Essential Elements of Good Drug Policy

Introduction and Overview

THE DRUG CRISIS IN AMERICA

A culture of prevention normalizes practices that promote healthy brain and social development and strengthen protective factors that attenuate the risk of substance use.
Population-level changes in substance use require sufficient ongoing investments in permanent, embedded, multi-sector prevention infrastructures at the federal, state, and community levels that incorporate assessment, capacity, planning, implementation, evaluation, sustainability, and cultural competence.

Individuals and families benefit most from treatment, including medication, and care that is available, accessible, affordable, and attractive to those being served.
Interventions should occur along a continuum of care and must be tailored to the unique needs of each patient, addressing the physical, psychological, social, and spiritual aspects of recovery.
Evidence must support all the following outcomes for an activity to be considered as treatment: an end to drug use, which leads to symptom reduction, prevention of complications, improved functioning, and ultimately recovery.
Sufficient permanent funding, including insurance coverage, that incentivizes cost-effective and demonstrably clinically effective services along the full continuum of care is required to achieve its full impact.
In conjunction with recovery-oriented care, people who use drugs should have access to evidence-based harm reduction interventions, like naloxone, which can reduce—but not eliminate—the life-threatening risks that face them.
The fact that many people reach recovery without benefit of treatment does not obviate the need for treatment and recovery for those who do not.

Recovery should incorporate the recognized benchmark of sustained remission from addiction, achieved through individualized combinations of treatment and support, with interventions as needed.
Recovery takes place in a community—at times but not always starting in treatment—where people can access culturally, spiritually, and developmentally appropriate services and supports that help them.
Ongoing investment in a structure that utilizes a strength-based approach, delivers the right care and support when and where people need it, promotes the development of recovery capital, and achieves abstinence is needed to achieve recovery.

At a minimum, justice systems are called upon to make the critical distinctions among: (1) high-level and/or specialized participants in drug supply (drug manufacturers, producers, marketers, money launderers, and traffickers); (2) low-level functionaries involved in drug supply (mules, couriers, retail sellers, etc.); (3) those with drug possession/use who commit violent or other serious criminal offenses (including residential burglary, armed robbery, and vehicular homicide or vehicular assault); (4) those with drug possession/use who commit minor non-drug crimes (from impaired driving to shoplifting and other minor property crimes); and (5) those charged only with simple possession and no other crimes (some but not all of whom will have substance use disorder).
All punishments should be genuine, certain, and calibrated to redress harm, maximize deterrence, and reinforce healthy social norms, while taking into account the category of the charge and the nature of the individual’s involvement with drugs. This is the primary approach in the first three categories.
For those with a substance use disorder, multi-system alternatives to incarceration (ATI), such as deflection and diversion, should incorporate appropriate levels of treatment, care, and accountability, and should often be the primary approach. The criminal justice system can help encourage and motivate recovery.