As
Eric Sterling drafted tough drug laws, and Daniel McDowell broke them, it was
up to officers like Baltimore Police lieutenant Steve Olson to enforce them. In
the 1990s and early 2000s, Baltimore and many other cities had a zero-tolerance
approach to narcotics, and Olson participated in waves of drug arrests.
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"We
made a boatload of arrests, we took a lot of people to jail and the end result
is it's not any better," he told us as we drove in a police cruiser
through tough neighborhoods. "The vast majority of arrests didn't make a
difference."
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Steve,
an athletic jokester with a fondness for bicycle policing and marathons, comes
from a military family with a precise sense of order and propriety. He despised
the chaos and violence of the drug world, and he still carries scars from an
incident in 2013 when a criminal ran him down with a motorcycle. But Steve
eventually came to view the crackdown as more harmful than helpful. He loved
traveling overseas, and he would notice that other countries frequently handled
drugs with a lighter touch and seemed to have fewer problems.
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As
Steve was having these doubts, something happened in his personal life that
also changed how he saw the problem. In 2016, Steve was raising money for
Habitat for Humanity, his favorite charity, by offering to do chores for
people. His sister volunteered to donate if Steve would clean their dad's
truck, so he did so with his usual meticulousness - and was rocked when he
found drug paraphernalia. The issue wasn't his dad, he realized, but Steve's
brother Mark, age thirty-four, who often used the truck.
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To
Steve, all the things he hadn't understood about Mark suddenly made sense:
"Why he couldn't pay his rent, why he couldn't hold a job, why he had a
dirty appearance, why some of his actions were just completely out of
character, why he would explode in rage." It was also clear why Mark
hadn't applied for jobs that his brother had recommended: he knew he would fail
the drug test. Steve had once found Mark's vehicle in a notorious drug zone,
but Mark - who worked on cell phone towers - explained that he was checking on
the local tower. "Addicts are great liars," Steve noted resignedly.
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So
he phoned his brother. "Mark," he told him. "I'm cleaning Dad's
truck." Mark immediately understood and overdosed in an effort to kill
himself. He failed, and then he and Steve had a heartfelt conversation. Mark
confessed that he had a $300-a-day habit. The family tried to get him into a
long-term rehab program and initially couldn't find one that would accept
Mark's health insurance. That's all too common. Finally, the family found one,
and Mark stayed off drugs for three and a half months. He struggled with his
cravings, calling his brother several times a day. Once he explained that the
downside of sobriety was the need to face up to a wrenching world.
"Sober," he added, was actually an acronym for "son of a bitch,
everything's real."
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Then,
a few months after Mark went into rehab, Steve was in Malawi volunteering with
Habitat for Humanity when he received an urgent text message to call his wife.
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"I
knew what that text message meant," he said. "It meant my brother was
dead."
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Craving
a fix, Mark had been driving ninety miles an hour on the highway to buy a $20
bag of heroin when he lost control of his vehicle. He was killed in the crash.
The tragedy made Steve more sensitive to what families were going through. When
fellow police officers referred contemptuously to "junkies," Steve
would respond, "Oh, you mean like my brother?"
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The
tragedy also made him more aware of the barriers to treatment.
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He
saw how difficult it was for people to get help, and he became more understanding
of the need for public health approaches to addiction in addition to criminal
justice approaches.
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"When
my brother first started down this road, he did something wrong," Steve
told us somberly. "He broke the law. He made a decision, and that was a
moral decision. And somewhere down the line during his course of addiction,
during the way he lived his life, it stopped being a moral issue, it started
being a health issue.
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"When
you feel as though you're lost, as my brother felt, you're not going to seek
the resources. And it's not made easy. There are so many different loopholes
and hurdles and doors to go through."
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The
year after Mark's death, Baltimore began a pilot program called LEAD - Law
Enforcement Assisted Diversion - that attempts to address these barriers. LEAD
responds to drug users not with arrest and imprisonment but with social
services, working with users rather than handcuffing them. LEAD started in
Seattle, where it led to a 60 percent drop in recidivism, and it has now been
copied in many cities around the country. It marks a step away from the
traditional American approach toward a Portugal-style decriminalization of
narcotics, and it is long overdue. We followed Steve as he made the rounds,
looking for people on the streets with addictions, not to arrest them but to
guide them toward LEAD counselors.
