Introduction 

Drug policy defines which drugs are illegal and governs how these drugs are controlled and regulated. Drug policy also outlines the government’s response to illicit drugs, including methods of demand reduction, supply reduction, punishment, and treatment. These policies are  written and implemented by Congress, the President, the Courts, and executive agencies/offices.  

The Causal Stories Theory can help explain the evolution of drug policy over time. This theory contends that policies change when the stories we tell about issues change. Thus, the stories we tell about drug use affect the punitiveness of drug policy. When drug use is viewed as criminal, policy solutions focus more on punishment and prison time. Viewing drug use as a matter of public health (e.g. medical marijuana and addiction) leads to policy solutions that are centered around decriminalization, treatment, and rehabilitation.

Data  

This figure graphs the number of bills about illegal drugs introduced in Congress compared to the number of Congressional hearings held regarding illicit drugs from 1965-2020. The data was collected from the Comparative Agendas Project. The graph illustrates that the issue of illegal drugs has received ongoing attention from Congress. However, the focus of these bills has changed over time due to altering causal stories.  

Causal Stories & the History of Drug Policy  

Use Reduction 

There are two main approaches to drug policy: use reduction and harm reduction. Use  reduction policy views drugs as fundamentally wrong and seeks to stop all drug use. This causal story is told because people arbitrarily morally condemn illicit drugs and are unable to recognize the difference between the use and abuse of illicit drugs as they can with alcohol and tobacco. Additionally, people wrongly believe illicit drugs have higher health costs than alcohol and tobacco. Historically, most American politicians have approached drug policy with a punitive focus and an abstinence-only mindset, seeking to stop all drug use rather than only focusing on remedying the harm, disease, and death associated with drug abuse. Use reduction drug policy often takes the shape of treating drug use as a criminal matter. 

When framing drug use as criminal, the policy solutions often focus on punishment and prison time. This became especially evident throughout the 1980s to the early 2000s with the enactment of numerous policies. The first significant one was the Anti-Drug Abuse Act of 1986 which created mandatory minimums for drug-related crimes. The Violent Crime Control and Law Enforcement Act of 1994 further developed this by increasing prison funding, making sentences harsher, and instituting the three strikes law. Additionally, research suggests that police departments only became invested in the drug war when they received funding and training for SWAT teams, military equipment, and other resources. These policies disproportionately helped incarcerate people of color. 

Since the 1980s and 1990s, when these policies were first introduced, numerous studies have disproven the effectiveness of this approach. Yet, many politicians still promote and strengthen use reduction policy. Reinarman et al. compared samples of cannabis users in Amsterdam, Netherlands, and San Francisco, California to measure the effectiveness of punishment for drug use as a deterrent. They did not find any significant evidence to support the claim that penal threats actually lower drug use. There were many similarities in cannabis consumption between Amsterdam, a city with decriminalized marijuana, and San Francisco, a city with criminalized marijuana. This is just one of many studies which disproves the notion that the threat of punishment stops people from using drugs. Despite these findings, government officials continue to tell the story that drug use is best addressed with harsh penalties.  

Similarly in 2007, President George W. Bush proposed a 31% increase in the funding of  an anti-drug ad program proven to “increase the likelihood that all teens would smoke marijuana” in a five-year study conducted by the Government Accountability Office. The Office of Management and Budget also released an evaluation concluding that the program “showed virtually no results.” The White House was aware of these reports, but wanted increased funding for the ad program nevertheless. 

This pattern suggests that drug policy in the United States has been largely based on  “fear, prejudice, and ignorance” rather than “common sense, science, public health concerns, and human rights.” In Figure 1 above, there are numerous points at which there were significantly fewer Congressional hearings held on illegal drugs than the number of illegal drug bills introduced in Congress. These disparities demonstrate how at times, even though members of Congress were not fully educated on the current findings about illegal drugs, they were still passionate about passing drug laws. 

Conversely, a study conducted in Australia found that most drug policy-makers, when making policy decisions, consulted experts and technical reports, while others conferred with the Internet, statistics, and other policymakers. Perhaps this finding contrasts with those of the United States because of the severe polarization in the United States. According to Pew Research Center, “27% of Democrats see the Republican Party as a threat to the nation’s well-being” and “36% of Republicans see the Democratic Party as a threat to the nation’s well-being.” American politicians are likely aware of the inefficiency of these drug policies, yet they support them anyway because it has become a part of their party identity. Strict drug policy is also an easy place for liberal politicians to “prove their tough-on-crime credentials.” Thus, regardless of the evidence suggesting that punitive drug policy is ineffective at reducing drug use and its consequences, politicians continue to tell the same causal story because it serves them politically.  

This justification also explains why Michael Gerson, a columnist for The Washington  Post, inadvertently demonstrated his inability to “convey current policy, identify the actors who  bear responsibility for it, or understand the actual opinions of his ostensible interlocutors” in an  op-ed he wrote criticizing the decriminalization of drugs. Despite not seeming to grasp what was happening, he was strongly opposed to the decriminalization of drugs because his party told him to be. 

