U.S. DRUG REFORM: A CULTURAL SHIFT.

• Author: Noah, Leiona J.

Addicts are just like everyone else--only more so. - Anonymous As the nation's drug overdose epidemic worsens, the American Medical Association ("AMA") issued a brief in which it stated that a handful of illicit drugs, often in combination or in adulterated forms, are becoming the driving force behind the epidemic. (6) The AMA thus urges policymakers to take action to increase access to evidence-based care for substance use disorders, as well as for pain and harm reduction measures. (7)

Although the Department of Health and Human Services ("HHS") publicly favors clean needle exchange programs since they slow the spread of diseases such as HIV/AIDS and hepatitis among drug users, it has yet to take a stance on supervised consumption sites and other such controversial matters of ongoing litigation that are still federally banned. (8) Taboo or not, two safe consumption sites have since opened in Manhattan through grassroots means and are operating successfully. (9)

Drug policies in the United States appear to focus more on immediate measures, such as needle exchanges, drug testing kits, and reduced access to prescription opioids. (10) These are effortful steps toward change, but the New Haven School of Jurisprudence approach to social problem solving reveals a deeper and more critical issue to be resolved if the United States is ever to break its pattern of drug policy failures. Drug overdose deaths appear to be the tip of the iceberg, wreaking societal havoc, while the underlying and disregarded cultural factors continue to push this devastating problem to the surface, where buzzworthy news coverage fuels quarrelsome politics over who is to blame and who should step up and fix it. Part I delineates the nation's drug overdose crisis. Part II depicts the conflicting claimants and their different perspectives. Part III explores the past legal decisions in light of their conditioning factors to provide historical and environmental context. Part IV objectively predicts future decisions and what will happen. Part V provides appraisals for the above sections. Parts VI and VII illustrate alternatives and a proposal for what ought to happen.

1. DELIMITATION OF THE PROBLEM

   The American culture is consumed by conversations about drugs. (11) Nearly half of Americans report having been affected, directly or indirectly, by substance use or addiction. (12) In 2020 alone, 1,155,610 arrests in the U.S. were drug law violations. (13) Of that total, 1,001,913 were for personal drug possession, while 150,229 were for intent to sell. (14) Notably, the U.S. houses 2,300,000 incarcerated people, and one-fifth are incarcerated for drug offenses. (15) 100,000 people are held for drug offenses at the federal level, while 2,100 are in youth facilities. (16) Since the passing of the Controlled Substances Act of 1970, the U.S. has spent over a trillion dollars enforcing its drug policies. (17) Since 1999, over 1,000,000 people have died in the U.S. from a drug overdose. (18) Currently, the number of deaths is nearly 100,000 each year, and the rate is rising with every passing year. (19)

   Importantly, Americans are now more likely to die from an accidental opioid overdose than from a motor vehicle crash. (20) Additionally, 945,523 people in the U.S. have died from COVID-19 between January 2020 and March 2022. (21) While the number of confirmed cases of COVID-19 is decreasing globally, (22) the number of drug overdose deaths in the U.S. is increasing yearly. (23) This decrease is because the COVID-19 pandemic is viewed and treated as a public health crisis, (24) whereas U.S. drug laws are not motivated by public health and science. (25)

2. CONFLICTING CLAIMS, CLAIMANTS, BASE OF POWER

   Mood-altering substances have long been used by many species, even before the existence of humans and other primates. (26) Evidence shows that animals will repeatedly search for and ingest rotting fruit for the alcohol produced in them and other psychoactive plants. (27) The establishment of civilization may have been motivated by a desire to expand the early human palate when tribes began settling and cultivating wheat and barley, not for food but to produce beer. (28) Although the evolutionary precursors of drug use have yet to be fully understood, what can be inferred is that a permanently abstinent human culture does not appear to exist. (29) "[Statistically, it is non-users who are abnormal." (30) Given the seemingly illimitable grasp of drug abuse currently in the U.S., one might come to believe that addiction has always been the soft underbelly of civilizations worldwide; (31) historically speaking, however, the concept of addiction is relatively new. (32) Thus, the best way to understand modern drug policies intended to reduce rates of addiction and overdose is to adopt and analyze the various perspectives of those involved in the creation of these laws. (33)

