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Drug and Alcohol Addiction


Opioid, Drug, and Alcohol Policy

We should start off with what Rinaldo Del Gallo will not do. As a Bernie Sanders progressive, he will not spend money on more prisons.

  • Instead of mass imprisonment, Del Gallo believes we should focus on treatment of those addicted to opioids, alcohol, or other drugs. This requires making it a budget priority.
  • Del Gallo supports drug courts, but would implement them very carefully.
  • Del Gallo supports implementing the LEAD (Law Enforcement Assistance Diversion) program utilized in Seattle which focuses on intervention and not arrest.
  • Del Gallo believes in “Housing First,” which is a program that actually treats homelessness before trying to cure addiction, as often homelessness is the root cause of the addiction.
  • Del Gallo believes that methadone clinics (or similar alternative drugs such as suboxone [or other forms of buprenorphine] ) are essential to address the opioid epidemic. This is a disease epidemic–we need to have an opioid management policy rather than merely an absolutely only approach. Some patients would do better with abstinence only, but others would do better with opioid management—this must remain an available treatment tool.
  • Del Gallo believes that relapse is not a moral failure but a symptom of a disease that needs to be treated.
  • Del Gallo believes we need to destigmatize drug addiction.

SPECIFICS

Rinaldo Del Gallo grew up in Pittsfield graduating from Pittsfield High School, and returned to the Berkshires as an adult in 2000. When Del Gallo grew up, the biggest substance abuse problem was teenagers drinking in the woods. The Berkshire now has an enormous substance abuse problem, particularly with opioids, and it has only become much worse since 2000. And it is not just Pittsfield or North Adams. Recently, a young woman from Hinsdale died from a drug abuse. . Mention also must be made that in addition to heroin, the district suffers from chronic abuse of alcohol, which often takes a back seat to the heroin epidemic, but is also a serious problem. Arguably, in sheer numbers, alcohol is even a more serious problem that both kills and destroys lives. Crack is also a big problem. Because all of these problems are different, we should be smart in our drug and alcohol policies to reflect the different needs of different kinds of addictions.

Drug use has affected Del Gallo’s life. Many people Del Gallo knows through both work as an attorney and in his personal life have addiction problems. One young adult that Del Gallo prayed with had not reached his 25 year and was addicted to heroin. After praying for his sobriety and cleaning up, he had a relapse. He made the mistake of after a clean period, using the same amount of drugs that he used prior to cleaning up. It is a mistake that often kills, because we are so bent on cleaning people up (as we should), that this basic information is not passed on to those that need it. We need to teach those that are addicted that using the same amount of drugs following a period of sobriety as before will literally kill them.

We also need to rethink the downside of abstinence only programs as compared to opioid management plans. While, obviously, the ideal thing is for an opioid addict to just give up this highly addicting drug that creates incredible urges—but given that this is a disease and relapses do occur, we need to have a realistic plan to deal with addiction. An excessive focus on “abstinence only” programs results in many deaths, such as the young person in Del Gallo’s religious community. Because many do not understand that opioid addiction is a disease, they mistakenly think that relapse is profound moral failure and an unforgivable character flaw as evidenced by lack of willpower compared to those that have “seen the light.”

Our criminal justice system often reacts with more punitive measures, rather than more therapy to deal with this disease. Needless to say, in such an environment, those that relapse may become even more depressed and face even more negative images of themselves as worthless, immoral people that lack willpower and resolve to make the “moral choice.” This hopelessness and despair results in unintended consequences—a drug policy that actually might put people in a dark, desperate place where they would be even more inclined to use drugs. For this reason, Del Gallo calls for a plan that is much less judgmental and much more tolerant of relapse. Opioid addiction is less like a chronic burglar and much more like diabetes. It is a disease that requires treatment, not merely social behavioral modification as in the case of your typical criminal.

Abstinence only approaches have had lethal consequences apart from the failure to understand all the health risks associated with withdrawal. For instance, you can kill a person by just throwing an addict in a jail without proper medical supervision. Smart policies have to be in place. Viewing drug addiction through the prism of the criminal-justice behavioral modification lens all too often is a recipe for disaster.

