Recently in Drug Policy Category

Prison is not a particularly safe place to live. For newly freed inmates however, the streets are even more dangerous.

Australian researchers examined the mortality rate of newly released prisoners, looking at the risk of death during the first two weeks after release. They call it carnage. Newly released men are 29 times more likely that the general population to die during that first 2 weeks - women are 69 times more likely to die - 69 times more likely.

What's killing them?

Drug overdoses mostly. It seems as though prison isn't doing much to break long dormant opiate habits, and the newly released addicted are soon back to their old ways - minus any real tolerance for the drugs.

They are shooting heroin, and what used to be a manageable dose is now a fatal dose, and that's the end of that story.

We think that a death sentence for non violent drug crimes is unreasonable - but what we give, when we sentence heroin addicts to prison - is pretty close to capital punishment anyway.

Read more about it in the February 2008 edition of the journal, "Addiction".

Yay Drug Courts!

It's hard to find anyone these days with much of anything bad to say about drug courts. These alternative sentencing vehicles are saving tax payers a huge amount of money, they are freeing up space in overcrowded jails, they are helping people in need beat terrible addictions, reuniting families and the recidivism rates for drug court graduates are far lower than for offenders processed through the traditional court system.

Yay!

Seriously, they work, and they save everyone money, and it's great news that drug courts are now in operation in all 50 states, with a total of 2000 in operation or in the works. But They have created a rather strange set of circumstances.

• If you are poor, addicted to drugs and alcohol and really want some help to get better - but are not a criminal - you are out of luck.
• If you are poor, addicted to drugs or alcohol, don't care if you get help or not, and commit crimes - then you get free drug treatment.

It's an absurdity, and I have spoken with a few people over the last months who find themselves in this frustrating predicament. It seems to them, that the only way they are going to be able to get drug treatment, is by being arrested for a crime.

Not ideal

 Drug courts aren't going away, nor should they. They work better than the traditional court system, they are more humane and they treat the root cause of such a lot of the criminal behavior in this country today. But why should we wait to provide funding for people only after they commit crimes? Why not give them a leg up before it gets to that stage?

Let's keep the drug courts, but expand the programming so that anyone in need can have access to the same sorts of treatment programs. Maybe that will cut down on the eventual need for courts and drug courts alike, while saving a great deal of tax-payer money on everything from law-enforcement to welfare to health care.

Besides, it's the right thing to do - and it's only fair.

They say that every dollar spent on addiction treatment and prevention yields a 7 dollar societal dividend. Hey – you gotta' spend money to make money right… Or maybe not – as the Bush administration must like money, yet once again they have cut total spending on addiction treatment and prevention programs; shaving an additional few hundred million or so from the 2009 budget. They must have a master plan - those crafty buggers. They must know something we don't! Here are some of the highlights:

• SAMHSA, the main recipient of federal funding, will receive 70 million less in 2009 than in 2008.
• The Center for Substance Abuse Treatment will lose 63 million.
• The Center for Substance Abuse and Prevention will lose 36 million.
• The Center for Mental Health Services will limp on, short 126 million.
• The Safe and Drug Free Schools Program will lose 194.8 million in 2009 (but how important are safe and drug free schools anyway?)

It's not all bad though; the National Institute on Alcoholism and Alcohol Abuse will actually see a funding increase in 2009 – that's right, an extra four hundred thousand dollars… Well, it seems crazy to me – but when you consider that spending on drug related law enforcement has increased a whopping 57% during the last 8 years (treatment is up 3% - a below inflationary increase) I guess they've just decided on going ahead with Plan B…throwing EVERYONE in jail! Americans now jail 1 in 100 - A record high, in any country, and at any time.

Government can't seem to reduce the flow of prescription drugs for abuse; and in those areas where they have had some success, all they've accomplished by reducing the supply is increasing local rates of heroin addiction. We need to stop thinking about this as a criminal justice issue, and start dealing with the problem as a health challenge. We need to stop addicting ever increasing generations with easy access to prescribed medications, and we need to give the already addicted the drugs they need, while also trying to effect some therapeutic change for the better.

The National Drug Intelligence Center, in its 2007 drug threat assessment on the abuse of prescription drugs, reported a number of findings…and none of them can be considered positive.

Firstly, the organization asses that the availability and supply of illegitimate (not taken or acquired in a medically prescribed manner) prescription pharmaceuticals is high and increasing.

Secondly, the organization asserts that demand and use has remained stable over the last year despite law enforcement efforts at reducing supply.

Thirdly, the organization reports that in some States, where strict pharmaceutical chain of custody regulations have diminished the availability of diverted pharmaceuticals for illegitimate usage, there has been a significant increase in heroin usage.

