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The Drug Epidemic
This Could Work!
By Kate Burch

Probably no one above the age of ten is unaware that we are in the midst of a “heroin epidemic.”  That is actually a misnomer, as heroin is no longer the most dangerous drug of abuse.  Fentanyl, a highly potent opioid, and the drug that killed the performer Prince, is now the most circulated and most abused addictive drug.  Its derivative, carfentanil, is 10,000 times more potent than morphine, and an amount roughly the size of a poppy seed can be lethal.  In Ohio, there are now about ten deaths from overdoses daily, and drug overdose has surpassed traffic accidents as a leading cause of death. 

The actual drug users are not the only victims.  Addicts often steal, of course, to support a drug habit.  Families are torn apart and placed in jeopardy:  currently, in our county, half of the children placed in protective custody are there because an addicted parent cannot care for them.  Municipal and county resources are overstretched by emergency runs to help overdose victims, to the extent that people with other medical emergencies may face long wait-times for assistance.  The costs of these interventions, and of the arrest, prosecution, treatment, and incarceration of drug abusers, are immense.  This is not to mention the costs of wasted lives: people whose human potential is never realized because they are in thrall to, and often destroyed by, opioids.  Babies of addicted mothers are born addicted and, if they survive, very often have significant developmental problems and may never grow up to become productive, contributing adults.

The financial incentives for trafficking in this deadly substance are huge.  A gram of carfentanil can be purchased via the “dark web” from China for around $3000.  Its street value is in the millions, since an extremely minute quantity (about 3 ten-thousandths of a gram) may be lethal.   I learned from a Sheriff’s deputy that 79 pounds of carfentanil have been seized in our county in 2017.  That amount, calculating from the above figure, would be enough to kill roughly 1, 185,000 people! 

We have been quite unsuccessful in our attempts to treat addictions.  Treatment facilities for addicts who are in the criminal justice system are inadequate in number, and the duration of treatment is too short.  The success rate hovers around 6%; one might as well say it’s a futile effort.  We know that the most effective treatment is accomplished through the twelve-step programs.  This requires, however, real commitment and fortitude on the part of the abuser.  While relapses, early on, are common, the twelve-step group model can provide the support for people to continue, and we know that sustained abstinence of three years is associated with 90% decrease in the risk of relapse.   The twelve-step model really requires a moral conversion: giving up pride, acknowledging one’s need for God and others, and willingness to be unflinchingly honest with self and others.  In my professional experience as a psychologist, some of the very best people I came to know were those with substance abuse problems who were seriously and honestly “working the program” because they were genuine, and they had learned to function within a mutually caring community.  Mandated participation in a twelve-step program, however, has a low likelihood of effectiveness because it is viewed as punishment, rather than opportunity, and the coerced individual is likely to merely “talk the talk” and never “walk the walk.” 

So, what to do? 

In Ohio, legislation has been proposed to tackle one part of the drug abuse problem: that of individuals who become addicted when they use prescribed drugs for chronic pain.  This proposed law would target primary care physicians and require that, if they wish to treat chronic pain patients with opioids, they would have to: offer drug dependence/addiction treatment in their practice; complete a one-time course of 8 hours of continuing medical education on addiction; complete 2 hours of CME yearly regarding prescribing of opioids; and use an electronic medical records system that is directly connected to the state’s automated prescription reporting system.  This law seems like a bad idea to me, as it places a heavy hand on a whole class of professionals in response to the misdirected or criminal behavior of a very small minority of physicians. 

There is another bill, introduced by Ohio Dist. 41 Representative Jim Butler, that seems to me to be extremely reasonable, and to have a real chance for success.  This legislation provides for “Intervention in Lieu of Conviction” for addicts who have been convicted of or pled to a non-violent offense.  It would provide for a period of residential treatment in an Addiction Treatment Facility for up to three years.  This time is determined by the findings that three years of abstinence is associated with 90% reduction in chance of relapse.  Those who are deemed by medical professionals to have a strong likelihood of staying “clean” may be released early for continuation in an outpatient treatment program including mandatory, non-removable GPS tracking bracelets; mandatory sustained-release injections of naltrexone (non-addicting drug that prevents the euphoriant effect of opioids); randomized drug screening; prescribed counseling and other therapeutic activities; and physical relocation at least five miles from previous residence. 

This legislation would also significantly increase penalties and constraints on drug traffickers.  Current Oho laws addressing trafficking are too lax.  The new law would raise the seriousness of trafficking offenses; permit law enforcement officials to search individuals on probation without probable cause; and it would allow judges to impose restrictions on where convicted traffickers may be, so as to curtail open-air drug deals. 

This law would require weaning patients from addictive prescribed drugs within two months.  It would also increase availability of naltrexone, or equivalent drug, and training in its use. 

This proposal offers much promise.  It is sound from a mental health perspective, as the extended period of residential treatment allows for the establishment of a therapeutic community, giving time for an individual to begin to think more clearly and to see mutual aid within the community as a lifeline and an opportunity to build a safer and more satisfying life.  Effective response to the current crisis is essential to save lives, make our communities safer, and stem the flood of resources that are now being diverted from other, necessary services.

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