   The call to war on drugs, or rather the war on people, (34) summons three major parties: the prohibitionists, the private sector, and the reformists. (35)

   1. Prohibitionists

      Benjamin Rush, a Declaration of Independence signer and physician, was one of the first to term alcoholism as a "disease of the will." (36) Although viewing addiction as a disease is what ultimately continued throughout the Prohibition movement and beyond, early usage of the term addiction can be traced back to a religious belief that addiction was a voluntary choice. (37) The Bible, for example, describes a drunkard as a lover of wine. (38) Puritan minister Samuel Danforth preached that "God sends many sore judgments on a people that addict themselves to intemperance in drinking," ingraining the idea that drunkenness was not only a deliberate choice, but one that would banish people from the gracious presence of God. (39)

      The word addiction originally denoted a "social relationship of bondage, with its Latin roots meaning 'enslaved by' or 'bound to,'" but the idea that addiction was a form of chemical slavery did not catch on until about the mid-nineteenth century. (40) Interestingly, during this same time span, the United States was entrenched in the slave trade, the abolitionist movement, and the Civil War, the era which created debates about race and involuntary servitude that continue today. (41) It is no accident that the poor personality traits used to describe racist stereotypes are the same words used to identify people with addiction, "from criminal propensities, laziness, promiscuity, violence, and childishness to deviousness and an inability to tell the truth." (42) Unsurprisingly, the American Civil Liberties Union (ACLU) advocates the view that the modern War on Drugs diminishes the Bill of Rights and establishes a new Jim Crow. (43) The 1830s and 1840s depicted the nation's first major anti-alcohol movement. (44) Born out of an impassioned fight against slavery, many abolitionists began categorizing alcohol as "an equally great evil to be eradicated if America [was] ever to be fully cleansed of sin" and its role in proliferating slavery. (45) The Protestant-based temperance movement focused on alcohol, which culminated in National Prohibition. (46) Thus, a recounting of drug laws in the United States reveals a deeply rooted notion that drug abuse was primarily a personal weakness or moral shortcoming, and that the ensuing social ills were best avoided by wide-spread abstinence and, in the event of sin, punishment. (47)

   2. The Private Sector

      "In time of war the loudest patriots are the greatest profiteers." (48) The second group of fighters in the ongoing war against drugs are those who eagerly present a solution, specifically a commodified solution. (49) Throughout the twentieth century, society witnessed a shift away from the traditional, moral diagnosis of addiction and began using a new method of social problem solving. (50) Ultimately, what materialized was the disease model of addiction, (51) although in some communities the shift was grudgingly slow and met with harsh criticism and defiance by those holding onto their settled convictions that alcoholics and other addicts were simply gluttonous sinners. (52) Unlike this emerging disease model, historical depictions of drug use from around the world unveil a common story: drug use is a highly moralized behavior and is seen as "an overindulgence in pleasure, [despite the reality of the experience being described as] a joyless compulsion." (53) In contrast, the new disease model of addiction greatly improved access to crucial medical treatments since addiction could now be recognized and legitimized as a medical condition, rather than a miscellany of "human behaviors or characteristics that we just happen to find disturbing[.]" (54) With a new found mission to treat addicts like patients, rather than sinners or criminals, came an influx of new medications intended to facilitate the detoxification process and help people wean off their addicted substances. (55) Consequently, the United States now spends over $600 billion on substance abuse costs. (56)

      A heartbreaking story of three young women depicts the pitfalls of countless Florida rehabilitation businesses taking advantage of people, and causing deaths. (57) Katie Cruea was the first of three Midwestern girls--Cruea, Alison Flory, and Mikaya Feucht--to move into one of Kenneth Chatman's sober homes, and she was the first to die. (58) As for the others, Mikaya's mother

      Michelle Curran's insurance was to be charged more than $600,000 by the seven treatment centers her daughter attended between January and June of 2016, including Reflections, the facility whose owner, Kenneth Chatman, has pleaded guilty to healthcare fraud and sex trafficking. (59) Similarly, Alison's mother Jennifer Flory's insurance was charged about $1.2 million during the fifteen months her daughter bounced between nine different facilities in South Florida. (60) All three young women overdosed and died during the time they sought...