7 ms·

Massachusetts Chief’s Tack in Drug War: Steer Addicts to Rehab, Not Jail

85 points by frostmatthew 11y ago

mc32 11y ago
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.
- munin 11y ago
  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?
  - dalke 11y ago
    For another, related, account from 1999, see http://www.asktog.com/readerMail/1999-11-PumpReaderMail.html http://www.asktog.com/readerMail/1999-11-PumpReaderMail.html : > My wife, The Doctor, is a board-certified addictionologist, in addition to being an internist, with a subspecialty in prescription drug addiction and signficant experience in running drug and alcohol treatment centers. > She has informed me that (1) most “enlightened” doctors are liberal with narcotics for those who have not been previously addicted and stingy with those who have been hooked, and (2) these doctors don’t know what the hell they are doing. ... > What about the danger of getting people re-hooked? If the medication level, no matter how high, is kept below the threshold of euphoria, the chances for re-hooking the patient are low. And if the patient does become hooked, there are programs and facilities that can handle that problem. > The worst part about asking the patient if he or she has previously been hooked is that patients not in recovery, who are likely to con you out of all the drug they can, are going to lie, while patients in recovery, who will use the pump responsibly, are going to tell the truth. Therefore, those addicts who are most likely to get in trouble with high doses will receive high doses, while the rest are left in significant pain. > In my own case, I wrote down on my drug history that I had once had a single methadone tablet. This was prescribed by my oncologist while I was recovering from cancer some 20 years ago. I took one tablet and concluded, based on the side effects, that I’d rather die than take another. Nonetheless, one of the seven anesthesiologists that took turns deciding, a couple months ago, how much narcotic the pump would supply me “today,” took this fleeting mention of methodone to indicate that I was a dangerous heroin addict who had been on methadone maintainance. So he did the only thing reasonable. He reduced my pain medication to almost nothing. This would suggest that even in 1999 the order was still your #1/#2.
  - freshyill 11y ago
    When I had major surgery three years ago, the button to give myself a dose of hydromorphone only worked every 10 minutes. I imagine systems like this are pretty common. When I left the hospital five days later, my prescription wasn't anything nearly so strong—and this was a surgery with a months-long recovery.
  - alexqgb 11y ago
    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 11y ago
      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 11y ago
        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.
tomjen3 11y ago
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?
- cnp 11y ago
  When you hit "the bottom" you know, and jail is the last place you want to end up in that situation --to say nothing about having to then maintain a criminal record afterwards. Addicts are addicted, and like anyone who has ever suffered through such a plight the unconscious puts up a fight like none other in order to keep the body wired into the drug. You think you still want to use, but that is merely a projection of the condition, until you know you cannot use, but meanwhile cannot stop. At this point treatment can hopefully become available to the person outside of the criminal justice system.
- jkereako 11y ago
  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 11y ago
    But jail is the wrong way to help.
    - jkereako 11y ago
      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.
jwatte 11y ago
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!
- adventured 11y ago
  Hillary and Bill Clinton were the biggest supporters of "tough on crime" in the 1990s. Your premise falls flat accordingly. The Democrats also put huge numbers of people in prison with their participation in the war on drugs. Bill Clinton's presidency saw the most people added to the prison population of any president in US history. His tough on crime, tough on drugs policies successfully added roughly 650,000+ people to the prison numbers in just eight years. That's a record that is unlikely to ever be topped.
  - encoderer 11y ago
    Clinton was a man of his times. You have to remember that in 1993 all you knew was that violent crime had been surging upwards for decades. You had no way of knowing that it was about to peak and recede.
    - rhizome 11y ago
      Violent crime had not been surging upwards for decades. The 90s' highest year, 1993, was about where it was in 1980 when Reagan took office, under whose governance the rate dipped a bit before coming back up (how's that for leaving the place better than you found it?). What we saw was the rate ticking up only slightly in Clinton's first couple of years. http://content.gallup.com/origin/gallupinc/GallupSpaces/Production/Cms/POLL/ldah6rdp6ukvngoyqi1fcg.gif http://content.gallup.com/origin/gallupinc/GallupSpaces/Prod...
      - firebones 11y ago
        And nothing better than to simultaneously note that a support of unionized cops on the street + demographics-based decline in crime soon to follow would be an almost guaranteed winning policy for re-election for a Dem.
jbarciauskas 11y ago
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 11y ago
  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 11y ago
    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.
afarrell 11y ago
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-review-dying-to-be-free/ http://slatestarcodex.com/2015/02/02/practically-a-book-revi...
- Alex3917 11y ago
  > The best guesses by outside observers is that for a lot of them about 80% to 90% of their graduates relapse within a couple of years. The problem with this statement is that you can go back to using drugs, but in a significantly lower risk pattern than previously. E.g. if you were shooting up heroin, but switch to smoking weed. This is actually pretty common, so these top line relapse rates dramatically understate the efficacy of these programs. That's not to say they're super effective, but I think there's at least something to be said for intellectual honesty.
  - Retric 11y ago
    There are lot's of funny statistics where people will redo rehab several times if they fail. But, only once if they succeed. The same is true of prison. First offenders are much less likely to go back than the 'average' prisoner.
- CodeWriter23 11y ago
  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.
  - ChinoAntrax 11y ago
    That's why addicts should only use suboxone to get over the initial, physical withdrawal symptoms and only take it for maybe a week and then taper it down. Suboxone is a far worse thing to detox from because the half life is far longer than opiates -- something like 36-48 hours. Suboxone is a Godsend if you only use it to get over the initial w/d's
NN88 11y ago
Now that white kids are suffering...
dawnbreez 11y ago
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.

