
Massachusetts Chief’s Tack in Drug War: Steer Addicts to Rehab, Not Jail - frostmatthew
http://www.nytimes.com/2016/01/25/us/massachusetts-chiefs-tack-in-drug-war-steer-addicts-to-rehab-not-jail.html
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jwatte
The rest of the civilized world has known that rehab (and social/mental
support) is cheaper and more effective than prison for > 30 years.

But the "tough, not supportive" meme in US policy keeps warring people, time,
and money. Vote Republican, everyone, because "tough on crime" is tougher than
namby-pamby "science" that can never give a clear answer!

~~~
tgb
>30 years - huh? I just looked through wikipedia's Drug Liberalization page
and didn't see anything earlier than Portugal's 1999 decriminilization, except
that Uruguay never even criminilized them. So what are you referring to?

~~~
adventured
There isn't much in fact. Most of the so-called civilized world still puts
drug offenders in prison, a lot. Just take a look at Japan's extreme drug laws
for example (they apparently don't count as civilized).

The parent is claiming a few, mostly tiny European nations represent the
majority of all civilized nations.

~~~
tarpherder
Depending on what the word "civilized" is supposed to mean it could be true.
Nations where the death penalty is still given are not considered civilized in
Europe, so there's that. (But everyone chooses not to care in America's case
:))

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afarrell
Here is a psychiatrist presenting the flaws of rehabs and an argument that
governments also need to allow widespread use of suboxone to treat addiction:

[http://slatestarcodex.com/2015/02/02/practically-a-book-
revi...](http://slatestarcodex.com/2015/02/02/practically-a-book-review-dying-
to-be-free/)

~~~
CodeWriter23
Suboxone is just dope from a dope man in a lab coat. All suboxone does is
switch addiction from opiates or opioids, to opioids. I've known more than a
few people who were detoxing from suboxone say it's easier to kick heroin.

~~~
cubano
I had a very close ex-girlfriend who went on subs but wanted desperately to
get out of the whole game.

After I went to an inpatient treatment center and learned from the
professionals there that kicking subs was _way_ harder then heroin, and saw
with my own eyes a few people there who were having a bitch of time.

I ended up telling her this, and strongly advised her to get back on heroin
for a week and then kick...she followed my advice and thanked me for profusely
as she tried the sub detox taper and couldn't make it work.

~~~
s_q_b
Suboxone for heroin addicts is like benzodiazepines for alcohol withdrawal. It
should only be used in the initial withdrawal period for a short period of
time.

The proper protocol is to substitute the short-acting heroin for the longer
half-life Suboxone. This stabilizes the blood levels, thereby eliminating
inter-dose withdrawal symptoms.

The dose is supposed to be titrated to zero over a few weeks. Otherwise you'll
just end up swapping on addiction for another.

It's a shame, because Buprenorphine is a really good medication when used
properly.

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jbarciauskas
In the current opiate epidemic, a far greater proportion of addicts are white.
Whether consciously or unconsciously, it's seems highly likely that those in
power are drawing different conclusions about what the right solution to drug
abuse is based on the skin color of the victims.

~~~
awakeasleep
Don't get stuck oversimplifying with "whiteness" being the full explanation.

Meth has been a disproportionately white drug, but it strikes in areas of
poverty where the parents of addicts are already the underclass, and can't
drum up sympathy with the 'power structures' of their community. (Think
judges, police, town officials.)

Opiates often hit middle class or wealthy families. Thats the real difference:
This is a drug epiedemic that is crawling into areas of society with political
capital. Parents of addicts or the addicts themselves know or work with the
people who can show empathy when creating & enforcing policy.

~~~
jqm
Meth users are also (in my limited experience) considerably more prone to
antisocial/obnoxious/violent behavior than opiate addicts.

It might be harder for people to have sympathy for them VS. a person who
quietly struggles with a (sometimes deadly) addiction that begin from a
legitimate pharmaceutical prescription.

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mc32
This tack is a good start, for sure, a shift in how people think about the
drugs problem. Yet, it's only the beginning. Physicians need to understand the
ramifications of what they prescribe. They should be better equipped and
trained to determine when use of drugs goes from treating one symptom to
becoming a problem in itself.

