The Problem With How We Treat Drug Addicts

The United States is facing an opioid and heroin epidemic that is killing and harming record numbers of people; more people died of overdoses in 2014 than in any other year on record.

One of the latest and most troubling images of this problem was a widely circulated photo of a couple passed out in their car with their four year old left watching from the back city. The City of East Liverpool, Ohio saw fit to share the photo on its Facebook profile to “show the other side of this horrible drug”.

We feel we need to be a voice for the children caught up in this horrible mess. This child can’t speak for himself but we are hopeful his story can convince another user to think twice about injecting this poison while having a child in their custody.

We are well aware that some may be offended by these images and for that we are truly sorry, but it is time that the non drug using public sees what we are now dealing with on a daily basis. The poison known as heroin has taken a strong grip on many communities not just ours, the difference is we are willing to fight this problem until it’s gone and if that means we offend a few people along the way we are prepared to deal with that.

Given the toll of this problem, as well as the heartbreaking sight of a child left vulnerable and unattended to, the City’s motives seemed justified — as would the thousands of disdainful and outright hateful comments that were directed towards the parents and drug addicts in general. What could be more reprehensible than allowing your addiction to run so wild that it not only threatens your life, but those of your dependent loved ones?

But as Vox.com pointed out in a recent piece about the incident, such reactions are deeply troubling, not only because they ignore the public health aspect of the problem, but also because they do nothing to resolve the issue:

Addiction is not a choice; it is a serious illness. It can physically change the brain to drive people to do drugs, even if it leads to their deaths or puts others in dangers. Major medical groups recognize this, from the American Medical Association to the World Health Organization.

In fact, the best evidence shows that the most promising way to deal with opioid addiction is by treating it as an illness — and even giving people medicine to treat it. Such medicines, known as methadone and buprenorphine, are opioids that effectively tame people’s cravings for opioids like painkillers and heroin without producing, when taken as prescribed, the kind of euphoric high that painkillers and heroin do.

Decades of research have deemed these medicines effective for treating drug abuse. And the Centers for Disease Control and Prevention, the National Institute on Drug Abuse, and the World Health Organization all acknowledge their medical value and recommend their use. Yet they remain generally restricted — something the federal government is only now working to change.

Granted, whether addiction is a disease necessitating medical treatment, or a personal failing that must overcome with willpower, is still fraught with contentious debate. But ultimately, the distinction is irrelevant to solving the problem: regardless of whether one thinks addicts are fault for their condition, or are just victims of exacerbating genetic or environmental factors, treating them with scorn and contempt — as opposed to the effective above-mentioned solutions — is not doing anything for anyone, much less for victims like the four year old in the photo.

When the country stigmatized crack cocaine users in the 1980s, it led to a massively punitive crackdown on drugs that dealt with addiction as a crime, not an illness. Much of the reaction back then focused on “crack babies” — the idea that kids with mothers who used crack would turn out to have serious birth defects. Later studies found it was not solely crack but more so poverty and the ills attached to it that caused these kids to suffer later in life. Still, the myth took hold — often used as a means to shame black mothers and severely punish crack users.

At one point, the federal sentence for crack possession was 100 times harsher than it was for powder cocaine, even though the drugs are pharmacologically similar. The big difference between crack and powder cocaine: Black Americans are more likely to use crack, while white Americans used the more expensive powder version.

This helps explain the massive racial disparities in drug sentences: Although black and white people use and sell drugs at similar rates, black Americans are much more likely to be arrested and incarcerated for drug offenses.

Indeed, by criminalizing drug addiction, rather than addressing it as a public health problem, we make it less likely that addicts will get the help they need to kick their habits. When you risk severe social stigma at best, and incarceration at worst, you are less likely to be open about your need for help, or to have access to any resources or treatments. The end result is a stagnant, if not growing, addiction problem.

