In recent years, dehumanizing narratives about people who use drugs have lessened such that substance use is now considered by some as a public health issue instead of a moral deficiency. However, this varies greatly depending on the cultural and social contexts within which one finds themself. Around the world, many people still face social isolation, prison time, and death sentences for their involvement with illicit substances. Even among the most progressive of circles, the consensus is that drug use is negative. If we are to adequately address the potential harms associated with substance use, we must first address the stigmatization of substance use. For as long as humans have existed, we have used substances to alter our physical, mental, and emotional states. This phenomenon is not just prevalent in humans. It has been documented that elephants in southern Africa will drink the fermented fluid of the rotten marula fruit for pleasure. Reindeer in Siberia are known to indulge in psilocybin, commonly referred to as magic mushrooms. Wallabies consume poppy plants, and domestic cats love catnip. What is legal versus what is not has little to do with current scientific understandings of substance use and its centrality to human cultures.
This author calls for a radical acceptance of drug and substance use as normal behavior. Drugs have been used by people all over the world for several reasons, including but not limited to spiritual initiation, pain relief, mental expansion, emotional healing, community building, and physical repair. This is not to deny the immense suffering and loss that results from alcohol abuse and substance use disorder. The compulsion to engage in harmful substance use is a terrible condition that deteriorates one’s physical, mental, and social health. However, the level of stigma that one attaches to a particular substance and the person using it contributes greatly to physical, social, economic, and political harm. People living with addiction and dependency need care, not punishment.
Part of the paradigm shift this author calls for includes transitioning from the rehab model to the habit model for understanding drug use. Unlike the rehab model, which views drug use as a disease, the habit model recognizes that all habits, including drug use, are functions of normal psychological and physiological processes. Habits are learned behaviors that generally are practiced if they bring pleasure or ease and are often discarded when they cause discomfort or pain. For some, rehab is not effective because it does not address the social and material con- ditions that lead to drug use. It is also expensive and often inaccessible due to lack of governmental support for publicly available voluntary drug treatment. Under the abstinence-based rehab model, relapse is common because once people complete their 30-/60-/90-/120-day stint, they tend to return to the environments and social situations that encourage harmful substance use. Abstinence-only methods deny the basic human drive toward reward-seeking behavior and create mental conditions of shame that can contribute to the misuse of drugs.
From an economic perspective, we must contend with the fact that the demand for drugs is largely inelastic, meaning that even as the price of a good increases, the desire to consume it does not change significantly. The War on Drugs supposes that if supply is diminished or made expensive, demand will decrease, but this is simply not true. Failing to address and reduce demand, the WoD has targeted supply, which has significantly inflated the price of illicit drugs, increasing their market value and incentivizing participation in drug selling, arms trafficking, labor exploitation, and the growth of cartels, ultimately producing immense suffering, violence, and death.
To end the racist War on Drugs, we must abolish borders and the prison industrial complex. Border enforcement has long been touted as a necessary measure in stopping the flow of drugs into the United States, giving way to policies that unjustly target migrants from Central and South America. For example, during the Nixon presidency, Operation Intercept was launched with the aim of stopping marijuana from Mexico from entering the US. The operation instructed border, customs, and immigration agents to stop and inspect all movement by foot, vehicle, or plane, effectively targeting all migration from Mexico into the southern US.
In reality, border enforcement efforts to stop the supply of drugs have simply led to the increased trafficking of increasingly potent and deadly drugs. Historically, drug interdiction has incentivized drug sell- ers to produce substances that are more potent but smaller in size to avoid detection—a phenomenon referred to as the “iron law of prohibition.” This occurred with alcohol during the Prohibition era in the United States, and we are seeing this in our current era with the introduction of increasingly potent illicit opioids, such as fentanyl, into the drug market.
As in the past, migrants are being falsely targeted and scapegoated for drug trafficking and substance use in the United States, which is being used to justify increased border enforcement and deportations—neither of which will resolve our current overdose crisis. Borders, military, police, sanctions, and capitalist regimes do not keep people healthy or safe. They instead result in family separation, community disruption, forced removal, detention, and unsafe border crossings, which can cause psycho-physiological ailments and create conditions ripe for labor exploitation and human trafficking.