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"Joe!"
he shouted jubilantly to one scruffy, bearded man carrying pipes over his
shoulder. Joe greeted Steve warmly, although perhaps a little guiltily: he said
he had found the pipes in a dumpster, but that didn't seem terribly credible.
In the old days, Steve later explained, the police might have arrested Joe for
one thing or another, but now officers were focused on getting Joe into
treatment.
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After
a bit of chitchat, Steve made his pitch: "Joe, what if! told you that the
people I want you to talk to will help you get back to your family?"
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"Give
me the name and number and I'll call."
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"I'll
take you there."
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"I
know you got my back all the time," Joe replied, but then he wavered and
said he was too busy.
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"My
guys might come to you. Can you stay here for a few minutes?"
Joe
shuffled his feet and looked uneasy, then tried to put Steve off. "I'll
come down," he said, referring to some vague point in the future.
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"You
know how difficult it is to make that first step. You know that, Mr.
Olson."
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"Here's
my big thing. Can you give me fifteen minutes right now?
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Just
fifteen minutes? I'm not going to take you anywhere. I'm not going to ask you
to go anywhere. I'm going to bring people to you. Just fifteen minutes. I know
you've got to go. I know how much fifteen minutes means to you. But at the same
time, fifteen minutes can be the difference. You know that discomfort you're
feeling right now? How would you like it to go away?"
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"I
want everything to go away."
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While
Steve got on his cell phone to track down a social worker who could come over,
we asked Joe why he was wary of visiting the LEAD office. "That step is
the hardest," Joe said nervously. "You walk into a place where you
don't know anybody. You wonder, are they going to welcome you, or treat you
like a piece of shit?"
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Soon
Steve came back, dejected. The social workers were busy, he explained, taking
another young man to get a haircut so he could go to a job interview. But he
pleaded with Joe to go to the LEAD office.
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"I'll
go," Joe promised. "I really will." He seemed heartened when
Steve told him that some of the social workers themselves had previously been
addicted and know that world well. Joe added that he would prefer to have Steve
escort him, because he feels overwhelmed in strange settings.
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"Joe,
you call, I'll come running," Steve promised.
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Joe
was sweating, probably a little dope sick and in need of a fix. That may have
been why he was impatient to go, and Steve watched him walk away with his pipes
over his shoulder.
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"The
hardest thing about watching them walk away is this is how it happens all the
time," Steve told us when we were back in the cruiser.
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I've
been talking to Joe quite a bit for a number of weeks. And it's always closer
and closer and closer to it being a success. Today was the closest it's ever
come."
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We
asked Steve if this kind of policing is enormously rewarding, and he nodded and
said he was sure that he was saving lives. Then he sighed. "It's also
exhausting," he said. "It's mentally and physically draining to
scream without raising your voice eight hours a day. And to know that when I go
home at night, the people that were resistant or I couldn't get through the
door or don't want to talk to me are still out there." He paused, shook
his head and added, "It's not something that I can do for the rest of my
career, I can't do this. Physically, mentally, I can't do this."
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Baltimore
is pioneering a public health approach to drug addiction in part because of its
former health commissioner, Dr. Leana Wen. Like many other experts in the
field, Wen argues that we need to treat addiction as a chronic health problem
like diabetes or heart disease. Not everyone agrees, and it's true, of course,
that addiction depends partly on circumstance and behavior, and that users
should be encouraged to say no to drugs-just as diabetics should reject
cinnamon buns. Many people do manage to overcome substance abuse without
medication, by sheer force of will. But addiction, like diabetes, is about the
body's physical wiring, as well as about behaviors. As Wen noted, "We'd
never tell someone with diabetes, 'Why can't you get off insulin?' We'd never
ask someone with high blood pressure, 'Why do you need medicine, why aren't
exercise and diet enough?' "
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There
are signs of a bipartisan shift from an approach based solely on criminal
justice to a more effective one that also relies on treatment. Portugal's
sensible and effective public-health-focused drug policy has been the trend in
Canada and Europe. In the United States, such an approach would include three
crucial elements.
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First,
treatment must be available to all 21 million Americans who need it, and this
should include both psychosocial counseling and medication-assisted treatment.
