expository essay about war on drugs

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• v.54(1); 2022

How the war on drugs impacts social determinants of health beyond the criminal legal system

Aliza cohen.

a Department of Research and Academic Engagement, Drug Policy Alliance, New York, NY, USA

Sheila P. Vakharia

Julie netherland, kassandra frederique.

b Drug Policy Alliance, New York, NY, USA

Associated Data

Data sharing is not applicable to this article as no new data were created or analysed in this study.

There is a growing recognition in the fields of public health and medicine that social determinants of health (SDOH) play a key role in driving health inequities and disparities among various groups, such that a focus upon individual-level medical interventions will have limited effects without the consideration of the macro-level factors that dictate how effectively individuals can manage their health. While the health impacts of mass incarceration have been explored, less attention has been paid to how the “war on drugs” in the United States exacerbates many of the factors that negatively impact health and wellbeing, disproportionately impacting low-income communities and people of colour who already experience structural challenges including discrimination, disinvestment, and racism. The U.S. war on drugs has subjected millions to criminalisation, incarceration, and lifelong criminal records, disrupting or altogether eliminating their access to adequate resources and supports to live healthy lives. This paper examines the ways that “drug war logic” has become embedded in key SDOH and systems, such as employment, education, housing, public benefits, family regulation (commonly referred to as the child welfare system), the drug treatment system, and the healthcare system. Rather than supporting the health and wellbeing of individuals, families, and communities, the U.S. drug war has exacerbated harm in these systems through practices such as drug testing, mandatory reporting, zero-tolerance policies, and coerced treatment. We argue that, because the drug war has become embedded in these systems, medical practitioners can play a significant role in promoting individual and community health by reducing the impact of criminalisation upon healthcare service provision and by becoming engaged in policy reform efforts.

KEY MESSAGES

• A drug war logic that prioritises and justifies drug prohibition, criminalisation, and punishment has fuelled the expansion of drug surveillance and control mechanisms in numerous facets of everyday life in the United States negatively impacting key social determinants of health, including housing, education, income, and employment.
• The U.S. drug war’s frontline enforcers are no longer police alone but now include physicians, nurses, teachers, neighbours, social workers, employers, landlords, and others.
• Physicians and healthcare providers can play a significant role in promoting individual and community health by reducing the impact of criminalisation upon healthcare service provision and engaging in policy reform.

Introduction

Social determinants of health (SDOH) are “the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.” [ 1 ] There is a growing recognition in the fields of public health and medicine that SDOH play a key role in driving health inequities and disparities, such that a focus on individual-level medical interventions will have limited effects without the consideration of the macro-level factors that dictate how effectively individuals can manage their health. For instance, differences in access to nutritious foods, safe neighbourhoods, stable housing, well-paying job opportunities, enriching school environments, insurance, and healthcare can lead to differential health outcomes for individuals, their families, and their communities. And as these mid- and downstream SDOH have gained more attention, we must also focus on more macro SDOH in order to understand “how upstream factors, such as governance and legislation, create structural challenges and impose downstream barriers that impact the ability and opportunity to lead a healthy lifestyle.” [ 2 ]

One underexplored upstream SDOH is the “war on drugs” in the United States and how it exacerbates many of the factors that negatively impact health and wellbeing, disproportionately affecting low-income communities and people of colour who already experience structural challenges including discrimination, disinvestment, and racism [ 3 ]. President Richard Nixon launched the contemporary drug war in the U.S. in 1971 when he signed the Controlled Substances Act and declared drug abuse as “public enemy number one.” [ 4 ] Since the declaration of the U.S. drug war, billions of dollars each year have been spent on drug enforcement and punishment because it was made a local, state, and federal priority [ 5 ]. For the past half century, the war on drugs has subjected millions to criminalisation, incarceration, and lifelong criminal records, disrupting or altogether eliminating access to adequate resources and supports to live healthy lives.

Drug offences remain the leading cause of arrest in the nation; over 1.1 million drug-related arrests were made in 2020, and the majority were for personal possession alone [ 6 ]. Black people – who are 13% of the U.S. population – made up 24% of all drug arrests in 2020, despite the fact that people of all races use and sell drugs at similar rates [ 6–8 ]. While incarceration rates for drug-related offences skyrocketed in the 1980s and 1990s, they have decreased in recent years motivated both by cost savings and criminal legal reform efforts to promote a public health approach to drug use. However, estimates still suggest that roughly 20% of people who are incarcerated are there for a drug charge, and racial disparities in incarceration persist [ 9 , 10 ].

Meanwhile, the illicit drug supply has become increasingly unpredictable and contaminated due to drug supply disruptions, contributing to an exponential increase in drug overdose deaths [ 11 , 12 ]. Estimates suggest that one million people died of a drug-involved overdose between 1999 and 2020, with over 100,000 deaths occurring in a calendar year for the first time in 2021 [ 13 , 14 ]. Since 2015, overdose deaths have disproportionately impacted racial and ethnic minorities; Black people have had the biggest increase in overdose fatality rates, and today, Black and Native people have the highest overdose death rates across the U.S [ 15 ]. The most recent “fourth wave” of the overdose crisis can be attributed to a fentanyl-contaminated drug supply caused by drug prohibition; criminalisation that leads to stigma and fear of punishment that deters people from getting support they might need; and a lack of robust, scaled-up investment in harm reduction and evidence-based treatment services [ 16 , 17 ]. Although harm reduction interventions, including supervised consumption spaces (also called supervised injection facilities, drug consumption rooms, or overdose prevention centres) and heroin-assisted treatment have been widely studied and found effective outside of the U.S., these strategies have not been widely adopted in this country [ 18–21 ].

The drug war has also become deeply embedded within many of the systems and structures of U.S. life well beyond the criminal legal apparatus [ 3 ]. Since the health impacts of incarceration have been studied elsewhere, this paper will specifically discuss the impacts of criminalisation in other facets of life [ 22 ].

We argue that an underlying drug war logic has fuelled the expansion of drug surveillance and control mechanisms in numerous facets of everyday life in the U.S. We define drug war logic as a logic that prioritises and justifies drug prohibition, criminalisation, and punishment to purportedly address the real and perceived health harms of drug use over a public health approach to address these issues. In coining this term, we hope to make more visible the implicit assumptions about drug use that are often unnamed but common in the policies and practices across different institutions. We acknowledge that many actors in these settings where drug war logic is embedded, including physicians and other healthcare providers, are often well-intentioned yet unaware of how they may be perpetuating this logic through their own actions. We argue that drug war logic defies and contradicts widely accepted understandings of addiction as a health issue and has, in many cases, made a public health approach more challenging to implement [ 23 ]. Notably, the American Society of Addiction Medicine defines addiction as “a treatable, chronic medical disease involving complex interactions among brain circuits, genetics, the environment, and an individual’s life experiences.” [ 24 ] As this paper will outline, drug war logic undermines rather than supports the health of people who use drugs, their families, and their communities by treating drug use as a criminal issue.

Drug war logic is made concrete, not just within criminal legal systems, but also through mandated drug reporting and monitoring systems in treatment and healthcare settings, compulsory drug testing in employment and for the receipt of social services, the proliferation of zero-tolerance workplaces and school zones, mandated treatment in order to receive resources or avoid loss of benefits, background checks for work and housing, and numerous other measures which will be discussed in detail below. As a result, the drug war’s frontline enforcers are no longer police alone but now include physicians, nurses, teachers, neighbours, social workers, employers, landlords, and others who are required to engage in these forms of surveillance and punishment.

This commentary will use a SDOH lens to explore a number of systems where the drug war and its logic have taken root, impacting individual and community health and subjecting many people in the U.S. to surveillance due to suspected or confirmed drug use. Healthcare providers must have a robust understanding of the impact of drug war logic in employment, housing, education, public benefits, the family regulation system (commonly referred to as the child welfare system), the drug treatment system, and the healthcare system because these deeply impact the health of their patients, particularly their patients who use drugs (For the purposes of this paper, we are using the term “Family Regulation System,” coined by Emma Williams and used by other scholars, instead of the more commonly used term “Child Welfare System” to reflect the fact that, particularly for low-income families and families of color, state intervention often occurs in order to regulate their families rather than to prioritize the welfare of the entire family unit, of which the child is a part).

Employment, with its link to income and health insurance, is an important determinant of health. However, drug testing, criminal background checks, and exclusions of those with criminal histories from certain professions create significant barriers to obtaining and maintaining employment. Beginning in the 1980s, employment-based drug testing became widespread. In a 1994 report, the National Research Council noted that “[i]n a period of about 20 years, urine testing has moved from identifying a few individuals with major criminal or health problems to generalized programs that touch the lives of millions of citizens.” [ 25 ] Between 2017 and 2020, the National Survey on Drug Use and Health found that approximately 21% of respondents were tested as part of the hiring process, and 15% were subject to random employee drug testing [ 26 ].

Despite the widespread use of testing, less than 5.5% of results are positive for any drug, according to data from Quest Diagnostics, one of the largest testing companies in the country [ 27 ]. There is little evidence that these policies are effective in reducing drug use, improving workplace safety, or increasing productivity [ 28–30 ]. Notably, drug tests cannot specify how much of a drug was consumed, whether the person is currently intoxicated or impaired, or if they have a SUD. Drug tests cannot indicate if drug use will impact a person’s ability to perform their work or if they present a safety risk. Rather, drug tests simply show whether or not someone has a particular metabolite in their system [ 31–35 ].

