Drug decriminalization without mandatory treatment is a flawed fix

Oregon is embarking on a bold new direction in drug policy by decriminalizing low-level possession of illicit drugs and focusing instead on expanding drug treatment. It’s an enlightened approach, recognizing that addiction is a public health problem that won’t be solved by putting users in jail — where drug use is rampant and adequate treatment services are rare. 

Yet despite its promise, this program is deeply flawed. Although individuals will no longer face criminal charges and possible imprisonment for drug possession, they will also be given a pass to avoid entering treatment if they simply don’t want to.

As a clinician with more than 50 years of experience treating substance abuse, I know that taking the first step on the long road to recovery and a life without drugs is extremely difficult. That’s why Oregon must make entering drug treatment compulsory if it wants this program to succeed. 

Such a demand acknowledges that battling addiction is never easy. So strong is the pull of drugs that most users vehemently resist accepting treatment. And often, even the encouragement of family members, friends and peer-based counselors is not enough to convince a user to break with drugs. 

Under the Oregon law, a person found with small amounts of hard drugs as heroin, cocaine or methamphetamines would either face a fine of no more than $100 or a comprehensive health assessment at an addiction recovery center. If the individual agrees to be evaluated, they may then be referred for services to address substance use or other “problematic behaviors.”

But the ultimate decision to enter treatment is entirely voluntary. In my experience, when given a choice between treatment and paying a small fine, most addicts will find a way to get the money and then walk away. In this life or death situation, the fine is a cruel joke, allowing the user to return to the streets to harm themselves and the community.

Oregon is moving in the right direction in that the decriminalization initiative calls for investing upwards of $100 million to expand drug treatment and recovery services that will provide assessment and evaluation, connection to services and intensive case management based on individual needs. 

The well-trained addiction professionals dealing with patients on the front lines are therefore well placed to determine the best treatment options and direct patients to get started. But without the power to mandate treatment, they are virtually powerless to effectively combat drug use. 

In the past, drug courts offered individuals a choice between incarceration and treatment and this worked for many people. But if criminal penalties are removed — as they should be — we must have the ability to compel individuals to enter treatment. Once engaged with sound, evidence-based practices, they become more motivated to continue and have a better chance of completing the course of treatment.

Oregon’s landmark decision to decriminalize drugs is already inspiring other states to consider similar programs. Hopefully, this will lead to a paradigm shift away from the failed, decades-long “war on drugs” and reduce the terrible stigma of addiction at a time when overdose deaths are at a record high. 

As it stands now, however, individuals in Oregon who are struggling with addiction and those that need treatment the most are not likely to receive it. We must ensure that treatment — the best hope for recovery from the disease of addiction — is not an option, but mandatory.

Mitchell S. Rosenthal is a psychiatrist who founded Phoenix House, the national substance abuse treatment organization, and is now president of The Rosenthal Center for Addiction Studies in New York City.