An astonishing one in seven young adults, ages eighteen to twenty-five, need
treatment, the government estimates. Back in 1971, President Nixon ordered that
treatment be made available for all people with drug addictions, without fear
of criminal sanction, and obtained substantial funding from Congress to provide
that treatment. For a time there was real progress against heroin, but, sadly,
in the decades afterward, treatment actually became less available. Only one in
five Americans with substance abuse disorders now receive any treatment. That
is an astonishing failure of our government and health-care system, and the
Trump administration arguably made it worse by chipping away at the Affordable
Care Act and Medicaid. "I cannot imagine if we said only one in ten people
with cancer can get chemotherapy, or one in ten patients who need dialysis is able
to receive it," Wen told us. "But that's what happens for
addiction."
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The
Affordable Care Act included mental-health care and treatment of drug-use
disorders as essential health benefits, but reimbursements for addiction
treatment and mental health are very low and many users have no health
insurance at all. A much more comprehensive and better-funded national program
is needed. We've spoken to people who tried to get into rehab but were told
that their addictions weren't yet serious enough to qualify; in effect, they
were told to wait, deteriorate and try again. That's obviously shortsighted,
particularly because researchers find that increasing access to drug treatment
pays for itself by reducing crime. Outpatient substance abuse assistance costs
about $4,700 a year; incarceration costs five times as much, according to the
National Institute on Drug Abuse. It says that a dollar invested in addiction
treatment programs saves $12 in reduced crime and court costs, plus health-care
savings. The Baltimore Station's program that helped Daniel is an example of an
effective program that could be replicated.
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A
second step is to make drug use less lethal for those who resist treatment. The
United States has succeeded in making naloxone, an antidote for opioid
overdoses, far more available, so that police officers like Steve Olson now
carry it with them to administer in an instant. Naloxone truly is a miracle
drug: jab someone comatose from an overdose and, astonishingly, he or she will
typically revive and, just minutes later, seem almost as good as new. Wen
issued a citywide prescription to all 620,000 Baltimore residents for naloxone,
and she worked to distribute naloxone to high-risk communities, such as the
red-light district.
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Promoting
needle exchanges to reduce transmission of HIV and hepatitis also helps, and
this is now widely accepted in the United States. More controversial are safe
injection sites, where users can go to use their own heroin or other illicit
narcotics, while monitored by a nurse or health aide. The injection site will
supply needles, but not the drugs themselves. When users overdose, they can
receive immediate treatment, rather than dying on a park bench. There are some
ninety safe injection sites in other countries, including Canada, and not a
single fatal overdose has been reported despite millions of injections. Dozens
of studies have found that they not only save lives from overdoses but also
allow health authorities to connect with drug users and gradually reel them in
for treatment. At the first safe injection site in North America, in Vancouver,
British Columbia, the result was a 35 percent reduction in fatal overdoses in
the area. One study estimated that a safe injection site in a U.S. city would
not only save lives but also some $3.5 million. Unfortunately, the Trump
administration has threatened to prosecute local officials who try to operate
safe injection sites.
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The
third step is the most complicated - to focus on prevention, education and
reducing the stigma that hampers users from getting help. "Society needs
to change its attitude to drug users," Wen said, reiterating her point.
"They are patients with a disease that needs treatment." One element
of prevention is to reduce opioid prescribing by doctors and dentists, and that
is belatedly taking place, but the numbers are still far higher than in our
peer countries; in 2016, doctors wrote more opioid prescriptions in the state
of Michigan than the number of people living in the state.
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When
Wen had a baby in 2017, she was prescribed a thirty-day supply of oxycodone.
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"Why
do I get this?" she asked.
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"Just
in case you need it," the doctor explained. "We don't want you to be
in pain."
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Prevention
also means criminal prosecutions of major drug smugglers and in particular
targeting Chinese businesses that operate fentanyl supply houses. But the
broadest challenge in prevention is to recognize that addiction is a symptom of
a deeper malaise and that a strategy also has to offer jobs, education and
hope. Whether in Baltimore or in Yamhill, drug use is often not just a trip but
also an escape from a place that has become unendurable.
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The
2018 First Step Act was an example of bipartisan criminal justice reform and
may benefit thousands of federal prisoners by lightening sentences, but it
should be just the beginning of greater change in incarceration policies. Eric
Sterling, who helped write the harsh drug laws of 1986 and 1988, has completely
reversed his perspective and is now working to undo those laws. "That
Congress has been unable so many times to change these laws is a real
indictment of its unwillingness to fix injustice."
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"It
was tragically misguided," he said of the war on drugs. "Everything
needs to change."
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Nicholas Kristoff "Tightrope:
Americans Reaching for Hope" (2020)
