Tightrope

Chapter 7 opens with a description of the popular basketball player Len Bias, who showed great promise early in his career but died after ingesting drugs in 1986. Due to Bias’s fame, his death led to a raft of anti-drug legislation, which the authors describe as more of an emotional attempt to “send a message” than a carefully considered set of policy proposals (87). The authors compare this approach to that of Portugal, which took the opposite approach by decriminalizing drug possession and treating addiction as a disease. As a result, Portugal now has six deaths due to drugs per million people aged 15 to 64, compared to 348 in the United States.

The American approach also criminalized a vast swath of the population; through the perspective of a Baltimore police officer named Steve Olson, the authors describe how arresting and prosecuting people for drug addiction doesn’t address the problem. One alternative, which began in Seattle and has expanded to several cities, including Baltimore, is Law Enforcement Assisted Diversion (LEAD). LEAD focuses on steering people with addictions into treatment programs rather than arresting them. A broader public health approach to addiction, the authors write, would include: treatment for all Americans in need; policies that make drug addiction less lethal, such as by increasing availability of the overdose-reversing drug Naloxone or creating safe injection sites; and a focus on prevention, including reducing prescriptions of opioids by doctors and dentists, and recognizing the societal malaise that drives addiction.