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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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