The U.S. policy regarding the drug problem is still centered mainly on the enforcement of its drug laws and intervention in the drug supply both within the U.S. and in neighboring countries. There is no question that this “crusade” has had an impact. Importing a kilogram of cocaine into the US costs approx $15000 (an average kilogram sells for $10,000-$15000) while sending a regular package weighing the same costs about $100 (1).

The result of the focus on enforcement

Still, the recent assassination of the Mexican “drug czar”, and the escalation of violence just south of the U.S.-Mexico border point to another fact: Where there’s money, there’s a way. Drug cartels will find a way to deliver their product as long as customers are waiting on the other side of the border. One of the battles in this war has to be fought on the prevention/intervention side. Dr. McLellan’s selection as deputy drug czar brought with it a lot of hope regarding the role of treatment in the big-picture. Still, bureaucracy moves slowly, and there have been few visible changes in policy to date, aside from the well needed symbolic nature of dropping the term “War on Drugs” from our lexicon.

What about treatment?

Unfortunately, health insurance companies in the United States rarely covers any of the cost involved in drug treatment, even though at least 42 states require them to do so by law! Even when they do, insurance companies often limit coverage to 30 days of residential treatment. I’ve made it clear before, but I feel that the notion that 30 day treatment can work needs to be removed from our consciousness (2). I realize this may require hypnosis…

Anyway, without funding, the hope of making drug treatment truly affordable and accessible is small and dwindling as it requires more medical treatment, which is obviously costly. I hope that this aspect of health care coverage finds its way into the ongoing debate, especially given the high, and increasing prevalence of drug abuse in this country.

As it stands, the U.S., with little more than 5% of the world’s population is consuming somewhere between 50%-70% of the world’s drugs. Talk about a problem with our GDP…

And prevention?

I can tell you, without a doubt, that saving someone from ever becoming an addict is the biggest cost saver in this entire equation. It would remove crime costs, treatment costs, and incarceration and court costs right out of this whole thing. The problem, obviously, is that we don’t know with certainty who will, and who won’t, become an addict. There are some recent advances, and I think that as technology (specifically imaging), and our knowledge (specifically about genetics and its interaction with environmental stress), improves we will be able to do a much better job of this.

I work on some projects that assess the cost benefit of treating rather than merely jailing drug users (prop 36 in CA). I can’t wait for us to have the knowledge to allow for the same analyses regarding prevention.

Citations:

(1) Reuter & Pollack (2005). how much can treatment reduce national drug problems?

(2) McLellan, Lewis, O’Brien, & Kleber (2000). Drug Dependence, a Chronic Medical Illness Implications for Treatment, Insurance, and Outcomes Evaluation.