When someone comes in for painkillers for hip problems, etc and the time
passes where it was either effective or not, but the drugs are still
prescribed because the patient claims the issue persists way beyond the normal
timeline, it's then time to reevaluate the usefulness of the drug's initial
prescription.

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munin
is this still a problem? from personal experience, the last time I needed pain
managed the #1 concern was not getting me addicted, #2 was pain management
itself. they were very cautious to start anything "strong" (morphine) and
very, very eager to end it. from these and other anecdotal experiences I have
a hard time accepting that doctors handing out strong painkillers like candy
and getting their patients hooked on them is a genuine problem, do you have
any data?

~~~
alexqgb
Doctors in general are generally cautious. The problem can be traced to a
small number of corrupt doctors who decided to abandon their medical scruples
so they could make very lucrative livings as semi-legal dealers of high-grade
narcotics.

The Feds eventually cracked down on this racket, but not before it had spawned
a tremendous number of white, middle-class addicts who found themselves
turning to the black market in heroin for their fixes. These people, in turn,
are running headlong into the insanely punitive legal structures developed to
terrorize, brutalize, and demonize black users when crack became a thing in
the 80s.

Given a choice between accepting the punishments they were happy to dole out
to others or abandoning this particular vector for racism, bigoted white
people are deciding they can find other ways to keep the spirit of Jim Crow
alive and well. For them, the Drug War has failed not because it failed to get
rid of drugs (that was never the point) but because it's no longer as
discriminatory as it used to be.

~~~
mc32
I think it's more complicated than that simplistic take. Just imagine the
numbers of people behind bars if that tactic were followed thru. It was pretty
much untenable as it was but we'd be looking at what, locking up 5 per cent of
the population?

If you look at who supported the drugs policies, blacks supported them almost
as much as whites did. Drugs were ravaging neighborhoods, and back then, this
is how societies had treated drugs addicts. Russia, China, Singapore, African
countries, etc. It wasn't till the Swiss experimented with alternative back in
the nineties that others began looking at alternative policies in treating
drugs addicts. Then we had a number of countries in Europe begin to try
alternative methods to treat their addicts and people began to see these
alternatives were more effective than jailing addicts and now we're seeing
similar approaches in the US.

~~~
alexqgb
That's a simplification, to be sure. And yes, there was support for the _idea_
of drug enforcement in the places where the drug trade spawned the most
violence. But the enterprise went badly sideways from there, quickly
degenerating into an excuse for detaining and harassing black people _en
masse_ , long after the violence that triggered the crackdown has abated.

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dawnbreez
This is a good idea on several counts:

First, it helps the addicts develop a better life. Regardless of your stance
on the drugs themselves, it's hard to defend real addiction.

Second, it frees up prison space.

Third, it reduces demand for the drug, which is how the drug war should've
been fought all along.

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tomjen3
That's probably about as helpful as not doing anything, so a step in the right
direction, but how often do addicts want to change and how often does wanting
to change actually result in the addicts quitting?

~~~
jkereako
All users want to change as soon as heroin is no longer fun and instead is
used to keep from being sick.

Once a habit is developed, a desire to quit will rarely be enough. Help is
absolutely necessary.

~~~
pstuart
But jail is the wrong way to help.

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jkereako
If executed correctly, then jail is a actually good solution for heroin
addicts. In jail, they can't leave to buy more junk, so they'll overcome
withdrawals with a 100% success rate. The hard part is staying clean.

Heroin use was popular in the Beatnik generation. In the book Junky, William
Burroughs describes how had himself jailed voluntarily. Police stations where
he was living at the time had a program similar to Gloucester's where users
would bring in their "works" in exchange for a 21-day lockup without charges.

~~~
pstuart
> If executed correctly

In that case, it would exclude using a jail for a health care issue. You could
apply the same logic to helping people lose weight.

~~~
jkereako
> You could apply the same logic to helping people lose weight.

Indeed you could!

Jail's intention is to correct bad habits, not to punish them.

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NN88
Now that white kids are suffering...

