Saturday, March 1, 2014

Time to End the War on Drugs

Each January, governors of our states give an annual address usually labeled as a “State of the State” address which is patterned after the presidential State of the Union address.  These usually include a laundry list of issues that are nicely packaged to appease as many interests as possible.  Virtually all of these are quite forgettable.
But this January, Vermont Governor Peter Shumlin in a cry for help to get as much attention as possible, broke the mold by devoting his entire annual speech to a single issue – the growing heroin crisis in his state.
“In every corner of our state, heroin and opiate drug addiction threatens us,” he said. He said he wanted to reframe the public debate to encourage officials to respond to addiction as a chronic disease, with treatment and support, rather than with only punishment and incarceration.
Every week, he said, more than $2 million worth of heroin and other opiates are trafficked into Vermont. And nearly 80 percent of inmates in the state are jailed on drug-related charges.
The governor made a plea for more money for treatment programs, noting that incarcerating a person for a week costs the state $1,120, while a week of treatment at a state-financed center costs $123. He asked for money to expand treatment centers, where more than 500 addicts are on waiting lists.
And make no mistake – this is a growing problem that is affecting not just the urban poor but those at all economic levels including suburban and rural people.  Unfortunately, it took the death by heroin overdose of celebrated actor Philip Seymour Hoffman to bring this vital issue to the attention of the average American.
Certainly, this is a complex problem that eludes simple solutions.  But like for any problem, we can often make some headway by simply examining what works – and do more of it.  But just as importantly, we need to also see what is not working – and do less of that.
This is certainly unassailable logic.  But in my view, the biggest obstacle to making progress toward better solutions is that this problem is viewed by too many through a puritanical lens – the view that people who use drugs are immoral and should be punished by throwing them in jail.  This is the logic behind the so-called War on Drugs which is based on a belief that we can solve the drug crisis by incarcerating enough users and dealers.  But even many of the people who actively participated in this war have finally confessed that the war has been a failure that has resulted in the US having the world's highest incarceration rate (largely from drug offenses) with not much else to show for it except for the emergence of the for-profit prison industry which spends significant amounts of  money lobbying for policies that increase incarceration rates.
By 2010, drug offenders in federal prison had increased to 500,000 per year, up from 41,000 in 1985. Drug related charges accounted for more than half the rise in state prisoners. The result, 31 million people have been arrested on drug related charges, approximately 1 in 10 Americans.
Perhaps we should realize that treating this as the governor suggested as a public health crisis to be treated by medical personnel instead of as a moral/criminal issue to be addressed by law enforcement may well be a step in the right direction.  I urge the reader to read one of my previous postings, Can We Talk About Legalizing Drugs? for some of my thoughts on the matter.
I fully realize that legalizing drugs is a total non-starter for many people since this is perceived to convey public approval.  With marijuana now legalized in some areas with the approval of many, it is not hard to understand this view.  But legalizing (or at least decriminalizing) drugs can simply be an admission that this problem can better be solved by medical professionals as opposed to law enforcement which does not imply approval at all but is just a more effective means to address the problem and mitigate the damage it causes.  And in fact, our law enforcement efforts have tended to breed a host of unforeseen consequences more than effectively address the problem.
For example, there had been a steady rise in addiction to prescription pain killers, either starting from using these drugs for legitimate treatment of pain or perhaps another way to get high. However, instead of focusing efforts on rehabilitation to treat these addictions, the solution was to cut off these drugs and make them as difficult and expensive to obtain as possible with the presumption that addicts will then stop using these drugs.  But then heroin was discovered as a cheaper and more available source to satisfy these people’s addictions.  So now we have people who used to be prescription pain killer addicts now becoming heroin addicts.  Being a heroin addict now brings a whole lot of additional risks because there is no way to know for sure what is in that bag of heroin obtained from a dealer.  Earlier this year in the Pittsburgh area, there were about 23 deaths discovered of addicts buying heroin that unbeknownst to them was laced with fentanyl which greatly increased its opiate strength likely causing the fatal overdoses.  And then there is the added problem of spreading diseases by those sharing needles.  Clearly, this was a serious problem that was only made worse.
Recently, a task force in Southwestern Pennsylvania was assembled to make recommendations on how to address the heroin addiction crisis.  This was the most interesting one:
Cheryl Andrews, executive director of the Washington Drug and Alcohol Commission, along with several other panelists, lobbied for the passage of “Good Samaritan legislation” statewide. The legislation is designed to protect witnesses of an overdose who call 911. 
"There are people shooting dope who will literally let someone die so they won’t get prosecuted for using,” Ms. Andrews said.
This at least acknowledges that the fear of incarceration hampers efforts to help others in need of medical help to perhaps even save their lives.  By the way, this even includes doctors.  Read on. 
So what does work? One of the most promising drug treatments for heroin addiction is the use of suboxone which not only replaces the need for heroin but also has an opiate inhibitor that inhibits the high from taking heroin while on this drug.  This is an example of what is called opiate replacement therapy.
The track record of opiate replacement therapy, while not perfect, has permitted hundreds of thousands of Americans (and millions more worldwide) to achieve a reduction in the number and severity of relapses to illicit opiate use and associated costs to society in terms of criminal activity (burglary, theft, robbery, muggings) necessary to obtain money for drugs which ultimately wind up financing the vast, globally connected drug cartels. Additionally, opioid replacement therapy reduces the risk of contracting Hepatitis C and HIV among other communicable diseases.
While this certainly looks like a step in the right direction, for a long time doctors not part of rehabilitation centers were forbidden to treat addicts with drugs like this under threat of imprisonment.  These federal laws have been loosened a little but only a very small number of approved doctors have authorization to administer drugs like these because well, they too are illegal!

The drug enforcement community is now celebrating the recent capture in Mexico of Joaquín Guzmán who many considered to be the world’s number one drug kingpin.
Mr. Guzmán’s Sinaloa Cartel is considered the largest and most powerful trafficking organization in the world, with a reach as far as Europe and Asia, and has been a main combatant in a spasm of violence that has left tens of thousands dead in Mexico. 
But while they are celebrating, nobody is delusional enough to think that this signals any long lasting victory in the War on Drugs.  This is not like World War II when after we got Germany and Japan to surrender, the war was over.  As long as there is a lucrative market for drugs we deem to be illegal, there will be a never ending parade of new drug kingpins to carry on.
It remains to be seen if the arrest will interrupt Mexico’s thriving drug trade. The capture or killing of a drug lord sometimes unleashes more violence as internal feuds break out and rivals attack. And given the efficiency of the Sinaloa Cartel, it is possible the group will manage a smooth transition to a new leader and continue with business as usual.
Perhaps the biggest toll of all extracted by the War on Drugs has been on the many people who have been arrested for little more that possession and now have that on their permanent record.  It’s hard enough to find a job nowadays in any event.  But with many if not most prospective employers relying on background checks, having an arrest on one’s record can ruin any hopes for a productive career.  It was Barack Obama who wrote that in his younger years, he partook in marijuana along with some other illegal drugs.  Of course, his career went on to bigger and better things.  But if he had had the misfortune of being arrested for taking those drugs like so many others, do you think we would have ever heard of him after that?  I think not!