Some states and nations have realized the harm of the drug war and made efforts toward legalization, which has the potential to reduce drug costs and thus the incentive for participation in the illicit drug trade. However, to bring greater benefits to societies, full decriminalization is a must. This will not only reap the benefits of legalization but also erase the harms that carceral systems have brought upon marginalized people and communities. The hundreds of thousands of people incarcerated for their use or sale of drugs face material consequences long after they are released, including lack of access to affordable health care and housing, few employment prospects, and restricted mobility across geographies. This impacts their ability to rebuild their lives after the trauma of incarceration, which often leads them to continued misuse of drugs and engagement in criminalized activities that send them back to jail or prison.
The current popular trend is toward the legalization of marijuana—at the time of writing, over half of the states in the US have decriminalized recreational marijuana use. However, the world’s drug violence is not largely due to marijuana distribution and use but instead to the prohibition of other drugs, namely cocaine, opioids, and methamphetamines. If we are to create healthy systems for the people and the planet, we must decriminalize all drugs, not just marijuana. As the push for legalization continues, we must also ensure the retroactive release and erasure of criminal records for people with drug convictions.
Another means of promoting health for communities and people impacted by the War on Drugs is by abundantly funding comprehensive health and social services to address conditions that lead to addiction and fatal overdose, including counseling and medication like buprenorphine and methadone. Availability of universal health care can help those suffering from abscesses, hepatitis C, and other medical ailments related to excessive, prolonged, and unsafe drug use seek treatment.
Grassroots organizing, participatory defense, and mutual aid networks are some tactics we can use to push back against the violence of the prison and military-industrial complexes. Through these means and others, we are able to diminish the PIC’s reach and scope while creating new ways of caring for one another. We must commit to building solid alliances, formations, syndicates, and networks that increase our trust in one another in order to achieve and maintain our health and well-being.
Those in service provider roles can honor a client’s dignity by decoupling service provision from punitive systems and using a person-first approach, wherein a person’s substance use is not considered as the primary trait that defines them. Furthermore, medical care providers can attend continuing education courses on topics including harm reduction, addiction medicine, opioid agonist therapy, and pain management to deepen their understanding of how drug use impacts patients and how best to provide care without stigma.
A truly effective way to ensure health and safety for people who use drugs is through the creation of overdose prevention sites (OPS), sometimes called supervised injection facilities or safe consumption sites, where people can safely use drugs and have an overdose reversed, if necessary. In 2003 Canadian drug user activists launched Insite inVancouver—the first OPS in North America. There are now over 200 safe consumption sites operating in fourteen countries throughout the world.
In all those legal safe consumption sites, not a single death has occurred in the past thirty-one years. Due to the federal “crackhouse” statute introduced in 1986 under Ronald Reagan’s presidency, which makes it a crime to maintain drug-involved premises, these sites are currently illegal everywhere in the United States except for New York City. As someone who has lost loved ones to fatal overdose, I often wonder what would have happened if they were able to use drugs in a safe environment instead of dying alone out of fear of being criticized or persecuted. We can and must do better by advocating for the establishment of more OPS and learning from existing sites.
Countless activists have done the hard work of community outreach, network building, and abolitionist visioning to understand what fosters true health. Using a nonjudgmental harm reduction approach, healthcare workers can eliminate stigma in service provision and client interaction. By meeting our clients where they are and connecting them to wraparound services, we can support them in accessing counseling, stable housing, nutritious food, space for leisure and rest, and fulfilling activities. To do so, health workers must first examine and change our carceral behaviors and practices to provide the best quality care to the people and communities we serve. To that end, I close this chapter with a set of questions for health-care workers to reflect upon in considering how they provide care to people who use substances.
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SELF-REFLECTION QUESTIONS FOR HEALTH-CARE AND SOCIAL SERVICE PROVIDERS
- What barriers do you face in providing quality care to your clients?
- What are some methods of care delivery that can honor the agency of those you serve?
- How have you perpetuated or sustained the PIC, either intentionally or unintentionally?
- What local healing justice efforts exist for you to engage in? If none, what would you need to start one?
- What is one concrete way you can disrupt carceral logic and practice in your care work?
Authored by Onyinye Alheri
From All This Safety Is Killing Us by Ronica Mukerjee & Carlos Martinez, published by North Atlantic Books, copyright © 2025 by Ronica Mukerjee & Carlos Martinez. Reprinted by permission of North Atlantic Books.