Harm Reduction

Opposite of the use reduction approach is the second approach to drug policy: the harm reduction approach. The harm reduction approach to drug policy focuses on the health problems, crime, violence, and more associated with drug use. This causal story ignores casual drug users, focuses on treatment, and pays more attention to drug users susceptible to violence and disease. Countries in Europe and Asia that have turned to harm-reduction policies, such as needle exchange programs, methadone distribution, and marijuana decriminalization, have seen much better outcomes on public health and crime than the United States has. A specific example is in Portugal, where small amounts of illicit drugs have been decriminalized since 2001. After this policy change, the country saw a drop in opioid overdose deaths and “new cases of diseases associated with injection drug use, such as hepatitis C and H.I.V.”

Switzerland’s drug policy underwent a significant change and became more focused on  the health and societal problems associated with drug use. Researcher Daniel Kübler applied the Advocacy Coalition Framework (ACF) to Switzerland’s drug policy and found that policy change occurred when advocacy coalitions replaced the abstinence belief system with harm reduction in the drug policy subsystem. Causal Stories Theory can also explain this policy change. When advocates and politicians stopped telling the story that all drug use was bad, and began asserting that only the harmful consequences of drug use should be focused on, Swiss drug policy changed. 

The start of President Barack Obama’s term was thought to signal a shift towards more  harm-reduction and health-based drug policies in America. Two actions of note are the passage of the Fair Sentencing Act, which lessened the gap between sentencing for crack and powder cocaine (long shown to be a racially motivated disparity), and Attorney General Eric Holder’s “Smart on Crime” initiative. Gil Kerlikowske, the director of the Office of National Drug Control Policy during Obama’s presidency, further developed harm-reduction policy by institutionalizing overdose prevention initiatives and syringe exchange programs. He also publicized the notion of drug reform as a health issue. These bills, initiatives, and rhetoric all signal a change in the story told about drug use; the story Obama’s administration told emphasized the government’s responsibility to mitigate the harm caused by drug use rather than punishing those involved with drugs.  

While the Obama administration made strides toward improving drug policy in the  United States, they were not able to fully realize a harm-reduction approach. Kerlikowske made disappointing budget decisions that continued the persecution of marijuana users and enacted harsh prescription drug policies which caused a dramatic increase in the number of deaths from heroin overdoses. Also, throughout Obama’s presidency, marijuana remained classified as a Schedule One drug under the Controlled Substances Act, representing the government’s denial of marijuana as a medical treatment. These actions contradicted the overall causal story told by Obama’s presidency. 

The Return to Use Reduction  

Much of the progress made by the Obama administration was seemingly undone by  Donald Trump. While campaigning for the presidency, Trump stated that his main strategy to  address the drug problem in America was to focus on limiting the supply of heroin by increasing  southern border control. Experts have found that cutting off the supply of drugs does not decrease the number of drug users because the demand for drugs remains the same. Still, Trump supported this strategy. 

In May 2017, Attorney General Jeff Sessions and the Trump administration made it clear that they view drug use as “a crime to be policed and punished, rather than a public health problem.” Some examples of policies they enacted include the reinstitution of mandatory minimums for drug-related crimes and a budget proposal that cut Medicaid funding, in turn taking away millions of Americans’ access to substance-abuse coverage. Law enforcement figures, including AG Sessions, used “some of the apocalyptic anti-drug rhetoric that characterized much of federal drug policy in the ‘80s and ‘90s.” Despite what years of scientific research has proven, Sessions, Drug Enforcement Administration officials, and Trump himself maintained the arguments that drugs increase violent crime, medical marijuana is not legitimate, and longer prison sentences deter crime. The Trump administration’s actions and rhetoric towards drug use signaled a restoration of the causal story which considers drug use criminal.  

While Kerlikowske was able to make some progress toward his and Obama’s drug policy goals, the Office of National Drug Control Policy under Trump was highly ineffective.  Historically, the ONDCP publishes a Drug Control Strategy each year. The office under Trump  did not release a Drug Control Strategy until 2019 (two years after Trump’s inauguration). When they finally did, it was extremely short and lacked the data, details, and measures necessary to be a legitimate plan. The same can be said of the 2020 report. The office struggled under Trump due to disorganization at the top, high staff turnover, and inexperienced staff. 

Conclusion

In conclusion, the stories we tell about drug use affect the punitiveness of drug policy.  One causal story is that drug use is criminal; the resulting policy solutions of this story  emphasize punishment and prison time. This causal story was the popular approach from the 1980s to the early 2000s. In other countries, the causal story is that drug use is a matter of public  health, resulting in policy solutions focused on legalization and rehabilitation. While the Obama administration made progress toward changing the causal story of drug use in the United States,  they were not entirely successful. Additionally, Trump and his administration reinstated the punishment-focused causal story. 

For the U.S. to see improvements in public health and crime, government officials need  to stop “block[ing] resolutions supporting harm reduction, suppress[ing] scientific studies that  reach politically inconvenient conclusions, and silence[ing] critics of official drug policy.” In other words, the United States government needs to employ the causal story that views drug use as a matter of public health and enact policy solutions focused on decriminalization and treatment.