Solution Journalism: Mobilizing resources and meeting addiction halfway

The Issue: Old Solutions to New Problems, New Orleans’ Opioid Crisis Wears a New Face  

Clear vials containing white powder.

“The opioid epidemic in Orleans Parish is being fueled by a highly lethal, synthetic opiate known as fentanyl. As a result, street drugs in New Orleans are more deadly than they have ever been.” – Dr. Dwight MCKenna, New Orleans Coroner 

Synthetic opioids, such as fentanyl, were found to be responsible for over 56,000 overdose deaths nationwide in 2020 alone (“Overdose Death Rates.”). This is a nationwide problem, with Drug Tasks Forces all over the United States attempting to devise plans to combat this deadly and widely available drug that is up to 50 times stronger than heroin, making it dangerously easy to purchase large amounts of, knowingly or not, and inadvertently induce an overdose (“Fentanyl Facts.”). 

Fentanyl was created as a pain medication for surgery, but has since entered the illicit opioid market beginning as soon as 1979. Though the drug has been the cause of overdoses since its first appearance on the market, the explosion of fentanyl-related deaths in recent years is attributed to it being synthesized in bulk in countries outside of the United States, such as China and Mexico, which allows large amounts to then be exported at once. The dark web, which offers a high level of anonymity and is often utilized by those dealing in illegal markets, has also allowed fentanyl and other illicit substances containing it to be shipped domestically with little risk (Babu). 

Though fentanyl can be used on its own, many overdose deaths are due to its use in other illicit opioids, such as heroin, as an adulterant. Adulterants, in this case, are substances added to illicit drugs which are not listed as an ingredient  and according to “Adulterants in illicit drugs: a review of empirical evidence,” are “deliberately added to increase bulk, enhance or mimic a pharmacological effect, or to facilitate drug  delivery.” (Cole, Claire, et al.) Fentanyl is commonly used as an adulterant in heroin, cocaine, and methamphetamine without the user’s knowledge. 

The Orleans Parish coroner, when looking at information from 2015 and 2016, declared that there were more opioid related deaths, including fentanyl, than homicides in the district during the first half of 2016 (“Fentanyl Abuse”) According to WGNO, a New Orleans news station, Coroner Dr. Jeffrey Rouse also reported that, “There were more heroin and fentanyl overdoses in the first six months of 2016 than there were in all of 2015.” (WGNO Web Desk) 

This crisis has not gone unnoticed throughout the United States or New Orleans, and Acadiana Treatment Center, a psychiatric treatment center in Sunset, Louisiana which deals with drug addiction, said “resources have been diverted into raising public awareness of the acute dangers of Fentanyl, especially in regard to the mislabeling of certain substances. Further, many emergency responders are now carrying large amounts of naloxone, which is used to reverse the life-threatening respiratory suppression that Fentanyl is known to cause.” (“Fentanyl Abuse”) But, how well does education do with regards to combating these issues for people which are already addicted and how does the United States’ illicit drug policy factor in? 

Much of the response to various drug-related crises in the United States has been related to the model of a “war on drugs,” a term first coined in 1971 by then-President Richard Nixon. This model of combating widespread drug use in the United States is centered around two principles: prohibition and criminalization (Coyne). Prohibition involves making drugs harder to obtain, while criminalization causes those who use drugs or possess them to be imprisoned or fined. Today, nearly 500,000 are currently imprisoned for violations of drug law, whether that be use or possession, as well as more than 1.5 million drug arrests being made every year (Hodge). 

According to research done by the Cato Institute, this so-called “war on drugs” costs American taxpayers $51 billion annually as well as the government having spent over $1 trillion since its inception over 50 years ago (Coyne). With huge spending, one might expect that this model of decreasing the prevalence of drug use and abuse would be successful, or why would this still be the response over 50 years out of Richard Nixon’s presidency? However, since the years of its installment, there has been a steady increase in overdoses, drug charges, violence, and criminalization and incarceration of the poor and POC at an unproportional rate on the basis of drug use and possession (Coyne). 

Data collected in 2016 by the Vera Institute of Justice regarding policing and prison population demographics in New Orleans indicates that, “​​Black men were 50 percent more likely than white men to be arrested. Black women were 55 percent more likely than white women to be arrested.” (“New Orleans: Who’s in Jail and Why?”) Not only are Black men and women incarcerated at a higher rate in New Orleans, but in 2017, over half of overdose deaths in New Orleans were African Americans. Along with this, the New Orleans coroner recorded in their 2019/2020 report that 78% of accidental drug-related deaths involved fentanyl, “a 107% increase compared to 2019.” (“2019/2020 Coroner’s Report”) 

While fentanyl-related overdose deaths surge across the United States, data from New Orleans indicates congruence with this trend. Combined with increasing opioid use in Black communities in the city, as well as over policing and disproportionate incarceration, Black New Orleanians are at particular risk in this new era of illicit drug use.

Sign reading: No Drugs.