Beyond workplace drug testing, hundreds of thousands are excluded from stable, well-paid work because of drug-related convictions. Over 70 million people – more than 20% of the U.S. population – have some type of criminal record [ 36 ]. A drug arrest or charge, even without a conviction, can be a barrier to getting a job because it can appear in many web searches and background checks [ 37 ]. Criminal background checks have become cheaper and easier to access, even though these records are notoriously inaccurate [ 38 , 39 ]. In addition, more than a quarter of jobs in the U.S. require some kind of licence, and a drug conviction history can automatically prevent people from getting a professional licence for their trade, like trucking or barbering [ 40 ].

These employment barriers disproportionately affect Black men, who already face additional impediments to employment and who are most harmed by the drug war and criminalisation [ 41 ]. The federal Equal Employment Opportunity Commission issued guidance stating that denying employment based on criminal records could be a form of racial discrimination because people of colour are more likely to be targeted by law enforcement and thus more likely to have an arrest or conviction record [ 42 , 43 ]. As a recent report by the Brennan Centre points out: “the staggering racial disparities in our criminal justice system flow directly into economic inequality” [ 36 ]. This same report found that those with a history of imprisonment earned 52% less than those with no history of incarceration.

Employment is a health issue that should be of concern to healthcare providers because it provides income, access to health insurance and medical treatment, and social connection [ 44 ]. Precarious employment and low income are linked to poor health, and some research has shown that people who use drugs and who are precariously employed face increased vulnerability to violence and HIV infection [ 45–47 ]. Being unemployed can lead to poverty and negative health effects and is associated with increased rates of drug use and SUDs [ 48 ].

Rather than supporting people who use drugs in accessing employment and the health benefits attached to it, drug war logic in employment settings can erect barriers. Eliminating or greatly restricting workplace drug testing as well as banning criminal background checks and professional licencing restrictions are important steps towards restoring access to employment and the many health benefits it confers.

Housing is another key SDOH that is significantly impacted by drug war policies and practices. Drug war surveillance in housing began with the passage of the Anti-Drug Abuse Act of 1988, which prohibited public housing authorities (PHAs) from allowing tenants to engage in drug-related activity on or near public housing premises and deemed such activity grounds for immediate eviction [ 49 ].

The Cranston-Gonzalez National Affordable Housing Act of 1990 expanded on this so that if a tenant’s family member or guest - regardless of whether they live on-site - engages in drug-related activity, the tenant and their household can be evicted [ 50 ]. Additionally, the Act states that evicted households must be banned from public housing for a minimum of three years unless the tenant completes an agency-approved drug treatment program or has otherwise been “rehabilitated successfully.” [ 50 ]

Six years later in 1996, Congress passed the Housing Opportunity Program Extension Act, which established “One Strike” laws and expanded on previous acts to give PHAs the authority to evict tenants if they or a guest was suspected of using or selling drugs, even outside of the premises [ 51 ]. This series of public housing policies requires neither a drug arrest nor proof that a tenant or their guest is involved in drug use, sales, or activity [ 52 ].

Private housing markets can also enforce zero-tolerance drug policies. In over 2,000 cities across the U.S., landlords can certify their property as “crime-free” by taking a class, implementing “crime prevention” architecture, and including clauses in their leases that allow for immediate eviction should a tenant, family member, or guest engage in “criminal activity,” particularly drug-related activity, on or off the premises [ 53 , 54 ]. Landlords, in close partnership with law enforcement, can invoke these laws by claiming to enforce crime-free ordinances, regardless of whether the alleged drug-related activity is illegal. In states across the U.S., private landlords have evicted tenants following an overdose [ 55–59 ]. In practice, these programs and ordinances increase the surveillance and displacement of low-income Black and Latinx tenants while not decreasing crime and potentially deterring someone from calling 911 for medical assistance in case of an overdose [ 55 ].

Evictions can lead to unstable housing or homelessness, which is associated with a host of chronic health problems, infectious diseases, emotional and developmental problems, food insecurity, and premature death [ 60–63 ]. Lacking a permanent address and reliable transportation makes it more difficult to receive and store medications and travel to a hospital or clinic; this is compounded with the stigma and discrimination that unhoused people often face from healthcare providers [ 64 ]. Being unhoused or housing unstable is also associated with difficulty obtaining long-term employment and education [ 65–67 ]. Longitudinal studies have found that family eviction has both short- and long-term impacts among newborns and children, including adverse birth outcomes, poorer health, risk of lead exposure, worse cognitive function, and lower educational outcomes [ 68 ]. These negative health outcomes are compounded for people with SUDs [ 69 ]. Unhoused people who use drugs are often forced into more unsafe, more unsanitary, and riskier injection and drug-using practices to avoid detection [ 70 ]. Evictions and homelessness are also associated with increased risk of drug-related harms, including non-fatal and fatal overdose, infectious diseases, and syringe sharing [ 71–73 ]. In addition, evictions can disrupt relationships between users and trusted sellers, making an already unregulated drug supply even more unpredictable [ 70 ].

While housing is understood as a key component of health and safety for all people, including people who use drugs, drug war logic can encourage and facilitate displacement, making it hard for housed people to remain so and creating barriers for those who are unhoused to find safe, affordable housing options. Solutions for improving housing access include ending evictions and removing housing bans based solely on drug-related activity or suspected activity, restricting landlords from using criminal background checks to exclude prospective tenants, and ending collaborations between housing complexes and law enforcement. Housing interventions that can improve the health of people who use drugs, in particular, include investing in Housing First programs and permanent supportive housing, providing eviction protection to people who call for help during an overdose emergency (i.e. expanding 911 Good Samaritan laws), and establishing overdose prevention centres.

Education is also understood as a strong predictor of health [ 74–76 ], but drug war logic in educational settings can subject young people who use drugs to punishment rather than needed support. Adolescent substance use is associated with sexual risk behaviour, experience of violence, adverse childhood experiences, and mental health and suicide risks, which should justify greater mental health and support services in schools [ 77 ]. Despite this, punitive responses to suspected or confirmed drug use, ranging from surveillance and policing to drug testing and expulsion, are commonplace in the field of education.

In 2018, 94% of high schools used security cameras, 65% did random sweeps for contraband, and 13% used metal detectors [ 78 ]. Twenty-four states and the District of Columbia have almost as many police and security officers in schools as they do school counsellors [ 79 , 80 ]. Drug use is one of the most common sources of referrals of students to police [ 80 ]. And recent estimates show that over a third of all U.S. school districts with middle or high schools had student drug testing policies [ 81–83 ].

Drug war policies also impact higher education, which is integral to economic mobility [ 84 ]. Prior to December 2020, federal law prohibited educational grants and financial aid to people in prison, one-fifth of whom were there for a drug offence, and drug convictions could lead to temporary or indefinite suspension of federal financial aid for students [ 85 ]. Still today, fourteen states have some temporary or permanent denial of financial aid for college or university education for people with criminal records [ 86 ].

These education policies – surveillance, policing, drug testing, zero tolerance, and barriers to financial aid – restrict access to education and ultimately impede economic wellbeing and positive health outcomes. For example, dropout risk increases every time a student receives harsh school discipline or comes into contact with the criminal legal system, including through school police officers [ 87 ]. Dropping out, in turn, is associated with higher unemployment and chronic health conditions [ 88 ]. In addition, discipline, such as expulsion for a drug violation, can contribute to more arrests for drug offences or the development of SUDs [ 89–91 ]. In contrast, school completion can help reduce higher risk substance use patterns [ 92 ], and education is a strong predictor of long-term health and quality of life [ 93 ].

Rather than supporting young people in completing their education and getting the support they may need, drug war logic prioritises punishing them in schools while often restricting access to financial aid and educational services for those seeking higher education. If we want to improve the health of young people, we need to reverse these policies. For example, the American Academy of Paediatrics opposes the random drug testing of young people based on an exhaustive review of the literature finding it did more harm than good [ 94 ]. Removing police from schools, ending zero-tolerance policies, and offering young people who use drugs counselling and support, instead of expulsion, could also help improve completion rates, ultimately leading to better health outcomes.

Public benefits

Though economic and food insecurity are linked with poor health outcomes, decades of drug policies have restricted access to public assistance programs. In 1996, Congress passed the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) [ 95 ], and one of the stated goals was to facilitate the transition from reliance on public assistance to full-time employment [ 96 ]. This law restricted benefits for people who use drugs, people with prior drug convictions, and their families in several ways.

The PRWORA introduced a lifetime ban on Supplemental Nutrition Assistance Program (SNAP) and Temporary Assistance for Needy Families (TANF) cash assistance benefits for people with felony drug convictions, unless the state modified or opted out of the ban. Today, one state - South Carolina - fully bars people with felony drug convictions from receiving SNAP, and twenty-one states have instituted a modified SNAP ban [ 97 ]. Seven states fully bar people with felony drug convictions from receiving TANF, and seventeen states and the District of Columbia have instituted modified TANF bans [ 97 ]. Common features of modified bans can include mandatory drug treatment, drug testing, and parole compliance [ 98 , 99 ]. These zero-tolerance bans have discriminatory and disproportionate impacts among Black and Latinx people and women, who are disproportionately incarcerated for federal and state drug offences [ 100 ].