So there are lots of drugs around, the numbers of people using them has not decreased despite the best efforts of law enforcement, and in those areas where stringent regulations have limited local supply, addicts have been forced into even more damaging and dangerous practices such as heroin usage…hardly good news all around.

The challenges of regulating a product that does have a legitimate purpose, but that can so easily be abused, and that can be easily purchased through any of thousands of out of country illegal on line pharmacies is enormous; and increasing availability throughout most of the country indicates that law enforcement has so far been unable to really effect change. But when we consider that in those few areas where regulations have limited access, all that has occurred is a migration to even more dangerous and socially destructive usage of heroin or other illicit drugs, maybe we should question the philosophical motivation behind attempting to reduce the flow.

Enforcement and prohibition of psychotropic substance has an abysmal track record throughout recorded history, and the desperate realities of opiate addiction means that people will do whatever it takes to avoid the pains of opiate withdrawal. You cannot simply solve the problem by decreasing the supply, and when you consider the increased infectious disease rates, overdose risks, and criminal issues associated with the use of illicit drugs such as heroin, nor should we be striving to push people into even greater desperation.

My opinions are a bit contradictory in nature, and I feel that we need to both loosen availability as we tighten access???

We firstly need to stop creating ever increasing generations of addicts, and prescribing practices within the health care community need to change to reflect the dangers these drugs present to society. Extremely potent medicines, these drugs do serve a needed therapeutic function for some, but we as a nation consume far too many, and doctor's need to prescribe these dangerous drugs with greater judiciousness. We should also continue with legislations that have proven effective at limiting the supply of diverted pharmaceuticals into the community.

Secondly, we need to give those people that have developed addictions the drugs that they need. You can’t stop an opiate addict from taking drugs, and they will do whatever it takes to get a substance that both makes them feel good, and keeps away a very uncomfortable and scary period of detox sickness. Instead of making these people acquire the drugs illegitimately, or even worse, forcing them onto the even greater dangers of illicit drugs such as heroin; we should open clinics akin to methadone clinics, where addicts can get the drugs they need, safely, and without undue hassle.

Addicts participating in these subsidized programs would only be given enough for a day's usage and they would be required to pay for them at standard market prices. Governmental subsidies would fund corresponding and mandatory therapeutic involvement that would be a prerequisite to access into the program.

We can’t stop it, and we can’t even seem to control the flow of drugs, so instead of increasingly criminalizing the issue, why don’t we control the administration of drugs to those that need them, and while we're at it try to effect change through offered therapies, medical care and treatment.

Drug abuse is a disease and health care issue, and any attempts at criminal justice control always prove ineffective.

Treatment works, incarceration alone clearly doesn't, and although the knee jerk reaction in this country is still too often a crime and punishment based approach to drug offenses, an innovative program in Delaware is gaining impressive results using a more therapeutic approach. The vast majority of drug offenders incarcerated…and there are millions, receive either no drug therapy, or minimal prison based treatment, and these two approaches have not historically shown much effectiveness in reducing recidivism either to drug abuse or to re-offending. A NIDA funded program in Delaware prisons looked to explore a different matrix of treatment, using a three stage approach to therapy prior to complete release. Inmates begin in the general prison population, proceed then to a structured prison based drug treatment program, and finished their sentence in a community based drug treatment facility. The results demonstrate quite clearly that a progressive and lengthy model of correctional treatment shows far greater efficacy, and ultimately saves a great deal of money. Of prisoners who proceeded through the three stage program, 77% had not re-offended after 18 months, compared to only 43% of prisoners having participated in prison only drug and alcohol treatment programs. Demonstrating yet again that incarceration alone for drug offenses does not solve the problem, and that every dollar spent on treatment as versus incarceration yields an incredible societal dividend. Let's follow the lead of Delaware, and give sick people treatment, instead of just locking them away.

Addiction is a medical disease, and is recognized as such by the AMA and virtually all public health groups, including the government. The more research that comes out, the more we know that addiction creates fundamental changes in the way our brains' operate; and the more we understand that without treatment, few addicts have much chance of leaving the harms of drugs or alcohol behind them. So it strikes me…and a lot of other people…as kind of funny that although we know that addiction is a disease--and it's recognized as such by all public health organizations--that our insurance companies can somehow opt out of paying for treatment when we need it? Thankfully, it strikes a lot of lawmakers as a bit funny too, and over the last ten years or so federal and (to varying degrees) state legislatures have been increasingly demanding parity for mental health and substance abuse treatment needs. What parity means is essentially equality. That mental health and substance abuse treatment is considered to carry equal weight, and warrant equal types of coverage to physical conditions like cancer or arthritis or what have you. Now, we can be fairly certain that without mandated legislation our friendly neighborhood insurance providers are not just going to start increasing our coverage, and although the federal government does put forth some pretty strong recommendations for mandatory parity, state insurance law superseded these federal guidelines. An awful lot of people in need of mental health or substance abuse services just have the misfortune to live in one of the many states yet to adopt full parity legislation, and to put it bluntly…are getting the short end of the stick on this one. No Parity Legislation: Alabama

Alaska

D.C.