85 points by frostmatthew 11y ago

mc32 11y ago

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.

munin 11y ago
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?
- dalke 11y ago
  For another, related, account from 1999, see http://www.asktog.com/readerMail/1999-11-PumpReaderMail.html http://www.asktog.com/readerMail/1999-11-PumpReaderMail.html : > My wife, The Doctor, is a board-certified addictionologist, in addition to being an internist, with a subspecialty in prescription drug addiction and signficant experience in running drug and alcohol treatment centers. > She has informed me that (1) most “enlightened” doctors are liberal with narcotics for those who have not been previously addicted and stingy with those who have been hooked, and (2) these doctors don’t know what the hell they are doing. ... > What about the danger of getting people re-hooked? If the medication level, no matter how high, is kept below the threshold of euphoria, the chances for re-hooking the patient are low. And if the patient does become hooked, there are programs and facilities that can handle that problem. > The worst part about asking the patient if he or she has previously been hooked is that patients not in recovery, who are likely to con you out of all the drug they can, are going to lie, while patients in recovery, who will use the pump responsibly, are going to tell the truth. Therefore, those addicts who are most likely to get in trouble with high doses will receive high doses, while the rest are left in significant pain. > In my own case, I wrote down on my drug history that I had once had a single methadone tablet. This was prescribed by my oncologist while I was recovering from cancer some 20 years ago. I took one tablet and concluded, based on the side effects, that I’d rather die than take another. Nonetheless, one of the seven anesthesiologists that took turns deciding, a couple months ago, how much narcotic the pump would supply me “today,” took this fleeting mention of methodone to indicate that I was a dangerous heroin addict who had been on methadone maintainance. So he did the only thing reasonable. He reduced my pain medication to almost nothing. This would suggest that even in 1999 the order was still your #1/#2.
- freshyill 11y ago
  When I had major surgery three years ago, the button to give myself a dose of hydromorphone only worked every 10 minutes. I imagine systems like this are pretty common. When I left the hospital five days later, my prescription wasn't anything nearly so strong—and this was a surgery with a months-long recovery.
- alexqgb 11y ago
  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 11y ago
    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 11y ago
      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.

tomjen3 11y ago

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?

cnp 11y ago
When you hit "the bottom" you know, and jail is the last place you want to end up in that situation --to say nothing about having to then maintain a criminal record afterwards. Addicts are addicted, and like anyone who has ever suffered through such a plight the unconscious puts up a fight like none other in order to keep the body wired into the drug. You think you still want to use, but that is merely a projection of the condition, until you know you cannot use, but meanwhile cannot stop. At this point treatment can hopefully become available to the person outside of the criminal justice system.
jkereako 11y ago
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 11y ago
  But jail is the wrong way to help.
  - jkereako 11y ago
    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.

jwatte 11y ago

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!

adventured 11y ago
Hillary and Bill Clinton were the biggest supporters of "tough on crime" in the 1990s. Your premise falls flat accordingly. The Democrats also put huge numbers of people in prison with their participation in the war on drugs. Bill Clinton's presidency saw the most people added to the prison population of any president in US history. His tough on crime, tough on drugs policies successfully added roughly 650,000+ people to the prison numbers in just eight years. That's a record that is unlikely to ever be topped.
- encoderer 11y ago
  Clinton was a man of his times. You have to remember that in 1993 all you knew was that violent crime had been surging upwards for decades. You had no way of knowing that it was about to peak and recede.
  - rhizome 11y ago
    Violent crime had not been surging upwards for decades. The 90s' highest year, 1993, was about where it was in 1980 when Reagan took office, under whose governance the rate dipped a bit before coming back up (how's that for leaving the place better than you found it?). What we saw was the rate ticking up only slightly in Clinton's first couple of years. http://content.gallup.com/origin/gallupinc/GallupSpaces/Production/Cms/POLL/ldah6rdp6ukvngoyqi1fcg.gif http://content.gallup.com/origin/gallupinc/GallupSpaces/Prod...
    - firebones 11y ago
      And nothing better than to simultaneously note that a support of unionized cops on the street + demographics-based decline in crime soon to follow would be an almost guaranteed winning policy for re-election for a Dem.

jbarciauskas 11y ago

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 11y ago
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 11y ago
  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.

afarrell 11y ago

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

Alex3917 11y ago
> The best guesses by outside observers is that for a lot of them about 80% to 90% of their graduates relapse within a couple of years. The problem with this statement is that you can go back to using drugs, but in a significantly lower risk pattern than previously. E.g. if you were shooting up heroin, but switch to smoking weed. This is actually pretty common, so these top line relapse rates dramatically understate the efficacy of these programs. That's not to say they're super effective, but I think there's at least something to be said for intellectual honesty.
- Retric 11y ago
  There are lot's of funny statistics where people will redo rehab several times if they fail. But, only once if they succeed. The same is true of prison. First offenders are much less likely to go back than the 'average' prisoner.
CodeWriter23 11y ago
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.
- ChinoAntrax 11y ago
  That's why addicts should only use suboxone to get over the initial, physical withdrawal symptoms and only take it for maybe a week and then taper it down. Suboxone is a far worse thing to detox from because the half life is far longer than opiates -- something like 36-48 hours. Suboxone is a Godsend if you only use it to get over the initial w/d's

NN88 11y ago

Now that white kids are suffering...

dawnbreez 11y ago

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.