Drug testing of public benefits applicants is less discussed in the peer-reviewed literature [ 101 ]. Although the PRWORA authorised, but did not require, drug screenings of public benefits applicants, today 13 states drug test TANF applicants [ 102 , 103 ]. States that drug test as a condition of receiving TANF can only test if drug use is suspected. For example, some states automatically require people with felony drug convictions to take a drug test [ 104 ], while other states require all applicants to undergo a drug screening questionnaire and then require a test if there is suspicion of drug use [ 105 ]. Many TANF applicants, who are already low income, are expected to pay for their drug tests. The impact of drug testing on people with felony drug convictions is compounded since they are already disproportionately poor, unemployed, and food insecure compared to people who have never been incarcerated [ 106–108 ].

In most states that test, a positive drug test can temporarily or permanently disqualify a person from receiving TANF benefits [ 105 ]. Even if cash assistance is allocated to other household members (e.g. children) through a different parent or guardian, overall benefits for the family can be reduced. In some cases, a person who tests positive for drugs may still receive benefits but only if they complete mandated, abstinence-based treatment [ 105 ]. Such policies and practices can deter many eligible candidates and those in need of support from ultimately seeking these public benefits altogether [ 109 ].

There are numerous negative health consequences associated with food and economic insecurity [ 110–112 ]. In particular, studies have found that loss or reduction of SNAP is associated with increased odds of household and child food insecurity and increased odds of forgoing health or dental care [ 113 ]. Loss or reduction of TANF is associated with increased risk of hunger, homelessness or eviction, utility shutoff, inadequate medical care, and poor health [ 114 ].

When people are seeking financial and nutritional support to better care for themselves and their families, especially in crisis, drug war logic justifies more barriers to SNAP and TANF and the discontinuation of assistance precisely when people need it the most. To better support financial and economic security of low-income people, advocates can support removing TANF and SNAP bans for people who have felony drug convictions, ending drug testing requirements for public assistance, eliminating mandatory drug treatment requirements for public benefits applicants and recipients, and adequately investing in public benefit programs to ensure they provide enough assistance for families.

Family regulation

The family regulation system (FRS) often treats any drug use as a predictor of child abuse or neglect, even though research shows that poverty is one of the largest predictors of adverse infant and child health outcomes [ 115 ]. Drug war logic within the FRS justifies the separation and punishment of families for drug use even absent evidence of abuse or neglect. Half of all states and the District of Columbia require healthcare professionals to report any suspected drug use during pregnancy to FRS authorities, and eight states require them to drug test patients suspected of drug use [ 116 ]. Statutes in nineteen states and the District of Columbia define any drug use during pregnancy as a form of child maltreatment [ 117 ]. These policies exist even though most people who use drugs use them infrequently and do not meet criteria for SUDs [ 118 ]. Additionally, evidence proving causal links between prenatal drug use and child harm and maltreatment is limited. Research finds that in utero exposure to drugs may not have long-term negative developmental impacts on the child and that confounding variables, like poverty and food insecurity, have significant and often stronger impacts on child development than drug use [ 117 ].

Drug testing, mandatory reporting, and the prospect of punishments result in poorer health outcomes for pregnant people who use drugs, especially if they struggle with their use. A fear of punishment and family separation leads some pregnant people who use drugs to avoid honest, open conversations about healthcare needs or how to reduce drug use harms so that many delay, avoid, or forgo prenatal care altogether [ 119 , 120 ].

Like healthcare professionals, most school teachers, counsellors, social workers, and mental healthcare providers are required by law to report any suspicion of child maltreatment or neglect, which then initiates an FRS investigation [ 121 ]. A child can be removed from their home if the caregiver tests positive for drugs, even absent any other evidence of mistreatment or abuse. In addition, a positive drug test can lead to a parent being mandated to complete abstinence-based treatment even if the parent does not meet criteria for a diagnosable SUD [ 122 ]. Intervention by the FRS, such as placing children in foster care, can lead to adverse education, employment, and mental and behavioural health outcomes among children; increased parental mental illness diagnoses; and increased parental drug use to cope with the trauma of family separation [ 123–125 ].

These policies have disproportionate impacts on Black people. Black pregnant women are more likely to be tested for drug use, and Black women are reported to the FRS at higher rates than white women [ 126–128 ]. Over half of Black children will experience an FRS investigation at some point during their lifetime [ 129 ]. One study that analysed cumulative foster system removals between 2000 and 2011 found that 1 in 17 U.S. children, 1 in 9 Black children, and 1 in 7 Indigenous children will experience foster placement before they turn 18, and data show that many FRS cases involve allegations of parental drug use at some point [ 130 ]. These disparities in FRS involvement are not because Black parents are using drugs or mistreating their children at higher rates; rather, it’s because Black families, especially poor Black families, more often encounter state systems – like public hospitals and public benefits offices – and mandated reporters within these systems that monitor behaviour and drug use [ 131 ].

Drug war logic prioritises separation, coercion, and punishment in families where drug use occurs or is suspected. For pregnant people and parents who do use problematically, their use should be treated as a public health issue, according to international bodies like the United Nations General Assembly Special Session on drugs [ 132 ]. Advocates can support legislative policy changes to prohibit removals based on drug tests alone, eliminate mandatory reporting for drug use alone, and repeal laws that define drug use during pregnancy as de facto child abuse or maltreatment. Healthcare professionals can also advocate to only allow drug testing when medically necessary and when the parent provides informed consent; support practices that keep parents and infants together, like breastfeeding and skin-to-skin contact, that can mitigate the effects of neonatal abstinence syndrome [ 133 , 134 ]; and create programs providing both perinatal healthcare and SUD treatment to improve access and continuity of care as well as initiation and maintenance of medications for addiction treatment.

Substance use treatment system

Substance use treatment can be an essential lifeline for people with SUD working towards recovery. Yet surveillance and punishment are embedded into SUD treatment through the numerous constraints placed upon clients because of the role of institutional referral sources in treatment, such as the criminal legal system, the FRS, social services, and others. Studies suggest that roughly 25% of clients in publicly funded treatment were referred from the criminal legal system as a condition of their probation, parole, or drug court program [ 135 ]. This has led to therapeutic jurisprudence: the belief that the criminal legal system can support and facilitate efforts towards rehabilitation using the threat of incarceration [ 136 ]. Another 25% of clients are referred to treatment by other sources, including the FRS, social services, schools, and employers [ 133 ]. Criminal legal controls such as those from the courts, or formal social controls such as those from the other aforementioned institutions, coerce clients to either comply with treatment or face other harsh consequences, like incarceration, the termination of parental rights, or losing public benefits [ 137 ].

Treatment providers monitor client compliance and abstinence by conducting and observing routine urine drug tests, and providers are often in regular contact with referral sources about client progress in treatment. Any drug use or negative progress reports can be used as grounds to sanction those on probation, parole, or in drug court which can lead to incarceration and, in cases of drug courts, longer sentences than if participants had accepted a jail sentence [ 136 ]. Clients referred by other sources can also face ramifications for positive drug tests or treatment non-compliance, impacting child custody hearings as well as their ability to secure certain social services and resources, stay enrolled in school, or remain employed.

Referral sources influence the type of care that clients receive in facilities, including evidence-based treatments. Research suggests that only 5% of clients with opioid use disorder (OUD), who were referred to treatment from the criminal legal system, received either methadone or buprenorphine, compared to nearly 40% those who were not referred by the system [ 138 ]. This represents an extension of a broader problem within the criminal legal system wherein access to these gold standard medications for OUD is almost nonexistent in most jails and prisons across the U.S [ 139 ].

Drug war logic is also deeply rooted in the restrictions for prescribing and dispensing methadone and buprenorphine since they are controlled substances under the oversight of the Drug Enforcement Agency, a federal law enforcement entity. When taken in effective doses, these life-saving medications can cut the risk of overdose and all-cause mortality dramatically among people with OUD [ 140 ]. However, due to tight federal restrictions and guidelines for these controlled medications, patients can be subjected to routine drug testing, counselling requirements, daily clinic visits, and observed or highly monitored medication dispensing. Patients deemed non adherent to medications or who test positive for other drugs can then be subjected to dose reductions, required to attend treatment more frequently, or even terminated from care altogether [ 141 ]. The tight restrictions on both methadone and buprenorphine, combined with the oversight of the DEA, create obstacles for prescribers and stigmatise these medications by conveying that they cannot be used like other medications in routine healthcare [ 142 ]. These policies have also contributed to striking racial disparities in who receives buprenorphine versus methadone due to costly co-pays and insurance coverage issues [ 143 ]. Studies also suggest that the DEA’s involvement in monitoring buprenorphine has made pharmacies reluctant to stock the medication or to dispense it to patients for fear of triggering an investigation [ 144 , 145 ]. Ultimately, it is estimated that only 10% of all people with OUD receive these medications [ 146 ].

Providers can take steps to extract the drug war from our substance use treatment system, through their conscious and judicious documentation of treatment progress since those records could be used by criminal legal and other referral sources in decisions about clients and their families. In addition, eligible buprenorphine prescribers should begin prescribing to patients and join advocacy efforts to change policies to expand access to buprenorphine and methadone through looser restrictions.

