There’s good news and bad news from the drugs front in Amsterdam.
The good news is that a new coalition government of Labor, liberal Democrats and Greens want to pilot the legal sale of MDMA, also known as ecstasy. The three parties won the municipal elections in March.
The national government, in which the liberal Democrats rule with three center-right parties (including my own), has agreed to study the decriminalization of MDMA, although for medicinal use. A majority in the Amsterdam city council want to regulate recreational use as well.
The bad news is that Mayor Femke Halsema is still trying to convince the council to ban the sale of cannabis to tourists. I wrote an op-ed against her proposal in the NRC newspaper in April and have another story about it in Het Parool, the newspaper of Amsterdam.
The arguments used by both sides in Amsterdam will sound familiar to Americans. Proponents of decriminalization want to reduce harm. Opponents fear it would lead to more drug use.
The Christian Democratic party leader in Amsterdam insists it is “elementary” that decriminalization leads to higher drug use: “You see this everywhere.”
I’m not sure where, but not in the Netherlands. The country decriminalized cannabis half a century ago and has one of the lowest cannabis consumption rates (8 percent) in the developed world.
MDMA use is effectively decriminalized (users are seldom arrested and never prosecuted), but police still try to weed out production and sale, and the drug remains illegal. That doesn’t stop Dutch people from trying it. Half of under-35s in the Netherlands have taken ecstasy at least once. Few become long-term users. Only 3 percent of the overall population took MDMA in the last year.
Fatalities are rare, but a handful of users die of ecstasy every year, either from bad pills, an overdose or a combination with other drugs. The point of regulation is to take poisoned pills off the market and provide users with accurate information about risk reduction in licensed stores.
This would be unthinkable in the United States, which has much tougher drug laws. Yet it also has higher addiction rates, higher overdose rates, and higher hepatitis and HIV infection rates caused by needle-sharing than the Netherlands.
Take needle-sharing. When cities provide safe consumption sites, also known as needle exchanges, they see less drug use in public, lower hepatitis and HIV infection rates, and fewer complaints from residents.
In the Netherlands, there has been one death in a safe consumption site. In the United States, there have been none.
Yet the Republican state governments of Indiana and West Virginia closed down their needle exchanges during the pandemic.
The reason given by officials in Indiana? “I know people that are alcoholics, and I don’t buy him a bottle of whiskey.”
(Nor did they close all bars in the state or abolish regulations on beers and spirits.)
It’s the same fallacy: if we make drug use less dangerous, more people will take drugs. Decades of research argue against it, but the belief is persistent — and meanwhile people die.
(Not) saving lives
Naloxone is a life-saving anti-overdose medication. It can be injected into the muscle or veins, or sprayed into a person’s nose, and within minutes will block the effects of an opioid. It is cheap, it has few side-effects, and it has no effect on people who are sober.
Yet only 29 states allow pharmacists to sell naloxone to patients who are at risk of an opioid-related overdose, or a caretaker. The other 21 require patients to get a prescription first, which is absurd. By the time somebody needs naloxone, there’s no time to consult a doctor.
Overdose deaths in the United States have almost doubled (!) in the last two years (!) to 100,000. More Americans are dying of drug overdoses than in car accidents. Fentanyl alone has become the leading cause of death for Americans under the age of 45. (I’m running out of exclamation points to emphasize how much of a crisis this is.) A cheap, quick and safe method exists to save lives. Yet politicians in half the country think it’s too risky?
The same politicians will admit America has an opioid “epidemic” (half of all drug deaths are from legal opioids) and still treat drug use as a law-enforcement, rather than a health, crisis.
The last president, Donald Trump, asked Congress to cut funding for the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Medicaid expansion of his predecessor, Barack Obama, under which 1.2 million Americans with substance abuse disorders had been able to afford health care for the first time.
Congress wisely rejected both requests, but that didn’t stop Trump’s Justice Department from prosecuting doctors who overprescribed opioids without specifying what “overprescribing” meant. Some physicians stopped prescribing painkillers altogether, which in turn caused some of their patients to seek out illicit, and more dangerous, alternatives, like fentanyl.
American doctors do overprescribe painkillers. Americans don’t suffer more chronic pain than Europeans, yet Americans use two-and-a-half to four times more painkillers.
And they use more potent painkillers too, like oxycodone.
But suddenly cutting off a prescription is neither humane nor pragmatic. Going cold turkey works for some, but most addicts need help to quit.
They’re not getting it. The Centers for Disease Control and Prevention estimate that 41 million Americans need treatment for a substance abuse disorder (including addiction to alcohol and tobacco). 2.6 million are in treatment.
If you really believe the country is in an “epidemic”, how do you justify not treating 94 percent of people who are ill?
What Biden can do
Joe Biden, to his credit, has raised funding for SAMHSA by $1.5 billion. He supports evidence‐based harm-reduction strategies, like drug tests and needle exchanges. But it are often state laws that prohibit both.
Biden could ask Congress to repeal the so-called “crack house statute” of the 1986 Anti-Drug Abuse Act. It was written to criminalize the operation of houses where crack cocaine and other drugs are made or used; a superfluous criminalization, since the production and consumption of cocaine is itself illegal. The law has had the unintended consequence of putting safe consumption sites on legal thin ice.
Taking drugs to the streets
Closing down safe consumption sites doesn’t reduce drug use, it just moves it elsewhere.
Which takes us back to Amsterdam. Halsema’s proposal to ban the sale of cannabis to foreigners may deter some drug tourists, but it would cause others to buy cannabis illegally and smoke it in parks or hotels.
Two studies, one undertaken by the municipality in the Red Light District, another conducted citywide and paid for by the Amsterdam association of cannabis retailers, suggest that around four in ten tourists who take drugs in Amsterdam would stay away if Halsema got her way. Another 40 percent would come anyway. The rest aren’t sure.
The 40 percent who would still come are confident they could get weed some other way: online, from a Dutch friend or from a dealer. They’re probably right. According to Halsema, thousands of drug dealers sell cocaine and MDMA in Amsterdam every weekend, mostly to foreigners. (If they’re lucky: two in three sell fake drugs.) Why should they not sell cannabis too if it becomes illegal?
Far from deterring the worst tourists, the mayor would scare off foreign cannabis users who are unwilling to break the law and encourage more criminality.