Hello, My Name is America and I’m an Addict.

Hello, My Name is America and I’m an Addict.

Alexis ChapmanThursday,17 March 2016

As you probably already know the U.S. has a massive drug problem, specifically with opiates. The reason I’m betting you already know this is that, according to the American Society of Addiction Medicine, as of 2014, 21.5 million Americans 12 or older have a substance abuse disorder and of those, 1.9 million involved prescription pain relievers and 586,000 involved heroin. So, unfortunately, there is a good chance that you’ve been affected by this issue in some way. Also unfortunately, the number of Americans addicted to opiates is just the beginning of the horrifying statistics. In 2014 drug overdose was the leading cause of accidental death in the U.S., killing 47,055 people. Between 1999 and 2008, the overdose death rate quadrupled, and between 1999 and 2010, the sale of prescription painkillers also quadrupled. Four out five new heroin users began by misusing prescription painkillers. In 2012, 259 million prescriptions for opioids were written. That’s more than enough for each adult American to get their own bottle of pills.

In many ways the numbers suggest that this is a new problem, and in scope this may be something we’ve never seen before, but the fact is that drug use and abuse has been an issue in the U.S. for a long time. The late Nancy Reagan, while promoting her “Just Say No” anti-drug campaign in the 1980s, made the observation that “You cannot separate so-called polite drug use at a chic party from drug use in a back alley.” I’m not sure if people still do drugs at “chic parties” but these days the more accurate sentiment might be “You cannot separate opiates obtained from a pharmacy from opiate use in a back alley.” The “Just Say No” campaign probably did not do much to prevent drug use while it was going on, and the larger War On Drugs was an abject failure. Now, with the lines between medicine and drugs increasing blurring, there is an urgent need for new strategies to address what is well on it’s way to becoming a national crisis.

The idea of deploying nonsensical racist rhetoric to combat the drug problem has been tried by a few politicians like Maine Governor Paul LePage and at least one wannabe politician, but so far that seems to have had little impact on the problem. More rational people have tried taking legislative action at the state level. The Massachusetts legislature recently passed a bill to limit the number of opioids that can be prescribed and other states are looking at similar legislation.

Now it seems like the Federal government may be getting ready to act as well.

On March 11, the Senate passed S. 524, the Comprehensive Addiction and Recovery Act of 2016, and sent it to the House. This is one of those aspiration-ally titled bills that probably won’t live up to its name in terms of the promise of being “comprehensive.” The bill doesn’t seem to offer up a lot of actionable solutions to problems. It does mandate the creation of a “Pain Management Best Practices Interagency Task Force to review, modify, and update, as appropriate, best practices for pain management (including chronic and acute pain) and prescribing pain medication.” Stopping the over-prescription of pain killers would certainly go a long way towards reducing opiate addiction, but the process of creating a panel, looking at the issue, making recommendations (not rules just recommendations) and then disseminating them, somehow lacks the sense of urgency that this issue feels like it deserves. Especially since there are already some medical professionals who are proposing solutions that could be implemented right away. (The article linked in the previous sentence is by a doctor and I highly recommend it.) There are also indications that another easy way to lower deaths by prescription pain pills is simply to legalize medical marijuana nationwide, which is something that could be done quickly and cheaply and wouldn’t require convening a panel.

The bill also falls short in some other areas. Notably a number of the titles within the bill call for grants to states or other agencies and organizations working to combat addiction. Treating addiction rather than just locking up addicts is a huge step in the right direction but it also costs money. However, when Senator Shaheen (D, N.H) tried to get $600 million added to the bill to help cover the grants and other costs, his plan was rejected. The bill also fails to repeal mandatory minimum sentences for drug offenders, a practice which has filled our prisons with low-level drug offenders and caused a range of other problems. The use of mandatory minimums in federal drug cases is on the decline but almost half of all those convicted last year still had their sentence determined by a mandatory minimum, which may or may not have been appropriate to their actual crime.

On the plus side, what this bill does do is start an important shift away from some of the worst aspects of the War On Drugs like the overly simple idea of “Just Say No” and the criminalization of addiction. Perhaps most importantly this bill finally seeks to solve the problem from the demand side. In the past most of the resources in combating drug use have been spent on law enforcement rather than health care and those resources have been used to try and disrupt supply. This has been wildly ineffective and may be contributing factor in the ongoing violence that characterizes the drug trade. Drug use is endemic in prisons in the U.S.; if we can’t keep drugs out of these tightly controlled environments, then it’s not realistic to think we could keep them out of the country as a whole, or prevent the ones that are manufactured in the U.S. or shipped here legally from moving around freely. Focusing efforts on the supply side of the drug trade has been a losing battle, but with legislation that prioritizes treating addiction or preventing it in the first place, we may be able to start making real progress.

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Image Credit: Quinn Dombrowski on Flickr

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