Healthcare system

People with SUDs often have high rates of co-occurring medical needs requiring treatment, including psychiatric disorders, infectious diseases, and other chronic health conditions. However, research suggests that people with SUDs are often deterred from seeking healthcare to address their medical needs due to prior negative and stigmatising experiences with providers, and that having experienced discrimination in healthcare is associated with greater risk behaviours, psychological distress, and negative health outcomes among people who use drugs [ 147–149 ]. Some of these challenges are due to a lack of training on how to work with patients with SUDs, in addition to pre-existing personal biases and stigmatising views held by healthcare professionals, which impacts the type of care they provide [ 142 ].

The widespread use of drug testing in healthcare settings also creates ethical challenges and conflicts for providers and patients since results are often entered into the electronic health record (EHR). While EHRs are typically thought of as beneficial and intended for greater transparency and access, they also pose challenges surrounding patient privacy, confidentiality, and autonomy; they can, therefore, make patients reluctant to disclose drug use or consent to drug testing [ 150 ]. For instance, medical records that include drug test results, can be accessed by a wide variety of actors in the medical system, subpoenaed for court, and used in future medical decision making without the patient’s knowledge or consent. Providers might not receive adequate training to weigh the need for these tests as part of treatment adherence monitoring with the potential social or legal ramifications of these tests for the patient. Patients might also not be adequately informed of these potential consequences prior to testing.

Universal drug screening and testing in obstetric and gynecological care is an example wherein testing intersects with the role of most healthcare providers as mandated reporters. Mandated reporting for suspected child abuse or neglect due to parental drug use is purported to protect the foetus or children in the parents’ custody, yet this can often be a deterrent for patients to seek medical treatment altogether if they believe that they may lose their children or be subject to other mandates. The racial and class disparities in how such testing is used, as well as the punitive measures used against families, have been noted earlier in the text but is a compelling reason for healthcare providers to consider making recommendations for counselling or supportive case management in order to address family challenges.

Healthcare providers need more training and resources to work with patients with SUDs to ensure that they are engaging them in evidence-based treatments and treating their complex medical needs while avoiding some of the lifelong and harmful ramifications that can occur when drug testing, health records, and mandated reporting deter patients from seeking and receiving care.

Because of the social, economic, and health effects of drug policies, the work of ending the drug war cannot be situated within criminal legal reform efforts alone. The drug war and a punitive drug war logic impact most systems of everyday life in the U.S., subjecting people to surveillance, suspicion, and punishment and undermining key SDOH, including education, employment, housing, and access to benefits. Combined, these have resulted in poorer health outcomes for individuals, families, and communities, particularly for people who use drugs. These policies and practices, while race-neutral as written, are not [ 151 ]. The targeted effects on people of colour further entrench health and economic disparities. As the public and policymakers call for a health approach to drug use, it is vital to recognise how systems meant to care and support are often unable to serve their intended purposes; rather than help people who use drugs or are suspected of using drugs, they frequently punish them.

In their day-to-day practice, healthcare professionals must understand the deep roots of the drug war as well as their role in both perpetuating and undermining drug war logic and practices. Healthcare providers can treat people who use drugs with dignity, respect, and trust and ensure that healthcare and treatment decisions are made in partnership with individuals. Medical professionals can also work to situate drug use within a larger social and economic context [ 152 ], understanding that drug-related harms often stem from lack of resources – like housing and food precarity, economic insecurity, and insufficient healthcare – rather than from drugs themselves. Treatment need not be the only antidote for people who experience drug-related harms but should be one option among an array of health services, resources, and support.

At the mezzo- and institutional levels, healthcare providers can advocate to shift hospital and programmatic policies around drug testing, mandatory reporting, and collaborations with law enforcement. As outlined in this paper, drug testing is not an effective monitoring strategy for care and support, but rather, it is more often a punitive tool of surveillance. If drug testing cannot be eliminated, at the very least, patients should have the right to understand the implications of drug testing and provide explicit consent for the test. To the extent possible, providers should not share private patient information with police or state agencies. Healthcare professionals should understand the implications of reporting positive drug tests and suspicion of use and should work to change these policies where possible and inform their patients of them. Providers can ensure that their patients who use drugs have access to evidence-based, non-coercive harm reduction and treatment options in addition to robust and supportive primary healthcare. Healthcare professionals involved with medical education and licensure can work to ensure that all students graduate with a deep understanding of SDOH and the impact of the drug war on individual and community health.

Finally, healthcare providers can get involved with policy-level changes to end drug testing, mandatory reporting, zero-tolerance policies, coerced treatment, and denial of services and resources based on arrest or conviction records at the municipal, state, and federal levels. Providers can follow the leadership and expertise of people who use drugs, some of whom have organised themselves into user unions [ 153 ]. Policy advocacy can include drafting and joining sign-on letters, delivering expert testimony, speaking to media, writing op-eds, and lobbying medical professional organisations to release policy statements. Providers, who see firsthand the consequences of the war on drugs, are well positioned to be effective advocates in undoing these harmful policies that have for too long undermined key SDOH [ 154 ]. In order to improve individual and collective health, healthcare providers should resist drug war logic and work to transform these systems so they can truly promote health and safety.

For the purposes of this paper, we are using the term “Family Regulation System,” coined by Emma Williams and used by other scholars, instead of the more commonly used term “Child Welfare System” to reflect the fact that, particularly for low-income families and families of color, state intervention often occurs in order to regulate their families rather than to prioritize the welfare of the entire family unit, of which the child is a part.

Authors contribution

All authors (AC, SV, JN, KF) were involved in the conception and drafting of the paper, revising it critically for intellectual content; and the final approval of the version to be published. All authors agree to be accountable for all aspects of the work.

Disclosure statement

All authors are employed by the Drug Policy Alliance, a non-profit policy advocacy organisation. No other interests to disclose.

Data availability statement

The views expressed in the submitted article are those of the authors.

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The War on Drugs, Essay Example

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The “Drug War” should be waged even more vigorously and is a valid policy; government should tell adults what they can or cannot ingest. This paper argues for the position that the United States government should ramp up its efforts to fight the war on drugs.  Drug trafficking adversely affects the nation’s economy, and increases crime.  The increase in crime necessitates a need for more boots on the ground in preventing illegal drugs from entering this country.  Both police and border patrol agents are on the frontline on the battle against the war on drugs.  The war on drugs is a valid policy because it is the government’s responsibility to protect its citizens.  Citizens who are addicted to drugs are less likely to contribute to society in an economic manner, and many end up on government assistance programs and engage in crimes.

Introduction

This paper argues that The War on Drugs is a valid policy, and that government has a right, perhaps even a duty to protect citizens from hurting themselves and others.  Fighting drug use is an integral part of the criminal justice system.  Special taskforces have been created to combat the influx of illegal drugs into the United States. The cost of paying police and border control agents is just the beginning of the equation.  Obviously, the detriment to the US economy is tremendous.  But the emotional stress on the friends and family of the drug user represent the human cost of illegal drugs.  Families are literally torn apart by this phenomen.

(1). The cost of police resources to fight the drug war is exorbitant, but necessary .  In order for a war against drugs to be successful, federal, local and state authorities must make sure that there a plenty of drug enforcement officers to make the appropriate arrests.  This means that drug enforcement officers must be provided with the latest equipment, including technology to detect illegal drugs (Benson).  The cost of providing all the necessary equipment to border patrol agents and the policemen and policemen on the frontlines is well justified.  It is necessary to have a budget that will ensure that drug enforcers have everything they need to combat illegal drugs at their disposal.

(2). The government has the responsibility to protect its citizens.   If a substance is illegal, it should be hunted down by law enforcement authorities and destroyed.  The drug user is a victim of society who needs help turning his or her life around.  Without a proper drug policy in effect, the drug user will continue to purchase drugs without the fear of criminal punishment.  That is why the drug war is appropriate.  The government has a right to tell citizens what it cannot ingest, particularly substances that when ingested can cause severe harm to the individual.  This harm may take on the form of addiction.  Once a person is addicted to drugs, the government has treatment programs to help him or her get off drugs.  The economic cost of preventing illegal drugs from getting into the wrong hands, and the cost of drug treatment is worth the financial resources expended because people who are not addicted to drugs are more involved in society and in life in general (Belenko).

(3). Anti-drug policies tend to make citizens act responsibly .  Adult drug users must understand that what they are doing is negatively impacting society.  Purchasing illegal drugs drains the nation’s economy.  These users have probably been in and out of drug rehabilitation programs many times with little to no success.  These drug programs are run by either the federal, state, or local governments (Lynch).   Each failed incident of a patient going back to the world of drugs costs the taxpayers money.  Once the drug user is totally rehabbed, he or she will realize the drag that he or she has been on society.  Therefore, the drug treatment centers are a way to teach adults how to be more responsible.

(4). Drug regulation in the United States has an effect on the international community.  America’s image to the rest of the world is at stake.  If America cannot control its borders, rogue leaders of other countries will think that America is soft on drugs.  This in turn makes America’s leaders look weak (Daemmrich).  Border patrol agents on the United States-Mexican border represent the best that America has to offer in preventing illegal drugs from entering the United States.  It is imperative that part of the drug policy of the United States provides enough financial resources for the agents to do their job.  The international community must see a strong front from the United States against illegal drugs.  Anything less is a sign of weakness in the eyes of international leaders, including our allies.

