

How America Overdosed on Drug Courts - nbj914
http://www.psmag.com/politics-and-law/how-america-overdosed-on-drug-courts

======
phren0logy
>By the time Darren was assigned to drug court, his addiction story carried
almost every possible red flag for high-mortality risk: prior overdose, prior
treatment failure, a childhood ADHD diagnosis, and a family history of mental
illness. Any addiction doctor—or anybody who simply follows evidence-based
treatment guidelines—would know exactly what to prescribe for him: opioid
maintenance, by far the most effective treatment, known to lower the death
rate of opioid addiction by between 66 and 75 percent.

I am a psychiatrist, and I treat many people with addiction problems. This
formulation is a gross oversimplification. Opioid agonist therapy (methadone
or bupronorhpine) is not trivial or one-size-fits-all. There are many other
factors to consider, not the least of which is the person's interest in
getting clean.

~~~
worik
It is a generalisation but a good one. "Getting clean" is a loaded term. Most
(not all) people who have "drug" problems actually have police problems. The
drugs do them very little harm (impurities are a different story, but not as
common as people think) but the police and legal systems do them untold
damage.

Making the drugs available is by far the best treatment for most forms of drug
addiction in the vast majority of cases. The simplest way to do that is to
remove criminal sanctions from drugs and make prescription for addiction
legal.

Addiction is a complex beast and demanding that people deal with the chemical
dependence before dealing with the other problems in an addicts life is
usually a cruel approach and ineffective.

This is something a psychiatrist should know.

~~~
phren0logy
I can't really agree with your premise. Our current situation is pretty
broken, and our drug laws and enforcement have not achieved their stated aims.

That said, the legality of alcohol hardly keeps it from causing lots of people
very serious problems. "Drugs do them very little harm" is fantasy, though you
are quite right that a felony history and time behind bars only makes things
worse.

~~~
ufmace
I'm curious about a couple of your points here.

First, when people involved in addiction treatment say that drugs cause people
serious problems aside from legal issues related to the drug itself, I wonder
if they are biased by only seeing the users who hooked badly enough to land
themselves in various sorts of rehab/therapy programs. Do we know how many
people are using these drugs in a more casual way, suffering little to no real
harm from them, and never coming to the attention of the legal system?

Second, you say below in reference to heroin being dangerous how many people
die of overdoses every year. I was under the impression that the reason
overdoses are so common is that, since it is illegal, there is no regulation
or easy way to determine the purity of any given batch of it, so it is easy to
accidentally overdose if you get a stronger batch than you're used to. If
opioids are really that fundamentally dangerous, why is long-term monitored
use of methadone etc not considered to be a bad thing, as opposed to going
cold-turkey ASAP?

~~~
phren0logy
1\. There is a strong selection bias among the people I see, biased towards
people who are much more impaired. That said, many of them had a pattern of
spending more time/energy on their addiction causing themselves lots of
problems before they sought help. It is true that for some substances there
are many people who use recreationally without major problems, and I don't see
them (and don't need to see them) for treatment. I have never seen a casual
user of intravenous heroin, but perhaps there are some.

2\. Difficulty establishing purity is one issue, but the overdoses happen just
as often with prescription pain pills with predictable strength. Many people
will continue to chase a bigger high and get in trouble that way. Other people
(as described in the article) will stop using for a time and lose their
tolerance, then assume that a dose that was previously safe is OK. Then they
stop breathing.

