A New Era of Accountability (Again)

Hannah here — Happy Spring from Vermont, which is to say I have set up my outdoor furniture and also two days ago it snowed. Spring in Burlington also means the return of a debate I've been watching play out since I moved here — about visible drug use, public space, and what we actually owe each other. I have thoughts.

A few weeks ago, CNN ran a story about the sentencing of Matthew Perry's ketamine dealer under the headline "A New Era of Accountability for Drug Dealers." I thought, ah, yes — that sparkling new era of accountability that we've been in for about fifty years now. Despite some reforms passed during the 2010s and early 2020s, the United States continues to incarcerate more people for drug offenses than most countries incarcerate people for all offenses combined. Nothing about the long federal prison sentence handed down to Matthew Perry’s dealer feels new at all, just a slight retreat to a maximally punitive approach that has dominated drug policy since the 1970s.

Not long ago, it felt like the War on Drugs might actually be winding down. Marijuana legalization was spreading state by state, and the language of harm reduction was creeping into the mainstream. The opioid epidemic had put a sympathetic (read: white) face on addiction, and “treatment not incarceration” had gone from activist slogan to a relatively bipartisan talking point. There was real money going into recovery services. Some states were actually closing prisons. The momentum had shifted and seemed to be picking up steam – but then things changed again.

Today, politicians from both parties are refashioning the language of the War on Drugs for a new target–fentanyl–which has become the rhetorical justification for mandatory minimums and other penalties that in some states would exceed sentences for crack cocaine offenses in the 1980s. The Trump administration has directed federal prosecutors to seek the most serious available charges, reversing years of sentencing reform. New laws are undercutting Good Samaritan protections (or would make people too afraid to call 911 regardless of what the law technically allows).

For decades now, we’ve known the War on Drugs didn’t work…if (and this is a big if) the goals were actually to reduce drug use and associated harm. Nixon aide John Ehrlichman famously admitted years later that the administration knew it couldn’t make it illegal to be Black or leftist but that it could disrupt those communities through aggressive drug enforcement. By that measure, the War on Drugs didn’t fail at all. It decimated communities of color and gave rise to policing practices — no-knock warrants, civil asset forfeiture, routine SWAT deployments — that have been used on everyone from protestors to 92 year olds in their own home. As Radley Balko has been telling us for years, the War on Drugs literally turned our local police departments into a military force.

But the argument that the threat of harsh punishment deters drug use has real political staying power, and it’s not always made in bad faith. The evidence, however, doesn’t support it. Decades of research shows that the severity of legal penalties has no effect on rates of drug use. What does affect drug use is access to treatment, stable housing, and economic security – basically, opportunities to thrive. Humans have used psychoactive substances for all of recorded history, across every culture and every era. It’s no wonder that attempts to police and jail our way out of it keep failing, not because we haven’t tried hard enough, but because the approach is wrong.

And yet knowing the approach is wrong has not been enough to change it, because the problem isn’t really one of knowledge. Again, we know what actually reduces drug-related harm, and we’ve seen versions of it work. In Portugal, where overdose deaths and HIV infections fell dramatically, not because drug use disappeared but because the country stopped treating addiction as a crime and started treating it as a health problem. In Switzerland, heroin-assisted treatment didn’t make people stop using drugs — it kept them alive, reduced crime, and improved health outcomes for people the system had written off. That’s the honest version of what “working” looks like in this space: not the elimination of drug use, which humans have never managed in any era or culture, but a dramatic reduction in the death and suffering that our current approach produces in abundance.

What we haven’t done is build any of these treatment and support systems at scale, and a crisis — and it doesn’t feel dramatic to say we are still in a state of crisis when it comes to opioids in this country — is a terrible time to run the experiment, even when you’re fairly confident you know it will work. So we reach instead for what we have already built at scale, which is punishment: police departments, prosecutors, mandatory minimums, and prisons, the full apparatus of a fifty-year war that has consumed trillions of dollars and millions of lives and has not, by any serious measure, reduced drug use or drug-related harm.

And even when we do manage to try something different, we rarely give it time to work. Oregon is the clearest recent example. In 2020, voters passed Measure 110 with 58% of the vote, making Oregon the first state to decriminalize possession of small amounts of all drugs and directing marijuana tax revenue toward treatment. The theory was right, but the implementation was lacking. The treatment infrastructure that was supposed to be the point of the whole policy didn’t get built fast enough — funding was slow, programs were underdeveloped, and services were not there when they needed them. Meanwhile fentanyl arrived, overdose deaths climbed, and political support collapsed.

Measure 110 got blamed for everything. In 2024, the legislature voted 51-7 to recriminalize low-level drug possession. The most rigorous research found little to no evidence that Measure 110 caused the rise in overdoses or crime — that was primarily fentanyl and the pandemic, respectively — but by then the narrative had hardened and the political will was gone.

Part of what makes this so hard is that the visibility problem is real, and advocates for harm reduction sometimes undersell it. Arrests feel like they’re doing something because they produce an immediate (albeit temporary) change — the encampment is gone, the corner is quiet — even though the people who were there are simply somewhere else, usually worse off, and the conditions that put them there are completely unchanged. What “invisible” actually means in this context is cycling someone through a jail for a few days or weeks, where drugs are widely available but treatment is not, and then releasing them back to where they were before.

Harm reduction infrastructure, by contrast, keeps people alive and connected to services during the years it takes to actually address underlying conditions. It looks like it’s not working precisely because the people it’s helping are still visible — still present, still in need — rather than disappeared into the system and back out again in ways that feel, from a distance, like some kind of resolution. Burlington has been trying to open an overdose prevention center for years. It has been approved. It is still not open. In the meantime, the city has cycled through waves of visible drug use downtown, watched the political conversation tip toward enforcement and the familiar logic of clearing people from public spaces, and is now leaning again on responses that haven't worked before and won't work now. This isn’t a Burlington failure specifically. It's just what the reform cycle looks like everywhere.

Someone connected to an overdose prevention center is still using drugs, but they are also alive, being treated with dignity, with a private place to access services, and statistically more likely to eventually access treatment than someone who was arrested and released with nothing. Someone in stable housing is less likely to be using in public, less likely to be in crisis, less likely to generate the kind of visible disorder that drives public fear — but getting people into stable housing can take months or years during which public exposure to drug use continues. The political problem is that the timeline of harm reduction is long and the timeline of public anxiety is short.

The political will required to sustain harm reduction through its messy, visible middle period is almost impossible to generate in a media environment that covers addiction as a mess to be cleaned up rather than a public health crisis to be addressed. Media coverage shapes what the public thinks is happening, what they think is working, and what they think is possible. When the only stories about drug use are incident-based (an overdose, an arrest, etc…) the only solutions that feel intuitive are incident-based too. When Oregon’s overdose deaths climbed, driven primarily by fentanyl and the pandemic, too many news stories blamed Measure 110. The research said otherwise, but that wasn’t what made headlines.

This is not a small problem, so it doesn’t have a simple solution. The gap between what the evidence supports and what feels politically possible is partly a media problem and partly a patience problem and partly the entirely reasonable frustration of people who have been promised that help is coming and are still waiting. Journalism that takes the evidence seriously — that covers harm reduction as the mainstream scientific consensus it actually is and that asks why we keep funding the things that don’t work— makes the patience slightly easier to sustain. Long enough, maybe, to actually build the thing before we lose our nerve again.