Feb. 22, 2001 Vol . 20, No. 4
All is not as rosy as athe advocates of drug courts would suggest. There is little compelling evidence that drug courts will reduce violent crime related to the drug trade.
By Neil Boyd
In late November of last year Vancouver Mayor Philip Owen announced Vancouver's controversial drug strategy and harm reduction plan. Modelled on the approaches of many European cities, the plan aims to embrace a four pillar approach, emphasizing prevention, treatment, enforcement and harm reduction.
Much of what the city is suggesting is not especially novel or controversial: increased enforcement of upper-level dealers, a redeployment of police officers, a school curriculum on drugs and drug abuse, and the expansion of medical treatment for those who have difficulties with illegal drugs.
But there are also a number of recommendations that are more novel and controversial: the expansion of methadone maintenance and needle exchange programs, a research trial of prescriptions for hard-core heroin addicts, and the possibility of safe injection sites for injectable drug users.
These latter recommendations are, reasonably enough, designed to reduce the crime that flows from illegal drug use: if we expand methadone services and consider a program of heroin prescription, users will not have to turn to crime in order to obtain their drugs of choice.
The recommendations are also designed to prevent the possibility of HIV infection and overdose death: by expanding needle exchange and establishing safe injection sites, we can reduce both the spread of disease and the possibility of overdose. These are the lessons of Frankfurt, Zurich, and other European cities.
But I want to focus on the recommendation that all commentators seem most inclined to embrace the creation of drug courts, for it may also be the most problematic. Justice minister Anne McLellan has announced that by 2004 there will be drug courts in every major Canadian city. Politicians of all persuasions are enthusiastically supporting the initiative, tripping over themselves to herald the plan as cost-effective and compassionate, substituting the hope of treatment for the pain of imprisonment.
There is a good deal to be pleased about. Municipal, provincial and federal governments have all realized that drug addiction itself is less helpfully viewed as a crime and more usefully viewed as a public health problem. Thirty years ago our answer to the problem of injectable drug use was to grab "the hypes" by the throat and cart them off to jail. In suggesting that those who have such substance abuse problems can be best assisted by public health and social services, our society has accomplished a major transition in our paradigm for responding to illegal drugs.
Further, there is little doubt that helping injectable drug abusers will be much less expensive than jailing them, and that providing assistance with housing and life skills can be critical to withdrawal from patterns of self-destructive behaviour.
But all is not as rosy as the advocates of drug courts would suggest. First, there is little compelling evidence that drug courts will reduce violent crime related to the drug trade. Drug offenders who have committed violent crime and drug offenders who are commercial traffickers have typically been rejected for admission to these programs.
Those who are accepted into the programs are the most hopeful cases, and even then, studies of recidivism rates reveal something less than unqualified success. In a recent law review article Colorado judge Morris Hoffman wrote of the U.S. experience, "Reductions in recidivism are so small that if they exist at all they are statistically meaningless."
Further, a U.S. Department of Justice publication from May of last year points to inevitable future perils, "As less tractable groups participate, rates of compliance and graduation will decline and recidivism will rise."
Second, drug courts remove the traditional protections of the adversary system. As Toronto drug court judge Ted Bentley puts it, "They lose their Charter rights, they lose their right to speedy sentencing, speedy trial; they basically give up all their legal rights as we know it." It is important to realize that the health-care provider in the drug court scheme is not a physician, but the court. The alcoholic and the tobacco addict can be treated by physicians, but cocaine and heroin abusers are subject to a court-patient relationship.We cannot ignore this double standard, especially when we know that there are more overdose deaths related to alcohol than to illegal drugs; we must similarly acknowledge that tobacco continues to kill 10 times as many Canadians as all illegal drugs combined.
The sense of the legal-illegal drugs distinction has its roots in economics, politics and culture, not in the mandate of public health. And until we begin to place all mind-active drugs on the same page of analysis, we will continue to misunderstand the drug problem.
Perhaps most fundamental, we must recognize that treatment is simply not a magic wand that can be imposed by professionals on those who are abusing drugs. In fact, the idea that treatment is responsible for positive changes in reducing patterns of self-destructive behaviour has little sound empirical support.
European surveys of users who have quit reveal that they stopped not because of medical or professional intervention, but because they found something in life that was better than using drugs on a regular basis. In many instances this something was another person -- a recognition that someone else, often a love interest, cared enough to make change worth accomplishing. In some cases religious belief provided a way out, and in others the ability to find meaningful employment -- a better way of living -- was responsible for the change.
Simply put, placing users in treatment regimes with routine urine testing and regularly scheduled court appearances is not the key to changing behaviour. If users are to find a different route in life, most will usually do so through more practical kinds of change: better housing, lifeskills support and the caring of family and close friends.
And in some cases, nothing that anyone can do will be of assistance: taking drugs will always seem to be a better way of life than not taking drugs. For those with few social and intellectual skills, legacies of physical abuse, and significant mental and emotional disabilities, drugs may be virtually impossible to leave behind.
In sum, while much of the spirit that motivates drug courts is to be applauded, we should not be so naïve as to applaud the practice itself: there is little good evidence that these institutions will dramatically reduce rates of crime. More troubling, drug courts will no longer allow us to view illegal drug use as either a crime or a public health problem. The message from the bench will be a confused amalgam of two perspectives: the illegal drug abuser is now to be seen as both a criminal and as a person who is deserving of medical attention.
Neil Boyd is a professor in the school of criminology.
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