The Solution: Portugal’s Response to Opioid Addiction 

Not all countries have stuck with old methods, though. Portugal, once dubbed the heroin capital of the world, implemented a series of harm reduction policies in 2001 aimed at combating widespread drug addiction in the country. This included the decriminalization of all illicit drugs, both possession and use, as well as referring those struggling with illicit drug addiction or those caught with drugs to a panel who may recommend treatment or more minor penalties over prison time.  According to American Addiction Centers, “Soon after the change in law, the opioid epidemic leveled off and the country started seeing precipitous drops in addiction, HIV infection, overdose-related deaths, and even drug-related crime and incarceration.” (Schwartzbach) 

According to “Drug Decriminalization in Portugal: Lessons for Creating Fair and Successful Drug Policies” by Glenn Greenwald, illicit drug usage rates have remained largely the same, but the negative effects have drastically decreased. He writes, “Drug policy experts attribute those positive trends to the enhanced ability of the Portuguese government to offer treatment programs to its citizens— enhancements made possible, for numerous reasons, by decriminalization.” (Greenwald 1) 

So, what specific policies did Portugal implement and how were these policies implemented successfully? 

As Greenwald explains, decriminalization does not mean that illicit drug use and possession are no longer illegal, but that “only noncriminal sanctions (such as fines or treatment requirements) are imposed or that no penal sanctions can be” (Greenwald 2) This decriminalization also does not include drug trafficking, which is still very much subject to a prison sentence. 

Under this framework, Portuguese law distinguishes between those who are addicted or non-addicted when imposing penalties for possession or use of illicit drugs. Greenwald explains that instead of prison or legal action, “Commissions for Dissuasions of Drug Addiction” was established as a panel responsible for administrating sanctions according to one’s offense and addiction status (Greenwald 3). This panel, according to Transform Drug Policy Foundation, is “made up of legal, health and social work professionals.” Someone who is sanctioned but proves to be  non-addicted may only receive a warning. Someone who is evaluated by the commission and is shown to be addicted to the illicit drug they were caught using or in possession of will be fined, but is also able to avoid this fine by going to mandated treatment for their addiction. However, the commission cannot force anyone to attend treatment regardless of their addiction status. 

Lastly, those who are sanctioned by the commission reserve the right to have a therapist assist and advocate for them during their meeting with the commission as well as have a medical examination done upon their request. According to Greenwald’s study of the Portuguese drug policy framework, he says that the opinion of those on the commission is that “the overriding goal of that process is to avoid the stigma that arises from criminal proceedings… the process is structured so as to de-emphasize or even eliminate any notion of “guilt” from drug usage and instead to emphasize the health and treatment aspects of the process.” (Greenwald 6) 

According to data collected for the European Drug Report 2020, Portugal only had 6 drug induced deaths per million people, as compared to the total for the European Union which was 23.7 per million. This decriminalization also affected prison populations in Portugal. In 2002, 41.8% of people in Portuguese prisons were there for drug offenses. However, by 2021, only 19.4% of the prison population were drug-related offenders (“Annual Reports.”). Regarding money spent on the prison and police system in Portugal, Dr. Joao Goulao, a doctor of public health in Portugal, said, “90 percent of public money spent fighting drugs in Portugal is channeled toward those health-care goals — just 10 percent is spent on police enforcement.” (Brown)

Along with decriminalization, Portugal centralized one agency to do addiction outreach across the country. In “How Europe’s Heroin Capital Solved Its Own Crisis,” Chris Brown writes, “In Portugal, every health district in the country has outreach teams that visit addicts every day and get to know their stories and needs.” He also says that the once very open drug market in Lisbon is gone and the communities with the highest illicit drug-related deaths at one point are now not seeing many (Brown). 

The Implementation: Reconsidering Criminality and the Community Approach 

As of now, New Orleans, Louisiana has no centralized agency or approach to illicit drug use, possession, or addiction barring the Police force and prison system, which as previously mentioned, disproportionately arrests and incarcerates Black citizens. 

Firstly, I propose that legislation be passed in New Orleans, as well as Louisiana as a whole, to decriminalize the simple use and possession of all illicit substances such as cocaine, heroin, methamphetamine, and fentanyl in the amount considered to be personal use. Not that this would go unchecked, as this would still be illegal, though not punishable by prison time or arrest unless it accompanies a violent offense or an otherwise criminal act (such as drug trafficking). 

Now that drug use and possession has been decriminalized in its totality, a new system needs to be built in order to manage illicit drug use and serve communities struggling with drug addiction. 

Secondly, I propose that a council or commission, similar to that of Portugal’s Commissions for Dissuasions of Drug Addiction, should be created to serve the city and citizens who are found to be in use or possession of illicit drugs. This council should be composed of selected healthcare (including mental health), social work, legal, and rehabilitation experts who are willing to work towards creating a plan of action which offers alternatives to prison or large fines for those who would ordinarily be arrested for drug charges (barring drug trafficking). This would be a centralized council of people who operate from a government building, perhaps similar to an office of social work, where those who are sanctioned on drug offenses could meet with therapists or legal council to discuss their own cases. This council should also have a department which deals with outreach, possibly employing those specializing in social work or activism to go into communities identified with drug/addiction related issues and offer harm reduction or treatment options.

