Top Addiction Doctors Group Backs Drug Decriminalization And Expungements In Another Departure From Prohibitionist Roots

A top addiction-focused medical group is calling for the decriminalization of all currently illicit drugs in the interest of public health and racial equity.

The American Society of Addiction Medicine (ASAM), which has historically aligned itself with prohibitionists and resisted modest marijuana reforms, has undergone a significant evolution on drug policy issues in recent years.

While it has adopted a pro-decriminalization position on cannabis, starting in 2015, the organization is now recommending broad drug decriminalization, including ending criminal penalties related to paraphernalia—noting the “structural racism and stigma that are entrenched in U.S. drug policy.”

In the final of three public policy statements centering on racial justice in addiction medicine that was published on Thursday, ASAM said that it “supports shifting the nation’s response to personal substance use away from assumptions of criminality towards health and wellness.”

“Policymakers should eliminate criminal and onerous civil penalties for drug and drug paraphernalia possession for personal use as part of a larger set of related public health and legal reforms designed to improve carefully selected outcomes,” it said. “In the interest of harm reduction, policymakers should also eliminate criminal penalties for the manufacture and delivery of drug paraphernalia.”

Beyond decriminalizing drugs, ASAM said that lawmakers should “include consideration of expungement of records of such prior offenses, so that people do not remain marginalized for them.”

The organization similarly recommended expungements as part of cannabis decriminalization in an earlier 2020 policy platform, but the new statement notably expands that position to include all currently illicit substances.

“Concurrently, policymakers should support robust policies and funding that facilitate people’s access to evidence-based prevention, early intervention, treatment, harm reduction, and other supportive services—with an emphasis on youth and racially and ethnically minoritized people—based on individualized needs and with availability in all communities,” it said.

ASAM referenced decriminalization policies in place in Portugal, and it said that evidence shows the reform “can lead to improvements in health.”

It also took note of the voter-approved decriminalization law in Oregon.

“While it may be too soon to evaluate Oregon’s approach, and such evaluations must endeavor to ask the right research questions, the experience of Portugal and other decriminalization initiatives showcase the value of therapeutic responses to drug possession for personal use,” it said.

“The drug war has been wielded as a tool of oppression against people with [substance use disorder] and BIPOC. For over a century, investments have been made in ineffective strategies that have cost far too many lives. Reparative investments and structural policy changes are crucial for addressing the root causes of health inequities.”

The group said that its recommendations “intentionally do not include designing a framework for regulated access to currently illegal drugs for non-medical use given that even slight changes in the legal supply of certain drugs can pose great risk of increased use and harm, especially to marginalized people, and the current gaps in drug policy research.”

“While some may highlight that such decriminalization efforts will not address the nation’s toxic, illegal drug supply,” it said, “ASAM recognizes that any changes in laws that would increase legal access to currently illegal drugs would need to be carefully thought out, implemented gradually and sequentially, and scientifically evaluated at each step of implementation.”

ASAM’s other recommendation include facilitating clemency for people who’ve been convicted of non-violent drug offenses at the state and federal level, eliminating the crack-cocaine sentencing disparity and investing in research efforts “that aim to evaluate alternative public health approaches to drug use, with a focus on different types of drug policies, laws, and law enforcement practices.”

Further, the association said that policymakers should end drug conviction bans and drug testing requirements for public assistance and eliminate housing restrictions related to non-violent, drug-related activities.

“Stigma and criminalization go hand-in-hand to reinforce stereotypes, increase poor health outcomes, and perpetuate poverty, for many BIPOC in the United States,”  Stephen Taylor, co-chair of the working group that authored this public policy series, said in a press release. “Though it will not happen overnight, the policy recommendations we have laid out represent important first steps towards advancing racial justice and health equity for all people.”

The recommendations from ASAM represent a significant departure from the group’s historical positions on drug policy since its founding in 1954. In 2014, the group’s then-president, Stuart Gitlow, signed a letter circulated by prohibitionist organization Smart Approaches to Marijuana (SAM) that asked federal officials to resist pressure to even reschedule cannabis under the Controlled Substances Act.

Gitlow also signed onto a separate SAM letter opposing the Obama administration’s 2013 move to direct federal prosecutors to generally not interfere with state marijuana legalization laws.

In 2011, its then-president, Louis E. Baxter, said, “We do not recognize this as a ‘medication,’ having not gone through an official FDA-approval process”—making sure to use scare quotes around “medication.”

In 2012, ASAM published a white paper urging physicians to oppose local reform initiatives, but as more states legalized cannabis for medical or recreational purposes, the group appeared to start taking a more public health-focused stance with its policy positions.

The association has since become somewhat active in advocating for cannabis reform, even endorsing provisions of legislation in 2020 to federally codify the right of states to set their own marijuana policies. It’s stopped short of outright recommending allowing commercial cannabis markets, however.

Separately, another major medical group, the Minnesota Medical Association (MMA), also recently endorsed broad drug decriminalization, expungements for low-level possession and the promotion of statewide harm reduction programs.

Nationwide, a strong majority of Americans, including most Republicans, support drug decriminalization, according to a poll released last year. There’s also majority support overall for allowing the operation of overdose prevention centers where people can use illicit substances in a medically supervised setting and receive treatment resources.

Support for the decriminalization proposal increased by 10 percentage points overall since voters were asked about it in 2021 with a different question in a prior Data for Progress poll.

Nora Volkow, director of the National Institute on Drug Abuse (NIDA), said last year that the ongoing criminalization of people over drug use needs to end in order to effectively address substance misuse and the stigmatization of addiction.

In 2021, congressional lawmakers filed the first-ever bill to federally decriminalize possession of all currently illicit drugs, while also seeking to incentivize states to follow suit.