Drug policy debates are highly polarized, often framed around prohibition and decriminalization. Both sides present compelling arguments but overlook a critical element: a system capable of meeting the demand for addiction treatment and recovery services.

Prohibitionist Perspective

Prohibitionists emphasize the severe dangers posed by contemporary drugs, many of which are more lethal and addictive than past substances. Synthetic opioids like fentanyl are over 50 times more potent than heroin. According to the Centers for Disease Control and Prevention, these drugs contributed to more than 55,000 overdose deaths in a year, highlighting the need for strict controls.

Reformist Approach

Drug reformers point to the shortcomings of the “war on drugs,” which has failed to significantly curb drug trafficking, usage, and overdose deaths. They advocate for an approach centered on evidence, health, equity, and human rights. Despite extensive investments in enforcement, drugs remain cheaper, stronger, and more accessible now, indicating the need for a shift in handling illicit drugs as a public health issue.

The Role of Treatment and Recovery Services

Both prohibition and reform require effective treatment and recovery services. Without these, efforts like prohibition can lead to unforeseen consequences. In 2005, stringent U.S. controls on ephedrine and pseudoephedrine disrupted methamphetamine production domestically but pushed operations to Mexico, aiding drug trafficking organizations. Similarly, reduced prescription of opioids like OxyContin led many to seek out heroin and fentanyl.

Case Study: Oregon’s Measure 110

Oregon’s Measure 110 decriminalized possession of small amounts of illicit drugs but lacked adequate treatment frameworks. The measure intended to replace criminal penalties with a small fine and promote health assessments, yet over 95% ignored the ticket, and less than 1% completed assessments.

Addressing Infrastructure Challenges

Both strategies face the obstacle of inadequate treatment infrastructure. A shortage persists across critical occupations, such as addiction counselors, social workers, and healthcare professionals. By 2025, significant portions of the U.S. will face mental health professional shortages. Rural and carceral areas are particularly affected, with high substance use and overdose rates.

Investments are needed in behavioral health to attract talent through better pay, streamlined education, licensing, stable funding, and supportive systems. Additionally, the U.S. must expand physical treatment infrastructure. Facilities like inpatient detox beds, residential centers, and outpatient clinics are scarce, with 80% of counties lacking an opioid treatment program.

A Path Forward

Substantial investments in human capital and infrastructure are essential to revamp the treatment and recovery system. U.S. policymakers must prioritize these aspects to tackle substance use disorders effectively and advance drug policy. Building this foundational system is imperative for successful drug policy implementation.

Jim Crotty is a former deputy chief of staff for the U.S. Drug Enforcement Administration, adjunct professor at American University’s School of Public Affairs, and part of the Advisory Board for United Against Fentanyl and End Overdose.