(5). Women are disproportionately affected by illegal drug use and therefore neglect their children.   As emotional beings, women have to contend with many issues that evade men (Gaskins).  The woman’s primary responsibility is to her children.  If a woman is a drug user, her children will be neglected.  Most of the children end up becoming wards of the state.  Having to cloth and feed children places a major burden on organizations that take these children of addicts in.  A drug addict cannot take care of herself, and she certainly cannot take care of her children.  Both the woman and her children will become dependent on the government for food and shelter.  This person is not a productive member of society.  Increased prison sentences may seem harsh for women with children, but these sentences may serve as deterrence from using drugs.

(6 ). If students know that the criminal penalty is severe, it may serve as a deterrent to drug related crimes.   Educating students, while they are still in school about the harmful effects and consequences of using drugs is imperative in fighting the drug war.  However, many students may tune out the normal talk about how drugs affect them physically.  The key to effectively making the point to students that illegal drug use is wrong is to present them with the consequences of having a felony drug conviction on their record (Reynolds). In fact, having a criminal record is bad enough without the felony drug conviction.  Students should know that such a record can prevent them from obtaining employment in the future.  It should be stressed that many companies will not hire anyone with a criminal record, especially if the conviction was related to illegal drugs.  The threat of extensive incarceration should also deter students from using illegal drugs or participating in drug related activities.

(7). Parents who use drugs in front of their children are bad influences and contribute to the delinquency of the minor.    Children are extremely impressionable, and starting to use drugs at a young age can be devastating to their future.  The government fights the drug war to protect law abiding citizens, and to punish criminals.  People who use illicit drugs are criminals, and parents who influence their children by introducing and approving of their drug use need to suffer severe penalties under the law (Lynch).  It is more than likely that the parents that use drugs have been incarcerated at one time or the other.  This incarceration may be drug related.  Children see their parents go in and out of jail, so that becomes their “normal.” Thus you have generational incarcerations which are an expense to prison sector and taxpayers.  The government is right in ramping up the penalties on drug use in front of children.

(8). People who use drugs are likely to drive under the influence which has all sorts of possible negative outcomes. There are so many consequences resulting from illegal drug use that they are too numerous to list.  One of the “unspoken” consequences is driving under the influence.  The entire population has made a concerted effort to curtail drinking and driving, and the deaths from alcohol related traffic accidents gave gone down significantly since strict laws have been put in place.  The government needs to find a way to crack down on drivers who are under the influence of illegal drugs (Belenko).  Drivers must be clear headed and focused to driver responsibly.  The government should get harsher, and find a way to test (as in the breathalyzer for alcohol) for marijuana.  The government has been successful in keeping the number of drunken drivers down.  However, many drivers are still legally able to pass a breathalyzer test if they are smoking marijuana, or using other drugs.  Accidents can still happen regardless of what drug the driver is under the influence of.  The government must find a way to crack down on these drivers who think that they are beating the system.

If the United States wants to get serious on the war on drugs, it should wage the war more vigorously.  Although the war on drugs is a valid policy, it needs to receive more attention and financial resources from the Federal government.  Preventing illegal drugs from crossing our borders is costly, but highly effective if there are plenty of border patrol agents on the United States-Mexican border.  This is the main avenue by which illegal drugs make it into the United States.  The argument that the government has the right to tell citizens what they can ingest is correct.  This is because it is the government’s responsibility to protect its citizens.  Keeping people off of drugs makes for productive citizens who contribute to building a drug free society.

Works Cited

Belenko, Steven R., ed. Drugs and Drug Policy in America: A Documentary History. Westport, CT: Greenwood, 2000. Questia. Web. 2 Nov. 2012.

Benson, Bruce L., Ian Sebastian Leburn, and David W. Rasmussen. “The Impact of Drug Enforcement on Crime: An Investigation of the Opportunity Cost of Police Resources.” Journal of Drug Issues 31.4 (2001): 989+. Questia. Web. 2 Nov. 2012.

Daemmrich, Arthur A. Pharmacopolitics: Drug Regulation in the United States and Germany. Chapel Hill, NC: University of North Carolina, 2004. Questia. Web. 2 Nov. 2012.

Gaskins, Shimica. “”Women of Circumstance”-The Effects of Mandatory Minimum Sentencing on Women Minimally Involved in Drug Crimes.” American Criminal Law Review 41.4 (2004): 1533+. Questia. Web. 2 Nov. 2012.

Lynch, Timothy, ed. After Prohibition: An Adult Approach to Drug Policies in the 21st Century. Washington, DC: Cato Institute, 2000. Questia. Web. 2 Nov. 2012.

Reynolds, Marylee. “Educating Students about the War on Drugs: Criminal and Civil Consequences of a Felony Drug Conviction.” Women’s Studies Quarterly 32.3/4 (2004): 246+. Questia. Web. 2 Nov. 2012.

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Good Example Of Essay On Expository On Mexicos War On Drugs

Type of paper: Essay

Topic: Government , Commerce , Social Issues , Trade , Politics , Drugs , Crime , Mexico

Words: 1300

Published: 03/03/2020

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This paper analyzes the current situation in the fifty year war on drugs that has raged within Mexican boarders because of US policy towards drug trafficking. Mexico is not a production center of drugs, but a transit point from Colombian cocaine to reach an illegal US drug demand. As much as ninety percent of all cocaine that ends up in the US is trafficked through Mexico. Since Pablo Escobar began the first one, the drug trade in Mexico has been controlled by powerful entities known as cartels. This, mixed with lack of opportunity and poverty in Mexico, has led to a destabilization of security throughout the country. While there are a number of solutions on the table, even many of these are contradictory. During the last 50 years Mexico, due to pressure from the United States, has been in a war with the motive of stopping the illegal transport of cocaine from South America into the US. The death toll from this war has been significant, with not just drug traffickers, but also innocent Mexican civilians suffering from the war. It is a war where while all parties believe that a change must occur, there are various theories as to how that change can occur. Traffickers in Mexico are known as narcotrafficante, or the more abbreviated version, narco. Both of these terms refer drug smugglers within the country that are overseeing operations, and those from other countries who are either crossing border with drugs, or receiving them. Mexicans from all walks of life are familiar with these terms since the effects of narcotrafficking affects their everyday life. Though estimates vary, the figure of annual revenues that comes to Mexico from the drug trade is set at between fourteen and fifty billion dollars (Longmire, 2011). According to the US State Department, as much as ninety percent of all cocaine that comes to the US through Colombia comes through drug routes in Mexico. All of the revenues from cocaine goes to enable the narcos with vast financial means. This allows them to be powerful, militant entities and leads to corruption, crime, and what is known as parallel power structures. In any country, the most powerful entity of the country is the government. But one groups other than the government, non-elected groups, obtains political power that rivals the legitimate government, these are known as parallel power structures. Many in Mexico believe that the narco traffickers are parallel power structures that rival the power of the states (BBC News, 2008). The current President of Mexico, Enrique Piñera Nieto, was elected because many citizens thought that he would bring about a better way of handling an issue that is currently out of control. Drug trafficking was one of the most important issues of the campaign. This is not just a current issue in Mexico, but one that has a far reach into the history and geographical location of the country. Because Mexico is just south of the US, the country that consumes more cocaine per capita than any other country in the world, it makes sense that these problems would erupt in Mexico, which stands geographically between the US and Mexico (Vulliamy, 2011). Also, Mexico already has long established trafficking routes that immigrants have used to get illicit products and other contraband across the border. These routes go back far into the history of the relations between the countries. During the time that alcohol was illegal in the US, Mexico smuggled more alcohol into the US than any other country. As a drug cultured emerged in the US during the 1960s, drug trafficking began to reach the scale that we see between the countries today (Vulliamy, 2011). Historically the most prominent figure in the Mexican drug trafficking trade is a Colombian named Pablo Escobar, who is often called the father of the drug trade. (DEA History, 2011). Connecting the supply of drugs in his power in Colombia between the US, he set up the first cartels in Mexico. During the eighties and the nineties he was the kingpin of the illegal trade, and managed the production operations in Colombia and the transport routes in Mexico. Before his time, these drug routes were generally operated between the Colombia and the US via South Florida and the Caribbean. As cracking down in those areas increased, Escobar shifted the trade to through Mexico, many of which still exist today.

With time Escobar’s cartel split into various factions which formalized into the large entities that exist today.

