Today is the International Day Against Drug Abuse and Illicit Drug Trafficking, an annual observation established in 1987 by the United Nations General Assembly. It is an important day to reflect on the progress the world has made against drugs and the many challenges still to be addressed.
One notable example of progress is the increasingly widespread support for a public health-focused approach to the drug problem. Just a few years ago, a focus on prevention, early intervention, behavioral and medication-assisted treatment, overdose prevention, and recovery support services was controversial in many areas of the world. In fact, there was a time when the word “recovery” was not even accepted in U.N. documents. But in 2014, a U.S. resolution on recovery at the annual U.N. global drug meeting (the Commission on Narcotic Drugs) easily won approval. These discussions at the U.N. and elsewhere have led to a greater appreciation of the urgent need to reduce the stigma associated with substance use disorders – both out of genuine compassion and as a means to encourage those who need help to seek treatment.
Implementing public health policies requires a lot of hard work and an investment in building treatment capacity, including training medical professionals on how to address substance use disorders through screening and early intervention. Once medical professionals are trained to screen patients for substance use, they can identify and address problems earlier. This type of assessment can result in huge long-term savings in future criminal justice and other public costs.
Also critical to improving public health is the use of medications to treat addiction and the implementation of medication-assisted treatment (MAT) protocols. Although cultural and social stigmas regarding medications used to treat opioid use disorders persist in some places, clinical research has shown it is highly effective, reducing relapse rates and improving health outcomes significantly.
Another encouraging development is the emerging global consensus in favor of alternatives to incarceration for people with substance use disorders.
There are now over 2,900 drug treatment courts in the United States and dozens more internationally. Over the years, these specialized courts have continued to refine and improve their operations. This intervention has repeatedly demonstrated success in decreasing recidivism, driving drug use down, and reducing criminal justice costs. In addition, DTCs break down the walls that too often divide justice and health agencies, allowing them to work together toward the same goal. It is no surprise that international partners are studying these models and adapting them to the challenges they face in their countries.
In just over a decade, Hawaii's Opportunity Probation with Enforcement (HOPE) and similar initiatives operating in about 40 jurisdictions have helped to inspire probation reforms across the United States. The Swift, Certain, Fair approach reduces drug use, recidivism, and crime by employing brief, consistently applied sanctions for every probation violation. Treatment is provided to those who request it. An independent evaluation of the HOPE program found that participants – primarily methamphetamine users – were 55 percent less likely to be arrested for a new crime; 72 percent less likely to use drugs; 61 percent less likely to skip appointments with their supervisory officer; and 53 percent less likely to have their probation revoked.
As the international community prepares for the U.N. General Assembly Special Session on drugs in April 2016, the United States will advocate wider adoptions of vital reforms such as these around the world.
More information about medication-assisted treatment and alternatives to incarceration is available at http://www.dpt.samhsa.gov, the National Association of Drug Court Professionals, and the SwiftCertainFair Resource Center.
 “Swift and Certain” Sanctions in Probation are Highly Effective: Evaluation of the HOPE Program, Office of Justice Programs, National Institute of Justice. Available at: http://www.nij.gov/topics/corrections/community/drug-offenders/pages/hawaii-hope.aspx