In a move leaders say is focused on a commitment to the health and well-being of their patients, the group representing over 10,000 Minnesota doctors and doctors in training is advocating to decriminalize simple possession of illicit drugs.
Members of the Minnesota Medical Association’s board of trustees voted in December to approve the policy proposal, which calls for:
- The removal of criminal penalties for the possession of a small quantity of illicit drug for personal use and/or the possession of drug paraphernalia
- The creation of administrative panels that can render treatment referrals and civil penalties to offenders of simple possession
- An increased investment in statewide harm reduction and medication for opioid use disorder programs
- The release of individuals incarcerated for simple possession from detention settings
- The expungement of criminal records for simple possession
Minnesota Medical Association (MMA) members say they believe the proposal is the first of its kind to be approved by a medical association in the United States. The move made sense for MMA, said Dr. Will Nicholson, a family physician at St. John’s Hospital in Maplewood and the association’s president. MMA — a nonprofit professional association that represents Minnesota physicians, residents, and medical students — is focused on promoting the health of the patients its members serve, and Nicholson explained that the organization holds up its values and commitment to patient care by advocating for decriminalization.
While most physicians do not support the legalization of illicit substances like marijuana, Nicholson said many do support decriminalization, because research has shown that putting people in jail for drug possession only exacerbates existing health-equity gaps.
“There aren’t many people who work harder than physicians to help stem the tide of drug abuse in our state,” he said. “It is very important that we are doing the right thing for our patients.”
Because he and his colleagues at MMA believe that criminalizing the use of addictive substances has a disproportionately negative impact on communities of color — far-reaching impacts that can affect everything from voting rights to access to addiction treatment to home ownership to family stability — Nicholson believes that a public stand in support of decriminalization was in line with the founding medical ethic of “first, do no harm.”
“The way physicians look at any health care challenge is we try to apply the highest possible ethical standards to get the best outcomes for our patients,” he said. “The science on this topic is pretty clear: Criminalizing addiction and addictive behavior doesn’t get the best outcome for the patient. The more we look at it, the more we see it doesn’t get the best outcome for society, either.”
Dr. Ryan Kelly is an assistant professor at the University of Minnesota Medical School in internal medicine, pediatrics and addiction medicine and a member of the MMA working group that presented the policy proposal. He said that his support for decriminalization is rooted in his history of working with individuals struggling with substance use disorder combined with a professional commitment to supporting his patients’ health.
“I believe that criminalization is bad for one’s health,” Kelly said. “The whole role of a medical provider is to improve health. That is not only promoting individual health but also community health.”
A survey of members showed overwhelming support for decriminalization among those who participated, and the board later approved the policy proposal. Kelly said he hopes to see the approach catch on nationwide.
Members of other state medical associations have voiced interest, Kelly said. “Other groups are working to advocate on similar lines at the state level. I think more people are starting to organize on this,” he said.
It could have been easy for the MMA to avoid controversy and take a more neutral stance on the issue, Nicholson said, but he and other members believe that neutrality is no longer an option. And when influential people face serious issues and talk about them openly, they help society inch toward progress, he said.
“The MMA is choosing to take this issue on,” Nicholson said. “We are not sitting this out. That’s the thing I’m most proud of. Physicians in the state are stepping up. We are going to take this on with Minnesota, with Minnesotans. We are going to be part of this debate, part of this solution.”
By taking a more public, advocacy-focused position, he said, the MMA sends a clear message about the kind of medicine they hope to practice. “That, to me, is the most important thing,” Nicholson said. “We are here day-in, day-out, doing the work, trying to advocate for the best things for patients based on science and ethics.”
Equal levels of abuse, unequal repercussions
While substance use disorder occurs across all ethnic and racial lines, Nicholson and Kelly both believe that unequal and punitive enforcement of drug possession laws has only expanded gaps that already existed in American society.
People of color are far more likely to do jail time for drug possession, Nicholson said. Individuals charged with felony possession lose their voting rights, cannot be hired for certain jobs, cannot serve on a jury, or qualify for some social benefits or public housing. These limitations harm not only the person convicted of drug possession but also their family members.
These cascading impacts negatively affect individuals’ overall health, Nicholson said. He believes that physicians cannot ignore this larger impact and are compelled to take action.
Nicholson said while doctors are aware of the negative effects drugs have and would not encourage their patients to use illegal substances, he and his colleagues also believe that a punitive approach doesn’t work. Decriminalization is a more fair-minded and equitable approach to dealing with this crisis, he said.
“There are so many other factors that go into this issue,” Nicholson said. “It is hard to communicate to people that they should not do drugs — but we should also not criminalize it if they do drugs. To us that’s a medical challenge we accept and we are going to bring the best science, the best technology and the best resources to bear.”
Because felony drug convictions can block access to drug treatment, Kelly said that decriminalization could free up access for a greater number of people, therefore broadening the potential number of people who could benefit from addiction and recovery care.
“Decriminalization is the best way to give people a chance at recovery,” he said. “If you have a criminal record, it makes it almost impossible to get help.”
Jeremiah Gardner, Hazelden Betty Ford Foundation director of communications and public affairs, said that decriminalizing possession of “small amounts of drugs — as Minnesota did years ago with marijuana — can offer the opportunity to divert more resources to helping people overcome addiction rather than punishing them.” But he said it is important to make those reinvestments with care, with the aim of making sure those seeking recovery are able to access help.
“At the same time,” Gardner said, “for the sake of young people especially, I don’t think we want to normalize illicit drug use, so parameters limiting or forbidding public use would be important to look at as well.”
Whatever happens going forward, Nicholson said it is important that people not cast blame on patients with substance use disorder. A more objective, assistance-centered perspective is in line with decriminalization, he explained — and could help more people get access to the life-saving help they so desperately need.
Physicians, Nicholson said, “don’t judge patients. Our desire is never to get anyone in trouble for anything. We are in our patients’ corner. Every health care dollar is precious and we want to make sure that every life that is affected by drug addiction gets the most effective care with the recourses available.”
Decriminalization vs. legalization
One of the reasons the concept of decriminalization is controversial, Nicholson believes, is because people tend to confuse it with legalization.
“It is easy to get the two morphed together,” he said. “I think it is really worth the discussion. Legalizing illegal substances that are not good for your body is not something that physicians are going to support, ever.” But, he added, “We just believe that the tool of using criminal penalties to manage addictive behavior does not appear to be effective.”
Decriminalization, he explained, levels the playing field and creates more judgment-free opportunities for physicians to provide the best evidence-based care. “It’s the same as if we were looking at diabetes care. We can keep on doing the stuff we’ve done in the past but if the evidence comes out and says there is a better way to treat patients, we’ll do that. That’s where we are at with this problem.”
With Democrats now in charge of the state Legislature, legalization of recreational marijuana in Minnesota is all but assured, Nicholson said. While he and many of his colleagues continue to disapprove of the proposal, they are committed to providing addiction care without barriers for everyone in the state.
“As you know, we as an association have been involved in the discussion about medical cannabis,” he said. “If you are going to legalize, we need to learn from our past mistakes with alcohol and tobacco. It is our right and our passion is to make sure that we are a state where people who have drug-abuse challenges get the best possible care anywhere in the country.”
The addiction crisis can feel overwhelming, Nicholson said. There are times when it seems like an unsolvable problem, so it is important to sign on to any possible solution — even when it comes in the form of a policy proposal or legislative stance.
Any action is better than no action, he believes: “Every doctor has gut-wrenching experiences with chemical dependency. We all want to help fix it. It is going to take work, and we’re saying as a group that we’re willing to take the next step.”