New York Times has said that there, there is currently a power vacuum that exists since the breakup of a single cartel and so today many cartels not only fight the Mexican government in their efforts to shut them down, but also fight amongst each other (Buscalgia, 2013). Since after fifty years, neither Mexico nor the US can claim much victory in the wars on drugs, other options have emerged as solutions. One is being furthered by Otto Perez, the president of Guatemala who is open to looking at all options, including across the board legalization of all drugs, which will leave the problems in the US which consumes the drugs that go through Mexico (Buscalgia, 2013). The New York Times points out that while organized crime is the problem, Mexico is a unique case when it comes to the violence that results from the organized crime that runs the drug trade. He writes that other places such as China and Russia have organized crime elements that are even more powerful than Mexico with vastly lower body counts. The heart of Mexico’s problem Buscalgia believes is the rife poverty and lack of opportunities for everyday Mexicans. Plenty of disenfranchised youth see drugs as their only way out of the poverty traps that they were born into. While China and Russia are not necessarily model countries for educational opportunities, Mexico by comparison invests much less to the GDP. Mexico also has a powerful teacher union which often is an obstacle to reforms that aim to target the unequal distribution of education resources. As the World Economic Forum has it, Mexico does put a significant part of its GDP in education. In 2009 they spent 5.3% of their GDP in education. However, the same report also shows that plenty of people still receive subpar education partly because Mexico has a powerful teachers union that blocks needed reforms which democracy through the elimination would allow for an equitable distribution of educational opportunities (Longmire, 2011). The criminal justice system prevents the government from taking necessary action due to it being filled with corruption. Buscalgia believes that nothing will help the countries security without the country first completing a “transition to democracy through the elimination of state power vacuums and the establishment of the rule of law” (Buscalgia, 2011). As this essay indicates, the problem of the drug trafficking in Mexico is a complicated one. It involves multiple countries and historical and geographical realities. Poverty, and a weak government, and a strong parallel power structure of narco traffickers compound the issue. The solutions proposed are sometimes contradictory. Some believe there is more military might is needed. Others believe that legalization needs to solve it. It is an issue though that will continue to affect the Mexican government, it’s people, and most notably the border states in the US in which elements of the conflict have crossed over.

Analysis: Mexico’s drug wars continue. BBC News. 2002-03-12. Buscalgia, Edgardo. Mexico’s Deadly Power Vacuum. The New York Time. Mary, 30 2013 “History of DEA Opperations” DEA History. US DEA. Retrieved 2008-09-21. http://www.usdoj.gov/dea/pubs/history/history_part2.pdf Longmire, Sylvia Cartel: The Coming Invasion of Mexico's Drug Wars. Macmillan. pp. 103–104. 2011. “

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The War on Drugs is Also a War on Pain Patients

Related articles.

In a recent New York Times essay, a professor of anesthesia and pain management recently protested the Drug Enforcement Administration's opioid manufacturing quotas and micromanagement of doctors treating their patients' pain. At a time when DEA S.W.A.T. teams frequently raid doctors' offices for "inappropriate" prescribing, the professor's essay demonstrated boldness. Unfortunately, the professor's reform proposals were much less bold.

In a March 22 opinion  column  in the  New York Times  entitled “The DEA Needs to Stay Out of Medicine,” Vanderbilt University Medical Center associate professor of anesthesiology and pain management Shravani Durbhakula, MD, documents powerfully how patients suffering from severe pain—many of them terminal cancer patients—have become collateral casualties in the government’s war on drugs.

Decrying the Drug Enforcement Administration’s progressive tightening of opioid manufacturing quotas, Dr. Durbhakula writes:

In theory, fewer opioids sold means fewer inappropriate scripts filled, which should curb the  diversion of prescription opioids for illicit purposes  and decrease overdose deaths — right? I can tell you from the front lines that that’s not quite right. Prescription opioids once drove the opioid crisis. But in recent years opioid prescriptions have significantly fallen, while overdose deaths have been at a record high. America’s  new wave  of fatalities is largely a result of the illicit market, specifically  illicit fentanyl . And as production cuts contribute to the reduction of the already strained supply of legal, regulated prescription opioids, drug shortages stand to affect the more than  50 million people  suffering from chronic pain in more ways than at the pharmacy counter.

Dr. Durbhakula provides stories of patients having to travel long distances to see their doctors in person due to DEA requirements about opioid prescriptions. However, despite their efforts, they find that many of the pharmacies do not have the opioids they require because of quotas. She writes:

Health care professionals and pharmacies in this country are chained by the Drug Enforcement Administration. Our patients’ stress is the result not of an orchestrated set of practice guidelines or a comprehensive clinical policy but rather of one government agency’s crude, broad‐​stroke technique to mitigate a public health crisis through manufacturing limits — the gradual and repeated rationing of how much opioids can be produced by legitimate entities.

In the essay, Dr.Durbhakula does not question or challenge the  false narrative  that the overdose crisis originated with doctors “overprescribing” opioids to their pain patients.

Unfortunately, Dr. Durbhakula’s proposed policy recommendations would do little to advance patient and physician autonomy. She would merely transfer control over doctors treating pain from the cops to federal health bureaucracies and let those agencies set opioid production quotas. For instance, she claims, “It’s incumbent on us [doctors] to hand the reins of authority over to public health institutions better suited to the task.”

No. The “reins of authority” belong in the hands of patients and doctors.

Dr. Durbhakula suggests that “instead of defining medical aptness, the DEA should pass the baton to our nation’s public health agencies” and proposes that the Centers for Disease Control and Prevention and the Food and Drug Administration “collaborate” to “place controls on individual prescribing and respond to inappropriate prescribing.” She elides the fact that these public health agencies will “respond” to doctors or patients who don’t comply with their regulations by calling the cops.

To be sure, Dr. Durbhakula has good intentions. But replacing actual cops—the DEA—with federal health agencies that can order those cops to arrest non‐​compliant doctors and patients is like rearranging the deck chairs on the Titanic. True, her proposed new pain management overlords would have greater medical expertise, but they would still reign over doctors and patients and assault their autonomy. And, as we  learned  during the COVID-19 pandemic, they will not be immune to political pressures and  groupthink .

While her policy prescriptions may be flawed, Dr. Durbhakula deserves praise for having the courage to point out that the war on drugs is also a war on pain patients. Alas, courageous doctors are in short supply these days. Most doctors keep their heads down and follow the cops’ instructions.

After I read her essay, I wrote the following (unpublished) letter to the editor of the  New York Times :

Dear Editor— Kudos to Dr. Durhakula for speaking out against the Drug Enforcement Administration’s intruding on doctors’ pain treatment (“ The DEA Needs to Stay Out of Medicine ,” March 22, 2024). As my colleague and I explained in our 2022 Cato Institute white paper, “ Cops Practicing Medicine ,” for more than 100 years, law enforcement has been increasingly surveilling and regulating pain management. The DEA maintains a schedule of substances it controls, and it categorizes them based on what the agency determines to be their safety and addictive potential. The DEA even presumes to know how many and what kind of controlled substances—from stimulants like Adderall to narcotics like oxycodone—the entire US population will need in future years, setting quotas on how many each pharmaceutical manufacturer may annually produce. The DEA restricts pain management based on the flawed assumption that what they consider to be “overtreatment” caused the overdose crisis. However, as my colleagues and I showed, there is  no correlation  between the opioid prescription rate and the rate of non‐​medical opioid use or opioid addiction. And, of course, as fear of DEA reprisal has caused the prescription rate to drop precipitously in the last dozen years, overdose deaths have soared as the black market provided non‐​medical users of “diverted” prescription pain pills first with more dangerous heroin and later with fentanyl. Researchers at the University of Pittsburgh School of Public Health found that overdose fatalities have been rising  exponentially  since at least the late 1970s, with different drugs predominating during various periods. Complex sociocultural, psychosocial, and socioeconomic forces are at the root of the overdose crisis, requiring serious investigation. Yet policymakers have chosen the lazy answer by blaming the overdose crisis on doctors treating pain. When cops practice medicine, overdoses increase, drug cartels get richer, and patients suffer. Sincerely, Jeffrey A. Singer, MD, FACS Senior Fellow, Cato Institute

When cops practice medicine, overdoses increase, drug cartels get richer, and patients suffer.

Reprinted with permission. Dr. Singer's original piece can be found here on the Cato Institute website

View the discussion thread.

By Jeffrey Singer

Jeffrey A. Singer, MD received his BA from Brooklyn College and his MD from New York Medical College. After completing his surgical residency and receiving Board Certification he began a private practice as a general surgeon in Phoenix, Arizona and became a Fellow of the American College of Surgeons. He is a Senior Fellow at the Cato Institute in Washington, DC, serving in the Department of Health Policy Studies. He is also a Visiting Fellow at the Goldwater Institute in Phoenix, AZ. His principal areas of scholarship are health care policy, drug policy, drug prohibition, and harm reduction. Dr. Singer has been practicing medicine for more than 30 years.

Latest from Jeffrey Singer :

Positive Results of the War on Drugs Essay

The War on Drugs, over the course of its forty-year history, has gained widespread notoriety and sparked fierce criticism, with many going as far as to claim that this policy was a complete failure. Given the complex nature of the illicit drug trade phenomenon, this simplification and reduction of a project of such scale to a definite verdict is quite surprising. The present section argues that the War on Drugs yielded some significant results in the United States, mainly thanks to the country’s advantageous geographic position, in terms of reducing both production and consumption of drugs through price increases and public perception changes.

War on Drugs, in essence, is a public policy that extended beyond the United States borders as to eradicate production in the drugs’ countries of origin. Just like any other public policy, it has been often viewed in comparison with other countries with successful or failing drug policies, for instance, Portugal and the Netherlands. However, this approach is fundamentally flawed as it fails to take into account the unique geographic position of the United States which borders only on two countries: Canada and Mexico. The ever strict Transportation Security Administration’s regulations, especially in the aftermath of 9/11, make import of drugs by air nearly impossible.