Florida

Kansas

Michigan

Mississippi

North Dakota

Pennsylvania

Wisconsin

Wyoming

Great Parity Legislation

Connecticut

Maryland

Minnesota

Vermont

Oregon

And every other state just sort of falls in between, offering some parity coverage, but nowhere near inclusive access to all in need.

So although state insurance parity legislation debate sounds pretty dull, it is relevant, it could have a major impact on your life, and if you happen to live in one of the many states yet to adopt full party legislation, you might want to let your lawmakers know how you feel about this.

Mental health and substance abuse treatments are not superficial, not cosmetic and not extravagances; they save lives, better families and improve our communities. The sick have rights, they pay for insurance coverage like the rest of us, and when they do get ill, whether with a physical or mental heath condition, they deserve to be taken care of. They deserve the treatment that's going to get them better.

As much as the pharmaceutical companies might argue for greater self regulation as a way to streamline the approvals process and reduce the expense to the consumer (while creating greater profits as well) certain unsettling reports about the industry as a whole should raise serious questions about the industry's ability to self regulate. Most notoriously of recent months is the oxycontin settlement, where executives in the company where found guilty of misleading doctors and the general public about the dependency risk of oxycontin, and just last night on CNN was another report about troubling drug company practices. Apparently, there are massive quantities of medications sold throughout the country everyday that have not yet been approved by the FDA as safe, and some of these drugs have been on the market, consumed and available for some time. How can this happen? Through the FDA drug approval process, when drugs apply to begin testing for approval, they are issued a 10 digit tracking number. Problematically, this same 10 digit number is used by pharmacists selling the drug, whether or not they have been approved. What has happened is that doctors and pharmacists mistakenly believe that since the drug has the FDA number and is available for sale, that it has passed FDA testing as safe; when this is too often not the case. A knowing disregard of the law But although doctors and pharmacists may claim legitimate ignorance, obviously the manufacturers of the drugs are well aware of the status of each and every drug they market, and well aware that they are selling what is reported to be over 65 million filled prescriptions worth of these illegal drugs each year. Obviously this is not the FDA's finest moment either, but the fact that pharmaceutical companies are knowingly exploiting a previous lack in enforcement on the sale of unapproved drugs for profit is shameless, and seriously damages their credibility as a self regulating industry. Prescription drugs currently contribute to a massive abuse and addiction problem, and we may need to tighten regulation and control ever further on the production and sale of drugs, and obviously those in a position to profit from the sale of these drugs cannot be relied on to act ethically, or with the best interests of the public in mind. The money to be made in the pharmaceutical industry is enormous, and while the vast majority in the industry are likely conscientious and moral people, there are obviously enough that will engage in questionable practices--risking the safety of consumers--that the industry as a whole cannot be trusted to act with integrity.

At first glance it sounds ridiculous, but variations on this philosophy have been touted as a solution to our international drug problems for ages, and a number of countries have actually implemented programs to this effect with great results (the Netherlands and Canada).

1. Buy the raw ingredients and make our own drugs!!!

Governments need to start the process out on the poppy fields of Myanmar and Afghanistan and in the Columbian coca plantations, with massive investments into the infrastructure of the precursors to drugs of abuse. In one fell swoop, by becoming a legitimate, well funded and motivated buyer; you could eliminate the power of militant drug factions and end the profiteering of military based and terrorist organizations funding arms projects through drug sales.

We could also get enough of the medical drug precursors for legitimate usages, and as we burn poppy fields in Pakistan, we also suffer through a real medical shortage of morphine based derivatives…crazy!

Fill a few cargo planes and get this stuff into laboratories throughout America, where we could make high grade drugs of standardized purity, and with no harmful additives.

2. Give it away for free…or at least pretty cheaply!

The high street costs of drugs come from the profiteering of a series of middle men along the way to the consumer, and if government legitimately purchased and manufactured common drugs of abuse, the production costs per dosage would be laughably small.

Give addicts that need them the drugs they're going to take anyways, and provide drugs of a known standard of purity and without harmful additives to addicts at a price that doesn’t require of them to rob convenience stores or mug old ladies to get their needed fix. Drugs will be issued in small and controlled quantities, and addicts will need to register for programs to get involved.

It won’t be too tough to participate though, as the whole point of the program requires inclusivity of access, but neither will government be supplying recreational drugs to high school students looking for a buzz!

Overnight, the criminal drugs industry would disappear, and with it an enormous legacy of crime and urban violence. Selling drugs would immediately become unprofitable and neither would desperate addicts be forced to commit crimes or prostitute themselves to earn drug money.

