The City and County of Denver has fared extraordinarily well over the course of the last decade.  Denver took full part in the sustained economic expansion and the declining crime rate that characterized America in the 1990s.  As per capita personal income rose an impressive 46 percent nationwide during the 1990s, it rose 72 percent in Denver, to nearly $41,000.^[256]  As the national crime rate fell 19 percent from 1996-2000, crime in Denver fell by 28 percent.^[257]  With the good news came new residents.  The city added nearly 90,000 people between 1990 and 2000, an 18.6 percent increase that was surpassed by only seven other large U.S. cities.^[258]

But not all the news in Denver has been good.  By many measures, the city’s problems with substance abuse and addiction are considerably more severe than in the nation as a whole.  Among the 50 states, Colorado ranks second in the relative severity of its alcohol and drug abuse problems, according to a 2001 study sponsored by the U.S. Department of Health and Human Services.^[259]  As Colorado’s largest city, Denver could be expected to share in the state’s problems.  Indeed, substance abuse and addiction weigh heavily on Denver residents:

·                      Denver’s alcohol and drug-related death rate is more than 50 percent higher than the national average.^[260]

·                      Drug-related hospital emergencies occur in Denver at 2½ times the national rate.^[261]

·                      Substance abuse costs Denver residents, businesses and government at least $1.5 billion a year—in addition to the incalculable toll in human suffering.^[262]

Fortunately, Denver’s resilient economy and sound fiscal management^[263] mean that the city can bring to bear a wealth of human and economic resources to address substance abuse.  To target those resources, city leaders are charting a promising strategy that emphasizes significant new investments in prevention and treatment.  The state government, for its part, has an obvious stake in the well-being of its capital city, and a major role to play.  The residents of Denver and the rest of Colorado would benefit tremendously if state lawmakers shift their substance abuse policy and funding priorities toward prevention and treatment.

Voters in Denver and the rest of the state overwhelmingly endorse just such a policy shift.  A statewide survey in July 2001 found that nearly 75 percent of active voters favor “increasing funding to greatly expand the availability of treatment.”^[264]  The great majority of Colorado voters (73 percent) also favor decreasing criminal penalties for people possessing small quantities of drugs and investing the prison cost savings in prevention and treatment.  These preferences are especially pronounced among Denver voters, but strong support for change spans demographic categories across the state.

The following recommendations are intended to build on areas of recent progress while also addressing key areas of concern.

Leadership

The severe consequences of alcohol, tobacco and other drug problems in Denver require that the government’s response be formulated at the highest level—including the mayor, the city council and agency heads.  Mayor Wellington E. Webb appointed the city’s first drug strategy coordinator in 2000 and has made combating substance abuse a high priority during his final year and a half in office.

·                      To sustain this level of attention, Denver’s next mayor should reaffirm the role of the Director of the Mayor’s Office of Drug Strategy as a high-level official who reports directly to the mayor and is empowered to coordinate the city’s overall response to substance abuse.

·                      Denver’s elected representatives at the local and state levels should exercise their influence to reorient state legislative policy and budget priorities on substance abuse toward greater investment in prevention and treatment.

Information

Estimates of drug use rates and treatment needs extrapolated from data collected at the state or national level may provide a fair sense of the overall scope of the problems facing Denver.  But such estimates are no substitute for local data gathered expressly to inform local policymaking.  Denver is a geographically expansive and demographically diverse city; accurately identifying the most pressing problems will require correspondingly comprehensive and rich local data.  As Denver moves to enhance its prevention programming and shore up its treatment system, it is especially critical to have accurate and detailed information on the prevalence of alcohol, tobacco and drug use and the need for treatment among city residents.

·                      City leaders should therefore move quickly to undertake a comprehensive household survey of Denver residents on alcohol, tobacco and other drug use.  The information derived will inform policy planning and serve as a baseline for measuring the future impact of Denver’s new strategies to reduce substance abuse.

·                      In setting substance abuse policy priorities, city leaders should take advantage of “Denver Benchmarks,” a community information system designed to provide detailed neighborhood-by-neighborhood data on health and quality of life.  Such data could be a key tool in targeting substance abuse policy interventions—including prevention, treatment and enforcement.

·                      Ongoing policy planning and evaluation will require a high level of expertise in data gathering and research.  To make best use of the household survey findings and the wide variety of complementary data from other sources—substance use among students, illicit drug use among arrestees, drug-related hospital emergencies, drug-related AIDS, etc.—Denver should establish its own interdisciplinary substance abuse policy research team, and coordinate its efforts with other research conducted in the state.