Methadone clinics generally provide the same steady dose, which avoids this
problem.

~~~
worik
"There is a strong selection bias among the people I see" This is a real
problem in drug policy. The majority of drug users stay well clear of medical
professionals. They learn quickly not to discuss their habits with doctors or
nurses as it leads all sorts of problems.

Prescription pain pills are _not_ heroin. They are dangerous in overdoes
because of the effect they have on the breathing reflex. It is a common
practice among the drug addicts I knew to never let a fellow user 'nod off',
that is loose consciousness as it leads to death when they stop breathing.

This is not a problem for heroin addicts using heroin. But (in the world I
inhabited 15 years ago) heroin was very rare.

------
CodeWriter23
This article focuses on a single failed case, the actual worst case scenario.
And though it is true cases like this exist, it is a tiny part of the story of
Drug Court. It gives no credit to Drug Court's immense success. I have
personally met dozens if not hundreds of addicts that came into recovery only
through drug court, and have achieved long term recovery, and have become
productive members of society.

After touting the worst case scenario and ignoring the success, this article
puts a little missive in there about how doctors (those mostly with no
personal experience in addiction or recovery) prefer opioid maintenance. This
is but another marketing message for Suboxone, in the massive PR campaign
underway to create an alternative to drug-free recovery through long term
addiction to a pharmaceutical product. In the recovery community, Suboxone is
referred to as Drug Replacement Therapy (DRT) because that is what it is,
switching street dope for dope that comes from your doctor. It gets you high
enough to avoid withdrawal, but not so high that you can't move boxes or
burgers in an entry-level job. If you do try to get off the Subs, you will
experience withdrawal that makes heroin withdrawal look like a walk in the
park on a sunny day with a sno-cone and a puppy. This article also fails to
mention the suicide rate of people on Suboxone. While I have no hard data on
that (ONLY because it has never been studied), I can tell you it happens. It's
happened to people I've known. It happens because so long as they are addicted
to dope, doctor prescribed or otherwise, the deeply traumatized individual who
is an addict remains traumatized. They will never experience the true freedom,
healing and wholeness that comes only through deep self-examination and a
conversion process of equal or greater magnitude, that leads to self- and
social integration. DRT only treats the most visible symptoms of addiction,
and does nothing to treat the underlying cause.

While I know not everyone succeeds as a result of drug court, on balance, it
is a net positive. Some people need to be re-arrested 2 or 3 times before it
takes. And some die. This is an unfortunate reality of addiction. And opioid
maintenance IS addiction. It really is up to the individual to work through
their trauma, and find the needed support to exist and find a reason to
continue living. That cannot be imposed by law, coercion, or prescription.

Bottom line though, research the history of Heroin in the United States. A
hundred or so years ago, heroin was touted as the solution for morphine
addicts. It was the Drug Replacement Therapy of that time. We have been down
this road before and we know where it leads.

------
Smeevy
There's another problem with drug courts which I think is a bit more serious.
Given the amount of judicial and supervision time required for a drug court,
the courts tend to be very selective as to who can be diverted into that
process. They prefer young people with no prior history and those individuals
are put through a very stringent process with the threat of going to jail or
prison for noncompliance.

The rub here is that that group of people (young, nonviolent first-time
offenders) tend not to reoffend anyway. In that light, these courts take
credit for putting someone through this process who would have been just as
likely to never see the court again if she or he had just been issued a fine
or given a stern talking-to. For this group, just being in jail for a night is
enough to stop (or never get caught again).

What makes this sadder, I think, is that there are many other people in the
system that would benefit from this kind of specialized attention from judges
and probation officers. The success rate for that group would be much lower,
but the individual successes would be more impressive. They just get put into
prison over and over until all they can do is be a criminal.

------
andrewstuart
Prohibition/The War on Drugs is stupid. All it does is put money into the
hands of criminals and costs the state money by locking people up who should
be leading normal lives and paying taxes.

~~~
mindslight
Why is your comment written with an assumption that one of the great things a
person can do is to pay taxes? That same attitude is what got us drug laws in
the first place.

------
gress
This points to a more general problem of the lack of accountability of judges.

~~~
dalke
So how do we get there? More mandatory minimums? Less judicial discretion?

Since I think the solution is to get rid of the drug courts and move them into
the medical system, and not to demand more accountability.

Plus, what of accountability for the politicians who set up the policies in
the first place?

~~~
exelius
IMO we need to decriminalize drugs, treat addiction as a medical issue, and
shift our cultural attitudes away from seeking punishment out of the justice
system. But none of those will happen because there are too many people making
too much money from the current paradigm.

And politicians have worked long and hard to ensure they have no
accountability. As long as the place that they're from is aligned to their
party affiliation, they have a job for life regardless of what they do.

~~~
worik
"none of those will happen because there are too many people making too much
money from the current paradigm"

Portugal

Colorado/Washington/Alaska

In the UK they have returned to prescribing heroin to drug addicts

In New Zealand there is new law around novel drugs that will make them legally
available in shops if they can be proved safe

It is happening.

~~~
OvidNaso
Colorado and Washington are already blowing it. They are taking tax revenue
from the sale of marijuana and using it as regular tax revenue for programs
such as schools. Just look at the insidious relationship government has with
the lottery to see that we are just shackling ourselves to a whole other host
of compromised interests. Once they get that money regularly, they are never
giving it back with out a (corrupt) fight which means any means to use the
revenue from drug sales can never be used for appropriate or creative means to
further solve the drug problem and we will quickly find ourselves in the
absurd situation where our elementary schools will be active drug pushers (see
the recent John Oliver piece that highlights a New York Public School ad
pushing gambling and the lottery as some noble activity).

It's the one major social issue that can completely fund, to the full extent
of current science, the research and treatment of it's ill effects on
society...and we are throwing the opportunity away that will be
extraordinarily, if not impossible, to get back.

~~~
icanhackit
_They are taking tax revenue from the sale of marijuana and using it as
regular tax revenue for programs such as schools._

Is that really blowing it though? I have nothing to prove my claim but I'd say
a good dose of substance abuse comes from lacking agency as a result of poor
education.

 _It 's the one major social issue that can completely fund, to the full
extent of current science, the research and treatment of it's ill effects on
society_

What about alcohol, which you could argue results in more violence and
negative health effects than marijuana consumption?

