States Shifting to "Four Pillars" Approach, Instead of Mass Arrests and Scare Tactics, for Confronting Methamphetamine

Although the use of methamphetamine has remained fairly flat throughout this decade -- contrary to popular belief -- and its half-million semi-regular users are far fewer than regular users or heroin or cocaine, meth has been the demon drug du jour for the new millenium. The "meth epidemic" has aroused concerted law enforcement and propaganda efforts at the state and local levels, and belatedly aroused the attention of the Office of National Drug Control Policy (ONDCP), which turned away from its obsession with marijuana long enough to include a few anti-meth segments in its National Youth Anti-Drug Campaign.

But while the states and federal government fill their prisons with tens of thousands of meth offenders and crank out ever more draconian laws to try to suppress the popular stimulant, public health officials, harm reductionists, and drug reform activists say there is a better way. Instead of relying on punitive laws, scare tactics, and failed federal leadership in confronting methamphetamine abuse, states and the federal government would be better off adopting more enlightened alternative approaches.

Current, law enforcement-heavy approaches to meth are ineffective and counterproductive, said Bill Piper, national affairs director for the Drug Policy Alliance as he introduced a new report he authored, "A Four-Pillars Approach to Methamphetamine: Policies for Effective Drug Prevention, Treatment, Policing and Harm Reduction." "Meth is not a new drug," Piper told the Tuesday teleconference. "Its use has fluctuated for the past 40 years and has been relatively stable since 1999. But it has become more available, more potent, and more addictive over time, and federal policies have failed to reduce most of the problems associated with meth use."

Even when law enforcement can legitimately claim successes, as in the massive reduction in the number of home meth labs, it only breeds new problems, said Piper. "The law of unintended consequences brought us the increasing power of the Mexican meth cartels."

There is a better way, and that is to adopt the Four Pillars approach, Piper argued in the report. That approach, already in use in places like Geneva, Zurich, Frankfurt, Sydney, and most famously, Vancouver, "has resulted in a dramatic reduction in the number of users consuming drugs on the street, a significant drop in overdose deaths, and a reduction in the infection rates for HIV/AIDS and hepatitis," he said.

A Four Pillars approach to meth should include the following steps, the report said:

• Eliminate barriers to successful meth treatment, such as the shortage of treatment programs for pregnant and parenting women;

• Divert nonviolent methamphetamine offenders to treatment instead of jail;
• Invest in research to develop the equivalent of methadone and buprenorphine for the treatment of methamphetamine abuse, and allow doctors to prescribe dextroamphetmaine, modafinil, Ritalin and other medications to treat stimulant addiction as part of counseling and drug treatment;
• Eliminate failed, scare-based prevention programs like DARE and the National Youth Anti-Drug Media Campaign, and increase funding for after-school programs instead;
• Re-prioritize local and federal law enforcement agencies to focus on violent criminals instead of nonviolent drug offenders, and set clear statutory goals and reporting requirements for the disruption of major methamphetamine operations; and
• Make sterile syringes widely available to reduce the spread of HIV/AIDS and hepatitis C.

While New Mexico is the only state that has formally embraced a Four Pillars strategy including harm reduction as part of its approach to meth -- a program in which DPA played a key and continuing role -- promising developments are afoot in other places as well, including California and Utah.

In California, Proposition 36, the Substance Abuse and Crime Prevention Act, in effect since 2001, is making a significant contribution in drying up the flow of new drug prisoners into the state's swollen and budget-devouring prisons. Under Prop. 36, about 35,000 people a year have been diverted from prison to drug treatment through the criminal justice system, with slightly more than half of them reporting meth as their primary drug of abuse. With nearly 19,000 meth users a year entering treatment under Prop 36, the program is the largest meth treatment and prevention program in the nation.

"We are not only reducing the number of people locked up, but we have saved about $1.5 billion in the past seven years, with recidivism dropping and no negative impact on crime rates," said Margaret Dooley-Sammuli, Proposition 36 coordinator for DPA. "We can get treatment to people who need it with cost savings and a positive outcome."

Lou Martinez was one of those people. A chronic California meth user for a decade, he was arrested numerous times for possession of drugs or paraphernalia. "I was constantly getting picked up throughout the '90s, I could never comply with the probation conditions, I was in and out of jail all the time," he said.

Things changed after Prop. 36, Martinez said. "I got picked up again in 2002, but this time I was referred to Prop. 36 and was able to detox and get health and psych screenings. I spent 90 days in a transitional house, and when I graduated in 2004, for the first time in my adult life I wasn't under the control of the courts. Without Prop. 36, there is no way I could have broken that cycle of arrests and trying unsuccessfully to quit."

Martinez returned to college, got a bachelor's degree, and now works directly with Prop. 36 clients. "It saved my life," he said of the program.

In Utah, the Drug Offenders Rehabilitation Act (DORA), which provides substance abuse screening for anyone convicted of a felony is now taking an innovative Salt Lake County program statewide, while across the Four Corners in New Mexico, policymakers, state agencies and other stakeholders have developed a comprehensive meth strategy bringing together all four of the Four Pillars.

Harm reduction is a key element, said Reena Szczepanski, director of DPA New Mexico, and a key player in developing the New Mexico strategy. "What are we going to do for people before they are ready to go into treatment?" she said. "What other problems and conditions do they have? Since 1997, we've had a statewide system of needle exchanges, where drug users can get health education, access to testing, information on how to respond to overdoses. This is harm reduction. Before someone is ready to go into treatment, they are already engaging a system of services that will be there when they are ready," she said.

Methamphetamine may be over-hyped as a national drug problem, but it is a locus of concern among policymakers, health care professionals, law enforcement, and society at large. With meth such a high profile drug policy issue, the battles over how to approach it may set the tone for drug policy discussions for years to come. With its report calling for a Four Pillars approach, the Drug Policy Alliance is taking up the challenge.