Enforcement and Criminal Justice

Two decades of increasingly intense enforcement efforts to raise the price of illicit drugs by targeting supplies—at home, on the border and overseas—have achieved disappointing results.  The street prices of cocaine and heroin have fallen, not risen, and are now only about half and two-thirds their 1981 levels, respectively.^[265]  The arrest-and-incarcerate strategy used with good success to control other types of crimes is not a good fit for drug sales and possession offenses.  Imprisoning a thief directly prevents theft, but with an illicit commodity such as drugs, locking up one distributor simply creates a job opening for someone else.  Long prison terms for low-level, nonviolent drug offenders is counterproductive to crime control; expensive, limited prison capacity should be reserved for the most active and violent offenders.

·                      A sharp enforcement focus on the most pernicious, flagrant offenders—those who engage in frequent violence and employ youth—would go far toward reducing the overall levels of crime perpetrated by drug offenders.

·                      Denver’s elected representatives in the Colorado General Assembly should join the effort to lessen the state’s costly reliance on imprisonment to punish low-level, nonviolent drug offenders.  As Denver’s own drug court has shown, more constructive and less expensive alternatives to prison exist.

·                      Regardless of offense, nearly half of probationers^[266] and 80 percent of parolees ^[267] in Denver have substance abuse problems.   In concert with the state government, Denver should take advantage of the leverage afforded by the criminal justice system to reduce substance abuse among this population through a mix of drug testing, incentives, sanctions and treatment.

·                      Denver’s elected representatives, law enforcement officials and public health officials should work to amend Colorado’s drug paraphernalia statutes so that state law would no longer impede the operation of city-licensed needle exchange programs in Denver.  The City Council authorized the operation of needle exchange programs in 1997, but current state law makes its illegal to possess or distribute drug paraphernalia, such as syringes.

Prevention

While the goal of raising the price of illicit drugs through enforcement has proven elusive, raising the prices of legal substances—alcohol and tobacco—can be accomplished by raising excise tax rates.  Research has shown that youths and heavy smokers and drinkers are especially sensitive to price increases, and that tax increases translate into reductions in consumption and associated health and crime problems.

·                      Denver residents and their elected representatives should press Colorado’s General Assembly for substantial increases in the state’s tobacco and alcohol excise tax rates, which are currently among the lowest in the country.

School and community-based substance abuse prevention programs have proliferated in recent years.  While research has shown that prevention programs work, not all programs are equally effective.

·                      Denver should adopt school and community prevention programs with a sound theoretical basis and backed by research-based evidence of success.

Treatment

Drug Strategies estimates that between 45,000 and 60,000 city residents need treatment for alcohol and drug abuse and addiction, but that at most only 7,000 of them receive it.^[268]  This unmet need for treatment costs Denver residents, businesses and government dearly every day in the form of health care costs, crime and lost economic productivity.  Investments designed to close the city’s treatment gap will more than pay for themselves by reducing these costs.

·                      The city should devote significantly more of its own revenues to treatment.  As part of this increased investment, Denver should earmark funding for research to assess the effectiveness of local treatment services.  Ongoing evaluation research will improve local services and will underscore the cost-effectiveness of treatment for Denver.

·                      The city’s new investments in treatment should also be geared toward strengthening the entire continuum of needed services.  Effective treatment cannot be a one-size-fits-all proposition; people’s substance abuse problems vary considerably, so the appropriate array of services must be available.^[269]

Denver is not alone among communities in Colorado with serious substance abuse problems.  The state legislature’s support for treatment, however, has been inadequate.  While Denver must boost its own spending on treatment, city residents and elected officials should also seek to make state policies more supportive.  In particular, Denver should press the Colorado General Assembly and the Governor to:

·                      Devote the revenues generated by alcohol excise taxes to treatment.  The case for raising the  state’s alcohol excise tax rates is clear, but even without raising rates the current revenues could be devoted to treatment.

·                      Seek a federal waiver to expand Medicaid coverage for treatment.  Medicaid accounts for nearly one-third of public funding for treatment nationally, but currently plays only a negligible role in Colorado.  More than 130,000 Colorado adults are enrolled in  Medicaid, including poor parents, the elderly poor and persons with disabilities.^[270]  Even if only 5 to 10 percent of them were to receive Medicaid-financed substance abuse treatment,^[271] it would constitute a major expansion of Colorado’s public-sector treatment capacity.

·                      Require private health insurers to cover substance abuse treatment on par with coverage for any other illness.  In Colorado, 1.8 million adults are enrolled in employer-sponsored health insurance plans.^[272]  At least 100,000 of these insured Coloradans need treatment for alcohol or drug abuse,^[273] so parity for treatment benefits could make a sizeable contribution to closing the treatment gap, in Denver and statewide.

Substance abuse is a significant problem in Denver.  As this report has documented, Denver residents bear a heavy burden in substance abuse-related diseases, crime and other social problems.  The burden, however, is not so great that Denver cannot take steps to lessen it.  Indeed, Denver is a rich and resourceful city, and the new emphasis being placed on  prevention and treatment in the city bodes well for the future.

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