The sanctions in this case should be small fines, no larger than $50 for first time, non-addicted individuals, or $100 for repeat offenders who are still non-addicted. However, I believe that there should be alternatives to subvert these fines if individuals are willing and the council sees it fit, such as community service or routine counseling. For those who receive sanctions who are deemed to be addicted to an illicit substance, fines should follow the same limit as above for non-addicted individuals. However, the alternative to bypass this fine should be routine counseling and/or rehabilitation for an allotted time, as decided by a healthcare professional or therapist according to each individual’s case. I do not think that individuals found to be addicted who wish to attend treatment should shoulder the bill, but rather this would come from a  sector of the agency’s allotted budget. 

Ideally, I believe that the council’s budget should be funded by the city, as are other public institutions. However, an amount of money should also be taken from the New Orleans Police Department budget, currently $206,487,636, and reallocated to this council. As drug use and possession shifts away from being a criminal issue that one can be arrested for, and therefore a police issue, the estimated amount of money needed by the police to deal with drug-related offenses would be reallocated. All inmates currently in prison at the Orleans Parish Prison sentenced for non-violent drug charges (not including drug trafficking) should be released without exception. 

This implementation challenges the issue of fentanyl-related drug use deaths in New Orleans by getting in front of the problem. Since a large portion of these deaths are accidental, caused by unknown fentanyl used as an adulterant in substances such as heroin, using these tactics which decrease illicit drug use overall would also decrease fentanyl-related deaths as evidenced in Portugal. This would also likely work to decrease the disproportionate arrest rate of Black New Orleanians on drug-related charges because simple drug use and possession would no longer be classified as a criminal act. Instead of entering the carceral system, a community approach would be used through the council to provide help where it is needed. 

Works Cited 

“2019/2020 Coroner’s Report on Accidental Drug-Related Deaths in New Orleans: Orleans Coroner.” Orleans Coroner – Orleans Parish Coroner’s Office, http://neworleanscoroner.com/2019-2020-coroners-report-on-accidental-drug-related-deaths-in-new-orleans/.

“Annual Reports.” Annual Reports – Council of Europe Annual Penal Statistics, https://wp.unil.ch/space/space-i/annual-reports/.

Babu, Kavita. “What Is Fentanyl and Why Is It behind the Deadly Surge in US Drug Overdoses?” UMass Chan Medical School, 13 Oct. 2022, https://www.umassmed.edu/news/news-archives/2022/05/what-is-fentanyl-and-why-is-it-behind-the-deadly-surge-in-us-drug-overdoses/.

Brown, Chris. “How Europe’s Heroin Capital Solved Its Overdose Crisis.” CBCnews, CBC/Radio Canada, https://www.cbc.ca/news2/interactives/portugal-heroin-decriminalization/.

Cole, Claire, et al. “Adulterants in Illicit Drugs: A Review of Empirical Evidence.” Drug Testing and Analysis, vol. 3, no. 2, 2010, pp. 89–96., https://doi.org/10.1002/dta.220.

Coyne, Christopher J, and Abigail R Hall. “Four Decades and Counting: The Continued Failure of the War on Drugs.” Cato.org, 12 Apr. 2017, https://www.cato.org/policy-analysis/four-decades-counting-continued-failure-war-drugs.

“Drug Decriminalisation in Portugal: Setting the Record Straight.” Transform, 13 May 2021, https://transformdrugs.org/blog/drug-decriminalisation-in-portugal-setting-the-record-straight.

“Fentanyl Abuse Overtakes New Orleans.” Acadiana Treatment Center, 16 Feb. 2018, https://www.acadianatreatmentcenter.com/about/news-media/fentanyl-overtaking-new-orleans/.

“Fentanyl Facts.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 23 Feb. 2022, https://www.cdc.gov/stopoverdose/fentanyl/index.html.

Greenwald, Glenn. Drug Decriminalization in Portugal: Lessons for Creating Fair and Successful Drug Policies. CATO Institute, 2009. 

Hodge, Jamila, and Nazish Dholakia. “Fifty Years Ago Today, President Nixon Declared the War on Drugs.” Vera Institute of Justice, 17 June 2021, https://www.vera.org/news/fifty-years-ago-today-president-nixon-declared-the-war-on-drugs.

“New Orleans: Who’s in Jail and Why? .” Vera Institute of Justice , Mar. 2016, https://www.vera.org/downloads/publications/Jail-Population-First-Quarterly-Report-Jan-March_web.pdf.

“Overdose Death Rates.” National Institutes of Health, U.S. Department of Health and Human Services, 21 July 2022, https://nida.nih.gov/research-topics/trends-statistics/overdose-death-rates.

Schwartzbach, Kevin. “Portugal’s Harm Reduction Policies Seem to Be Working.” American Addiction Centers, 15 Sept. 2022, https://americanaddictioncenters.org/blog/portugals-harm-reduction-policies.

WGNO Web Desk. “Coroner: More Overdoses than Homicides in New Orleans This Year.” WGNO, WGNO, 14 July 2016, https://wgno.com/news/local/coroner-more-overdoses-than-homicides-in-new-orleans-this-year/.