Substance use disorder is a recognized medical condition that describes a compulsive use of a substance despite negative consequences. When the substance of abuse is also an illegal drug, a conflict arises between treating the patient through the most effective medically proven methods and enforcing state laws prohibiting personal possession or use of that substance. What really happens to people prosecuted for possession of small amounts of illegal drugs? What happens when the limited resources of a local government are spent on harm-reduction approaches to helping people with addiction, rather than arresting, jailing and prosecuting them in a court without treatment and support resources?

King County (WA) has embarked on the policy path of declining to prosecute most cases of possession of small amounts of illegal controlled substances and instead investing money in building connections between case managers and people with substance use disorder delivered through the model of the Law Enforcement Assisted Diversion (LEAD) program.

This Article will explore the legal, medical and ethical issues involved in treating substance use disorder as a disease instead of as a crime.