Therefore, ground transportation through Mexico is the main import channel, with as much as 90% of cocaine coming from Mexico alone (“US Claims Success” par. 6). When enforcement efforts concern only two countries, the task becomes unprecedentedly manageable, especially since the Mexican authorities have been highly supportively of the US drug eradication program (“US Claims Success” par. 10-11). The United States government is also able to concentrate all of its efforts on the southern border, bringing the necessary “personnel, infrastructure and technology” to it and doubling the size of the US Border Patrol since 2009 (Kerlikowske par. 1). This strategy allows the US to curb drug trafficking in the country.

The second important achievement of the War on Drugs is that it forces drug cartels to reduce or even stop their production or, at the very least, it disintegrates them into smaller groups. Up until the 1980s, the southern Andean countries Peru and Bolivia were the major producers of cocaine, responsible for 65% and 25% of the total supply, respectively. Thanks to the US-funded crop eradication project in these two countries, supported by the local governments, cocaine production largely shifted to Colombia in the second half of the 1990s (Bagley 3).

While many have argued that this victory was insignificant as it merely chased drug cultivators to a different region, battling the problem of cocaine in Colombia presented an easier task. According to David Murray, the former chief scientist of the Office of National Drug Policy Control (NDPC), supply reduction programs combined with the efforts of local citizens yielded a 75% decrease in Colombia’s “productive capacity” (“Has the War on Drugs Been Lost?” par. 24). The program also dismantled two of Colombia’s largest drug cartels, and 300 smaller “cartelitos” appeared to take advantage of this drug trafficking opportunity (Bagley 4). This is significant because smaller organizations lack the resources and networks to engage successfully in the international drug trade.

The changing dynamics of cocaine cultivation and production resulting in supply shortages had an impact on the use of the drug in the United States. Cocaine became far less affordable – and consequently, far less attractive – to American citizens, with the nationwide average price going up by 24%, and almost doubling in some places (“US Claims Success” par. 9). According to John Walters, the head of the Office of NDPC, this change affected at least 37 major American cities (“US Claims Success” par. 2).

Thus, even though the War on Drugs primarily uses the supply-side approach, meaning that it targets production rather than consumption, its successful implementation also results in decreasing use of drugs, as buyers are highly sensitive to their price. As costs incurred by drug suppliers increase, they have no other choice but to drive the street price up, as well, thus reducing the prevalence of cocaine in the society (Kindle 66).

With supply going down and prices going up, the War on Drugs yielded some favorable consequences as far as drug consumption is concerned. Even though the overall illicit drug use has been slowly rising, this upward trend is explained by the increased consumption of such substances as marijuana and pain relievers – both obviously undesirable but nevertheless not as detrimental to human health. Far more important is that the policy succeeded to reduce the use of such dangerous drugs as methamphetamine and cocaine, including crack cocaine (Kerlikowske par. 2).

This decline in consumption brought about some visible social benefits, as fewer Americans had positive drug test results and the number of “cocaine-related hospital admissions” also went down (“US Claims Success” par. 14). David Murray estimates the decline in the cocaine consumption rate to be as high as 45% – meaning that the drug’s prevalence was cut nearly in half (“Has the War on Drugs Been Lost?” par. 25). A more relevant question is thus not whether the policy brings about positive results but rather how to successfully sustain these results over a longer term, which is the main challenge that the government is facing (“US Claims Success” par. 4, 15).

Finally, a less material and thus a more difficult to quantify result of the War on Drugs was the change in public opinion and attitudes, including the changing perception about the US drug trade by the drug dealers themselves. According to David Murray, drug cartels favor “ungoverned safe havens where they would like to be to carry out their business with maximum efficiency” (“Has the War on Drugs Been Lost?” par. 26). Obviously, this is a highly reasonable strategy, and the key to fighting it is letting the offenders know that the US soil is not one of those safe havens. This is precisely what the zero-tolerance policy aimed to achieve.

As Peter Reuter, professor of public policy at the University of Maryland, put it: “the war on drugs was partly defined by its rhetoric” where the government sent a clear “signal to the population that [being tough on drugs] was a priority” (“US Claims Success” par. 34-35).

Thus, the prohibitionist strategy yields the most effective results in limiting “prevalence and harmfulness” of illicit drugs (Kindle 69). Like any other policy, it has its drawbacks and shortfalls, which merely means that the policy needs to be revisited and reevaluated occasionally, so it can be expanded and supplemented with new or improved strategies. The next section will now provide an overview of the arguments that are frequently cited against the War on Drugs and its consequences.

Works Cited

Bagley, Bruce. Drug Trafficking and Organized Crimes in the Americas: Major Trends in the Twenty-First Century. 2012. Web.

“Has the War on Drugs Been Lost?” BBC News . 2015: n. pag. Web.

Kerlikowske, Gil. “Successfully Fighting the War on Drugs.” The Washington Post . 2012: n. pag. Web.

Kindle, Peter A. “Is the War on Drugs Effective? Yes.” Controversial Issues in Social Policy. Ed. Howard Jacob Karger. Boston: Pearson, 2007. 64-69. Print.

“US Claims Success in War on Drugs.” BBC News . 2007: n. pag. Web.

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• Colombian Drug Cartels: Government Response
• The Negative Impact of Cartels
• Calderon and the War Against the Cartels
• Significant Career of Bill Murray
• The Mexican Drugs Cartels
• The Middle-Class Population in Colombia
• The Effect of Cocaine
• A Workaholic and an Alcoholic
• Drugs, Crime, and Violence: Effects of Drug Use on Behavior
• Drug Users as Role Models After Recovery
• Personality Issues Among Male People With Alcoholism

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Deadly war on drugs, again

What many thought that the war on drugs by then President Rodrigo Duterte that resulted in thousands of deaths had ended with the election of President Marcos has been proven wrong in the wake of its revival in Davao City.

In late March, Davao City Mayor Sebastian “Baste” Duterte, the son of the former president, announced the renewal of the campaign against illegal drugs in the city in light of the increase in drug dealing in his area. He said he will use the same tactics his father used when he was city mayor and later president.

Four days after that announcement, seven suspects were shot dead by Davao City police in a buy-bust operation. They reportedly fought it out with the authorities and were killed in the process.

In line with the standing operating procedure of the Philippine National Police when there are fatalities in police operations, the police officers involved in that incident were relieved from their posts and disarmed pending the investigation of the circumstances that led to the suspects’ death.

Extrajudicial means

The Commission on Human Rights had denounced the killing of the suspects as “… these acts constitute grave violations of fundamental human rights, particularly the right to life and due process, and are in direct disregard [of] the principles of justice and the rule of law.”

“The use of extrajudicial means undermine the rule of law and destroys the public’s faith in legal systems, hindering genuine efforts to address the root causes of drug-related problems in the country.”

The reason cited by the police officers to justify the shooting of the suspects, i.e., they fought back (or nanlaban), has a familiar (and tiring) ring. It was the same excuse used in similar incidents in the past when the elder Duterte was still in office.

International Criminal Court

In what looked like an uncanny coincidence, the killings happened when the International Criminal Court (ICC) is in the thick of its investigation of the death of thousands of Filipinos who were gunned down by the police during the Duterte administration for alleged involvement in illegal drugs activities.

It was as if Mayor Duterte was thumbing his nose on the ICC and publicly endorsing the strategy used by his father to stop drug addiction in the country despite its dismal failure.

The younger Duterte must have had a sense of hubris when he did that because he was in a place that, for decades, has been under the political control of his family and therefore, in his opinion, gave him “immunity” from accountability for his actions, regardless of their legal consequences.

He probably labored under the illusion that despite the end of his father’s term, the present administration would not dare question the effectiveness of the means the latter used in his war on drugs.

Besides, doesn’t Mr. Marcos owe his family a huge political debt for supporting his candidacy in 2022 by allowing her sister, now Vice President Sara Duterte, to be his running mate?

Drug dependence

Mayor Duterte’s revival of his father’s mailed fist strategy differs sharply from the approach that Mr. Marcos wants to take in addressing that social problem.

In his State of the Nation address last year, he said his policy “… is now geared towards community-based treatment, rehabilitation, education, and reintegration to curb drug dependence among our affected citizenry.”

Without being blunt about it, the President was, in effect, saying that the tactics his predecessor used to end drug addiction in the country were flawed and did not accomplish their objective. Even the new chief of the PNP, Gen. Rommel Marbil, vowed that the anti-illegal drug campaign under his watch will “always go for the rule of law.”

Something must have been lost in the communication (or translation) of that message to Mayor Duterte. Or did he deliberately ignore it because it runs counter to what he had been brainwashed into believing about the drugs issue?

Unabated mayhem

Unless Mayor Duterte has been living under a rock the past two years, there is a new sheriff in town who believes killing drug suspects will not minimize, much less, eliminate drug addiction in the country.

Local autonomy does not give him the right to pursue a course of action on the drug problem independent of that laid down by the national government. He cannot engage in another deadly war on drugs again under his own terms and conditions.

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By his errant actions, he has given more reason for the ICC to intensify its investigation on the extrajudicial killings that happened during his father’s watch and to recommend the prosecution of the people who may have thought that the uniforms they wore gave them the license to gun down drug suspects.

Six years of unabated mayhem and disregard of human rights in the name of ending the drug problem are enough. The Marcos administration should not allow itself to be a carbon copy, by default, of its predecessor on this issue.

