Criminalizing Drug Use Might Hinder HIV Prevention & Treatment Efforts

Although the United States has been waging on ongoing “war on drugs,” a war that has spanned numerous years and administrations, the number of deaths related to overdoses continues to rise—particularly when it comes to opioids. The Centers for Disease Control and Prevention (CDC) reports that 6 out of 10 deaths related to overdoses involve opioids. With 91 Americans dying each day due to an opioid overdose, the government has struggled to retaliate.

However, a new study out of Johns Hopkins Bloomberg School of Public Health and the University of British Columbia has found that the criminalization of drug use—which includes having strict penalties for more minor drug offenses—may have a negative impact on the prevention and treatment of a virus that is known to be directly transmitted through drug injection equipment: HIV.

Injection drug use is, in fact, a huge driver of the HIV epidemic in the United States. The CDC reports that in 2015, 6% of the 39,513 HIV diagnoses reported were linked to injection drug use. In the midst of the global opioid abuse epidemic, unmet needs among those who inject drugs are causing the number of HIV diagnoses to rise around the world, according to a recent press release on the Hopkins / UBC study. In 2014, the Joint United Nations Program on HIV/AIDS reported that a little over half (51%) of new HIV cases reported in Eastern Europe and central Asia were among injection drug users.

Over 1.5 million drug-related arrests are made each year in the United States alone, according to the nonprofit organization the Drug Policy Alliance; the majority of these arrests are solely due to possession. A staggering 56-90% of injection drug users “will be incarcerated at some point in their lives,” according to data in the press release. Despite the fact that law enforcement is getting these individuals off the streets, drug use remains high.

This raises the question: Is criminalizing drug use effective?

The researchers conducted a systematic review of 106 peer-reviewed studies pertaining to the criminalization of drug use and HIV prevention and treatment among injection drug users—all of the studies were published between January 2006 and December 2014.

Their findings? An overwhelming majority, 91 out of the 106 peer-reviewed studies, suggested that criminalizing drug use negatively affects the prevention and treatment of HIV. Furthermore, 15 of the studies “suggested no association.” Only 6 of the studies suggested that criminalization was beneficial. However, the studies that suggested criminalization was beneficial only “showed a small benefit and were generally methodologically weak.”

“More than 80% of the studies evaluating criminalization of drug use demonstrated worse health outcomes among those targeted by these laws and their communities at large,” study leader Stefan Baral, MD, MPH, associate professor of epidemiology at the Bloomberg School shared in the press release. He continued, “The evidence that criminalization helps is weak at best and the vast majority of studies show that criminalization hurts when it comes to health, economics, and society-at-large.”

There are several reasons why having strict legal penalties regarding drug use may be more harmful than helpful. For example, there is already a stigma associated with substance abuse. In fact, several studies have found that substance abuse disorders are “more highly stigmatized” when compared with other health conditions. Stigma coupled with the fear that they might be putting themselves at increased risk for arrest or incarceration if they seek treatment, might prevent users from receiving the care that they need.

This begs the question: What should be done instead?

The research conducted by Dr. Baral and his colleagues suggests that different strategies are needed, ones that will focus more on limiting the dangers associated with drug use, overdose, and “the inability to find employment due to a drug arrest.” For example, policies that allow for needle exchange programs, where drug users are allowed to exchange needles for clean, new ones, and maybe even “safe consumption facilities” might help curtail related infections and fatal overdoses.

According to Dr. Baral, these individuals should be “connected with treatment, such as a methadone program designed to wean them off of dangerous opioids.”

“We must understand that punitive laws neither decreased the supply or the use of drugs and have caused adverse health outcomes. The current approach is not working” Dr. Baral warns. “People have addiction and they have nowhere to turn. They are getting HIV and hepatitis C because they are sharing dirty needles. They end up in jail or the emergency room or worse. We are at a turning point with a massive increase in the number of people using opioids and there seems to be no end in sight.”