend $1 on harm reduction, $1 on recovery support, how many dollars would you spend on incarceration do you save? This is the sort of thing policymakers might look at when deciding where to put resources.
Blocking the supply of drugs is important, both internationally and locally. But if you divert people from the criminal justice system, reduce the harm associated with drug use, give them the treatment and support they need, over time – not immediately – that will save money.
How has the pandemic affected drug use and the increase in homeless people? Is there a relationship between the two things? It’s a complicated issue. We’ve seen an increase in overdose deaths and harm associated with substance use. We’ve had increases in alcohol use. The damage was exacerbated.
There was also a rupture in the health services, which would have been offered [se não fosse a pandemia]. But we had some good things. There has been a good job of offering telemedicine, which lowers barriers to treatment.
Over time this will be useful, but right now in the United States we have a lot of fentanyl being offered as a drug, which is why we see an increase year after year in overdose deaths.
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Regina LaBelle
Founder and Director of the Masters in Addiction Policy at Georgetown University and former director of the ONDCP (National Office of Drug Control Policy), where she served in 2021, at the beginning of Joe Biden’s administration. She was also at ONDCP from 2009 to 2017, as chief of staff and policy director. She studied law at Georgetown and political science at Boston College. She was a legal advisor to the Seattle City Council and a professor at the University of Seattle.