At the same time, drug users have languished without care: According to 2014 federal data, at least 89 percent of people who met the definition for a drug abuse disorder didn’t get treatment. Patients with drug abuse disorders also often complain of weeks- or months-long waiting periods for care. These are people who can’t get access to care for an illness that could kill them. (Even Prince, a fairly wealthy musician, died of a drug overdose after he couldn’t secure an appointment for treatment.)

The federal government now admits the criminal justice approach was a mistake. As White House drug czar Michael Botticelli recently said, “We can’t arrest and incarcerate addiction out of people. … Not only do I think it’s really inhumane, but it’s ineffective and it cost us billions upon billions of dollars to keep doing this.”

This is tough. Looking at the picture of the adults and child in that car, it’s obvious the kid is not in a safe environment. But the evidence suggests fixing that environment and preventing similar situations — not just for these adults but for other drug users as well — will require compassion and care, not disdain.

For clear evidence of the merit of this approach, look no further than Portugal. Although not as well known as the Netherlands when it comes to a liberal attitude to drug use, the nation of around 10 million is one of the world’s pioneers in decriminalizing all drugs, both in usage and possession (most nations still ban harder drugs, or make possession of a certain amount a criminal offense). And because the country took this radical step back in 2001, enough time has passed to get a reliable picture of what the likely long-term results of this freer approach might be elsewhere.

As Mic. com reported, the results have been stellar: after a brief initial increase following decriminalization, drug use has declined in both proportional and absolute terms, even among young people. Subsequently, there has been a marked decline in drug related deaths, HIV infections, and incarceration — and conversely a “surge in visits to health clinics that deal with addiction and disease”.

The visual data speak for themselves:

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Nevertheless, as many of you might already be thinking, not all aspects of the Portuguese example are translatable to the U.S. or other nations struggling with high rates of drug abuse:

Some social scientists have cautioned against attributing all the numbers to decriminalization itself, as there are other factors at play in the national decrease in overdoses, disease and usage.

At the turn of the millennium, Portugal shifted drug control from the Justice Department to the Ministry of Health and instituted a robust public health model for treating hard drug addiction. It also expanded the welfare system in the form of a guaranteed minimum income. Changes in the material and health resources for at-risk populations for the past decade are a major factor in evaluating the evolution of Portugal’s drug situation.

Alex Stevens, a professor of criminal justice at the University of Kent and co-author of the aforementioned criminology article, thinks the global community should be measured in its takeaways from Portugal.

“The main lesson to learn decriminalizing drugs doesn’t necessarily lead to disaster, and it does free up resources for more effective responses to drug-related problems,”  Stevens told Mic.

While there are no doubt other variables influencing the results, some of which are unique to the country’s size, culture, and society, it does present a working case study (along with other nations) on the merits and outcomes of a liberalized approach to drugs. The U.S. government, as well as a host of local and state institutions, has already conceded that the status quo of criminalization is not working to stymie addiction. Decriminalization might not be a politically palatable idea — it comes off as too “soft on crime” for our retributive society — but it is the most practical and effective one, compassionate reasons aside.

This sentiment is best summed up by the closing paragraph of the Mic article, which cites a firsthand account of addiction by a doctor in Portugal:

In a 2011 New Yorker article discussing how Portugal has fared since decriminalizing, the author spoke with a doctor who discussed the vans that patrol cities with chemical alternatives to the hard drugs that addicts are trying to wean themselves off of. The doctor reflected on the spectacle of people lining up at the van, still slaves of addiction, but defended the act: “Perhaps it is a national failing, but I prefer moderate hope and some likelihood of success to the dream of perfection and the promise of failure.”

The perfect should not be the enemy of the good. Addiction is a tragic and unfortunate problem that understandably elicits much passion and uproar, albeit often counterproductive. It will never go away, whatever its causes, but it can definitely been contained and addressed through compassionate, open minded, and results-driven policy. What more do we have to lose at this point, with so many lives already lost and ruined in the face of an ineffectual status quo?

What are your thoughts?

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