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Expository Essay on Drug Abuse 100, 150, 200, 300, 350 & 500 Words

Table of Contents

Expository Essay on Drug Abuse 100 words

Drug abuse is a critical issue that affects not only individuals but also society as a whole. In this expository essay, we will explore the root causes, effects, and potential solutions to drug abuse. Firstly, peer pressure, stress, and a need for escape are common factors that contribute to drug abuse. Secondly, the negative effects of drug abuse can manifest in various forms, including health problems, strained relationships, and financial instability. Lastly, addressing the issue requires a multifaceted approach, involving education, awareness campaigns, and support systems. By understanding the causes and consequences of drug abuse, we can develop strategies to prevent and combat this pervasive problem.

Expository Essay on Drug Abuse 150 words

Drug abuse is a serious societal issue that affects individuals from all walks of life. This essay aims to explain the causes and consequences of drug abuse in an expository manner.

First and foremost, drug abuse can be attributed to various factors. One of the primary causes is peer pressure, as individuals may succumb to the influence of their friends and seek solace in drugs. Additionally, some individuals turn to drugs as a means of escapism, trying to cope with emotional or psychological pain. Another contributing factor is the availability and accessibility of drugs, making it easier for people to engage in substance abuse.

The consequences of drug abuse are myriad and life-altering. Physically, drug abuse can lead to deteriorating health issues and even death. Furthermore, it often leads to strained relationships with family and friends. Drug addiction also has severe psychological effects, causing individuals to become isolated and trapped in a cycle of dependency. Additionally, drug abuse contributes to a rise in criminal activities, as individuals resort to illegal means to sustain their addiction.

Expository Essay on Drug Abuse 200 words

Drug abuse is a pervasive issue that affects individuals and communities worldwide. This expository essay aims to analyze the problem of drug abuse and provide factual information on its causes, consequences, and potential solutions.

To begin, it is important to understand the factors that contribute to drug abuse. Peer pressure, stress, and a lack of awareness about the dangers of drugs are common reasons for individuals to become involved in substance abuse. Furthermore, genetic, environmental, and psychological factors can also play a role in the development of drug addiction.

The consequences of drug abuse are far-reaching and devastating. Physically, drugs can harm vital organs, impair cognitive functioning, and even lead to death. Socioeconomically, drug abuse can strain relationships, hinder educational and professional opportunities, and burden healthcare systems. It can also contribute to crime rates and public safety concerns.

Addressing drug abuse requires a multifaceted approach. Prevention initiatives should focus on education about the risks associated with drug use, as well as promoting healthy coping mechanisms and positive peer influences. Additionally, accessible and effective treatment programs and support networks must be provided to individuals struggling with drug addiction.

In conclusion, drug abuse is a complex issue that poses serious threats to individuals and society as a whole. By understanding its causes and consequences, as well as implementing preventative and treatment measures, we can work towards a future free from the clutches of substance abuse.

Expository Essay on Drug Abuse 300 words

Drug abuse is a major global issue affecting individuals from all walks of life. It refers to the excessive and harmful use of substances such as alcohol, prescription drugs, and illegal drugs. This expository essay aims to shed light on the causes, effects, and potential solutions to drug abuse.

One of the primary causes of drug abuse is peer pressure. Many individuals succumb to the influence of their peers, wanting to fit in or to be seen as cool. This often leads to experimentation with drugs, which can quickly escalate to addiction. Additionally, stress and trauma can also drive people towards drugs as a means of escape.

The effects of drug abuse are wide-ranging and devastating. Physically, drug abuse can lead to health problems such as heart disease, liver damage, and even death due to an overdose. Psychologically, drug abuse can cause severe mental health issues, including depression, anxiety, and psychosis. Moreover, drug abuse negatively impacts relationships, leading to broken families and a breakdown in societal bonds.

Addressing drug abuse requires a multi-faceted approach. Firstly, preventative measures such as education and awareness campaigns are crucial. By educating individuals about the dangers of drug abuse, especially the youth, we can reduce the number of people succumbing to addiction. Additionally, rehabilitation programs and support groups play a pivotal role in helping drug abusers break free from their addiction and reintegrate into society.

In conclusion, drug abuse is a pressing issue affecting individuals worldwide. It is essential to understand the causes and effects of drug abuse to develop effective solutions. By implementing prevention measures and promoting rehabilitation programs, we can combat drug abuse and provide a brighter future for those trapped in the vicious cycle of addiction.

Expository Essay on Drug Abuse 350 words

Drug abuse is a prevalent issue that continues to affect individuals and societies across the globe. This expository essay aims to shed light on the realities of drug abuse, including its causes, consequences, and potential solutions. By examining the facts and presenting a balanced view, we can better understand this complex issue and work towards effective prevention and intervention strategies.

The primary cause of drug abuse can vary from individual to individual. Peer influence, stress, curiosity, and a desire for escape or pleasure are common factors that contribute to drug abuse. When people are surrounded by others who engage in drug use, they may feel compelled to experiment, thus increasing the likelihood of abuse. Additionally, individuals facing high levels of stress or seeking an escape from their problems may turn to drugs as a means of coping. The addictive nature of certain substances further exacerbates the problem, making it difficult for individuals to stop using once they start.

The consequences of drug abuse are far-reaching and affect not only the individual but also their families and communities. Physically, drug abuse can lead to organ damage, impaired cognitive function, and even death. Emotionally, it can cause mood swings, depression, and anxiety. Socially, drug abuse can lead to estranged relationships, unemployment, homelessness, and criminal behavior. The economic burden of drug abuse is also significant, as it places a strain on healthcare systems and law enforcement agencies.

To address the issue of drug abuse, a multi-faceted approach is necessary. Prevention programs should be implemented in schools, educating students about the dangers of drug abuse and providing them with the necessary skills to resist peer pressure. Parents and guardians should also play an active role in educating their children about substance abuse and maintaining open lines of communication. Furthermore, increased access to treatment programs, counseling services, and rehabilitation centers can help individuals overcome their addiction and pursue a healthier, drug-free lifestyle.

In conclusion, drug abuse remains a pressing concern that impacts individuals and societies globally. By understanding the causes, consequences, and potential solutions, we can work towards effective prevention and intervention strategies. Through education, awareness, and a focus on providing support to those affected, we can work towards reducing drug abuse and its devastating effects.

Write an Expository Essay on Drug Abuse 500 Words?

Title: an expository essay on drug abuse, introduction.

Drug abuse is a prevalent and multifaceted issue that affects individuals, families, and communities worldwide. It is characterized by the habitual misuse of drugs, often resulting in physical and psychological harm. This expository essay aims to provide an in-depth exploration of drug abuse, its causes, consequences, and potential solutions.

Definition and Types of Drugs

Drug abuse refers to the excessive and continuous misuse of both legal and illegal substances. Various types of drugs can be abused, including narcotics, stimulants, depressants, hallucinogens, and prescription medications. Understanding the diverse range of drugs abused is crucial to comprehending the scope and significance of the issue.

Causes of Drug Abuse

Drug abuse is often linked to a combination of genetic, environmental, and individual factors. Genetic predispositions to addictive behaviors can influence an individual’s susceptibility to drug abuse. Additionally, environmental influences such as dysfunctional families, poverty, peer pressure, and the availability of drugs contribute to the problem. Personal factors like low self-esteem, emotional distress, or mental health disorders can also increase the likelihood of drug abuse.

Consequences of Drug Abuse

Drug abuse has profound consequences on an individual’s health, relationships, and society as a whole. Physically, drug abuse can lead to addiction, overdose, and in some cases, death. Psychological effects include impaired cognitive function, an increased risk of mental health disorders, and diminished productivity. Social consequences encompass strained relationships, an economic burden on society, and an increase in crime rates.

Prevention and Intervention Strategies

Addressing drug abuse requires a multi-faceted approach that involves prevention, intervention, and treatment. Effective prevention strategies include education, raising awareness about the risks and consequences of drug abuse, and promoting healthy coping mechanisms. Early intervention programs that identify individuals at risk and provide appropriate support and counseling are crucial to curbing drug abuse. Treatment options such as detoxification, therapy, and support groups play a crucial role in helping individuals recover from addiction.

Governmental and Community Initiatives

Governments and communities have a crucial role to play in combating drug abuse. Public policies that focus on reducing drug availability, implementing stricter regulations, and offering rehabilitation programs are vital. Additionally, community-based initiatives like support groups, recreational activities, and counseling services can help create a supportive environment for recovery.

Drug abuse remains a significant challenge in contemporary society, affecting individuals of all ages and backgrounds. Understanding its causes, consequences, and potential solutions is essential to combating this harmful issue. By implementing prevention strategies, early intervention programs, and adequate treatment options, we can make progress in minimizing the devastating effects of drug abuse. It is the collective responsibility of governments, communities, and individuals to address drug abuse comprehensively and provide support to those impacted, in order to promote healthier societies for generations to come.

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Home — Essay Samples — Nursing & Health — Drugs — The Effects of Drugs on Our Society

The Effects of Drugs on Society: Health Problems

• Categories: Drugs Society

About this sample

Words: 1471 |

Published: Dec 3, 2020

Words: 1471 | Pages: 3 | 8 min read

Table of contents

Introduction, drugs in history, effects of drugs on society: health issues.

• Works Cited