Countries that have implemented free drugs programs do not see a massive influx in numbers of users, but they do see a great reduction in crime and associated social problems.

3. Work with addicts towards treatment and sobriety

When addicts are full and voluntary participants in non punitive governmental programs for illicit drugs we have a fantastic opportunity to effect real and substantial change.

Firstly, by giving drugs of a known quality and potency, and in limited (observed?) quantities, you greatly lower the risks of fatal or harmful overdoses. Secondly, addicts already participating in the program can be better encouraged to participate in accompanying therapies, drug education seminars and other medical peripheral programs. We can get these people healthier, we can keep them safer, and we can try to get them off drugs completely…and all while we do real societal good.

No one wants to be a drug addict

The idea that by giving out free or affordable drugs to addicts that we would create ever greater numbers of addicts is laughable. No one wants to become an addict, and those people who do end up dependent on drugs need our help and treatment rather than our scorn and sanction.

The enforcement of anti drug policies has ruined entire communities, has enriched overseas and local criminals, and has provided billions of dollars in funding to groups hostile to the United States. With one easy move we could change all of this, and have a better opportunity to reduce the number of addicts as we improve their health and reduce risk behaviors (sharing needles, prostitution).

The reason that this is an oldie though is that the political will to even suggest policies perceived as favorable or "soft" on drugs simply does not exist within the conservative drug climate of our nation; and as such we are sure to endure many more years of faulty drug policies that do far more harm than good, and squander opportunities for real societal change.

Write your elected leaders with and tell them you want free heroin…who knows, after they stop laughing they might even think about it.

Long term studies of the effectiveness of the D.A.R.E. drug education and drug resistance training programs offered in junior highs across the country have proven that the program offers almost no benefit to kids who receive it. We need to stop funding that which doesn't help our kids, and try to find something better. For now, parents cannot rely on the school system and need to take personal responsibility for drug education in the home. A whole lot of kids have passed through D.A.R.E. drug education and drug use resistance training during junior high, and the evidence seems pretty conclusive at this point that these programs have offered our kids very little of value. I don't dismiss the intentions of the school board officials and professionals involved in the DARE program, and others like it, and drug prevention training is a very difficult and problematic subject, especially when dealing with impressionable teens very prone to experimentation; but now that the evidence is in, and the program has been pretty conclusively proven ineffective, we need to stop wasting out tax dollars on it, and find something better to replace it. Although a number of school districts have disallowed funding for the program in response to studies that have questioned its effectiveness, the program is still being offered in most American schools, and the financial costs of the program are high. When the damage done by drugs, especially when used by kids, is so tragic, we cannot let inertia and a reluctance to change dampen our motivation to eliminate that which has been proven ineffective, and strive to replace it with something better. The only thing that really seems to help kids stay off of drugs is the involvement and concern of parents, and kids whose parents stay active in their teens lives are much less likely to use, and ultimately abuse drugs. Hopefully addictions professionals and educators will find something that works, but for now, parents cannot rely on the school system to educate about the dangers of drugs, and cannot assume that kids are getting what they need to stay off of drugs from the schools. Talk to your kids about drugs, do it now and do it often, and stay involved even as they try to separate, it's not always easy, but it's the single best thing that we as parents can do to keep our children safe from drugs.

A number of states still enforce laws that make the possession of needles for drug use a crime. These laws do not result in less drug abuse; they just make existing drug abuse more damaging. When we know that sharing needles increases the probability of HIV and other infections, why are we enforcing laws that penalize addicts who try to use safely? Why in this day and age, when we know so much about the risks of HEP C, HIV, and other diseases, would we possibly still want to criminalize the possession of clean needles? Certain states currently do have drug paraphernalia laws and these laws are enforced. These laws do not of course result in intravenous drug users using proportionally less heroin or cocaine, but they do greatly decreases the probability than an addict will risk carrying around clean needles to use. The risks of contracting a fatal blood borne disease are extremely high when abusing intravenous drugs, and public health and policy makers should be encouraging the use of clean needles, instead of penalizing addicts who try to use more safely. Heroin users, when it comes right down to it, are going to use; and while they would all prefer a safe and clean needle, when the choice is either a used needle, or no heroin…we all no how it's going to go down. Let's change this damaging law, encourage IV drug users to use clean needles, and supply these needles through needle exchange programs. Let's also have great access to drug rehabilitation programs available, and try to reduce the numbers of people that are dependent on these drugs, instead of simply forcing them into even higher risk administration practices Drug policy is rarely simple, but this is one policy that seems pretty clear. We are hurting them, and we are hurting ourselves. We are increasing the spread of infectious disease through outdated laws that increase the probability of unsafe injection practices.