A Moment for Opioid Policy

Traditional policy prescriptions just aren’t helping.

If daily reports of overdoses weren’t enough to get me thinking about the opioid epidemic and policy approaches to combat it, this ad sure did. Having seen a small section of the policy bowels, I can say that efforts to combat opioid abuse continue to be remarkably stove piped and international engagement woefully ineffective. There is a hawk and dove divide between law enforcement and health care officials, and a north-south rift on (Mexican) supply v. (U.S.) demand. Realizing there will never be a perfect solution, here are two approaches that seek to bridge those gaps.

Prevention, Treatment, Enforcement. These are the traditional pillars of U.S. demand-side drug policy. They usually include public awareness campaigns, like Just Say No, rehab, and incarceration. The results have been mixed: millions of dollars spent on prevention have led to a minor “slow of marijuana experimentation among teens,” the Council on Foreign Relations reports; rehab, while valuable to public safety, cannot help those who choose not to participate; and incarceration has not staunched drug epidemics but has remained racially and politically charged.

The current understanding of “treatment” and “prevention” needs updating. Today’s epidemic can in-part trace its roots to the over-prescription of opioids to treat pain. Policy makers should consider incorporating new approaches to pain management into efforts to both prevent and treat addiction. Specifically, they should revisit policies on medical marijuana. The Drug and Alcohol Review in 2015 found that “80 percent of medical marijuana users reported substituting pot for painkillers, and 52 percent said they drank less when taking medical marijuana.” Additional research on substitution of marijuana for pain management is not only warranted, but would support the Department of Health and Human Services’ strategy to combat the opioid epidemic.

Sure to be controversial, this line of debate is worthwhile if it can result in a policy prescription to improve our prevention and treatment efforts, while also easing the enforcement burden of drug-abuse-related incarceration. It may additionally prove worthwhile to pharmaceutical companies, which have not yet fully tapped into the medical marijuana market (estimated in the billions). Ultimately, only a policy shift will encourage Big Pharma to focus on medical marijuana for pain management vice pills to control opioid dependency side-effects.

The Lost War on Drugs As the Washington Post reported in May, the cartels feeding America’s opioid epidemic are destroying Mexican communities and exacerbating the country’s rule of law problem. Cartel decapitation efforts have arguably made things worse, as splintered organizations fighting for territory have brutalized society. Efforts under the $2.5 billion U.S. security investment in Mexico have also done little to impact the supply side, and Mexico’s June legalization of medical marijuana is another indication of the lost war.

Until recently, U.S. officials were reluctant to concede to Mexico on our own demand-side problem. Perhaps Secretaries Tillerson and Kelly’s May acknowledgement of the U.S. appetite for illicit drugs will improve the complicated U.S.-Mexico security relationship. But having spent significant time in Mexico, I doubt this admission will be sufficient for successful bilateral efforts. The Merida Initiative has, for the better part of a decade, shown we cannot want Mexican rule of law more than Mexico does. It is an investment that needs significant restructuring, and in fact, the State Department’s new budget reality will force prioritization of the most impactful programs. These will likely be the targeted efforts that have proven beneficial to U.S. law enforcement.

Additionally, policy makers should consider forfeited cartel assets as they think about both domestic and bilateral approaches. These assets, possibly valued at $24 billion according to court documents, could go a long way towards U.S. expenditures to combat the opioid epidemic (The Department of Health and Human Services puts total economic costs of the epidemic at $78.5 billion). While Senator Cruz’ EL CHAPO bill is unlikely to result in a border wall, a similar proposal could help fund prevention and treatment efforts, including those related to medical marijuana. The Mexican government would certainly press for repatriation of forfeited cartel assets, but U.S. policy makers should dangle that carrot in front of future results in establishing rule of law.

Lindsay Singleton served at the U.S. Embassy in Mexico City from 2013–2016 for the Department of Justice and has spent over a decade representing the Departments of State and Energy in Latin America. The views expressed in this article are the views of the author and do not necessarily represent the views of the United States government.