This abstinence only approach has caused all involved (parents/relatives/judges/probation officers/psychologist/clinicians) to fail to even dispense basic information about what to do if there is going to be a relapse—after all, the approach is to “just say no”, so why even discuss the possibility of relapse with the opioid addict? This failure to warn about the dangers of using the same amount of drugs after a period of cleaning-up stems from a larger problem of viewing a relapse as a moral failure, and is thereby preventing a discussion on what to do if there is a relapse with a patient. Del Gallo has prayed with people so overwhelmed by their addictions, they commit suicide. Because they “cannot clean up their act,” they are bad people. Del Gallo knows a young mother with two beautiful children who prayed for her sobriety only to have the mother kill herself by hanging. Del Gallo prayed with both the mother and the children. Had there been a different attitude about opioid addiction and relapse, would the outcome have been different?

What if there had been ongoing opioid management, perhaps with methadone, or some type of alternative treatment such as Buprenorphine? Opioid management might have literally prevented the suicide, and these two beautiful young boys would still have their mother. Instead, they will bear scares that will last with them the rest of their lives. Del Gallo will never forget the day he talked to the father of the boys—the father had told him that he had to go tell his children that their mother had passed. Del Gallo told him that he was about to do the hardest thing he would ever have to do in his life. This affair has caused Del Gallo to seriously rethink the “abstinence only” approach to opioid treatment that treats relapse (or even the urge to reuse) as a moral failure and rules out opioid management therapies.

Del Gallo believes that these problems should be treated for what they are: health epidemics that require life-long treatment made with compassion and without excessive judgment. Even these people—one a young man under twenty-five, another a young mother under thirty years of age—prayed very hard for their lives. Their succumbing to the powers of addiction was not moral failure.

 

chastin heroin

Perhaps one of the best documentaries on the subject of heroin overdose is “Chasing Heroin,” a two hour documentary created by Frontline, which you may watch at the link provided, or at the very bottom of this page.. (It can be clicked on to view, and there is also a written transcript if one wants to do a word search on a given topic.) No matter how many candidates for office may claim they have a concrete plan to fight the opioid, it is in fact an extremely difficult problem with many complexities. There are many different philosophies and approaches, and those better deal with the problem bring a great deal of research, smarts, and a loving heart to the problem—not just a neat multiple point plan that can be rattled off in a political debate or stump speech.

As Chasing Heroin shows (8:46), our country once had a very Puritanical attitude about opiates, and there was a time in America that those in serious pain, even cancer patients, had a very hard time getting hands on pain killing opiates. It was a barbaric attitude. It is important that when we justifiably castigate many doctors for over-prescription of pain medications, that we also make sure the pendulum does not swing too much the other way so that those in real pain do not have proper access to medication. Very few who discuss the war on opioids discuss this real potential. Eventually in America, the hospice movement came about and that is when there became a concerted effort to engage in pain management. Chasing Heroin (9:05). Unfortunately, it also marked a moment when Americans were using too many opioids and were becoming addicted to pain killers.

But first some terminology. “Opium” is a narcotic resin produced from opium poppies. Morphine and codeine are made from opium. In the far east, Opium was often smoked in opium dens. Many believe an “opioid” only properly refers to man-made chemical that acts like morphine in the human body. Under this definition, roughly speaking, an “opioid” acts like an “opiate,” but is not actually derived from the opium poppy. But “opioid” and “opiate” are often used as synonyms and are used interchangeably, so it might erroneous to correct someone who uses the terms synonymously. Using the two words synonymously was once probably an error. Because we have mixed the two words, we have a word loss as two words with two distinct meanings become blended into one.

OxycontinWord definitions aside, what is important to understand is that scientist have developed synthetic alternatives to the opium plant. One of these opioids is a drug called “oxycodone.” Oxycodone is a generic drug that is sold under different names and acts like morphine in the human body but is not made from opium poppies. OxyContin is one of the brands of oxycodone; its basic pitch was that because it time-released oxycodone into the body, it was less likely that people would become addicted while at the same time treating their pain. It was a pitch that was far from being true, and the manufacturer of OxyContin had to pay big fines. Chasing Heroin, 10:19. It was marketed aggressively. Its manufacturers (Purdue Pharma) produced promotional videos that maintained that under-treatment of pain was a major health problem. Chasing Heroin, 11:22. They claimed that addiction was exceptionally rare—in less than 1% of patients. The FDA allowed them to make the claim that it might be less addictive. By, Purdue’s 2001 OxyContin sales reached one billion dollars per year.

“We went from a country that used almost no opiate pain killer like in the 50’s and 60’s, to a country that used 83% of the world’s oxycodone, and 98% of the world’s hydrocodone. It’s a stunning statistic.” Chasing Heroin, 12:34. Today, the manufactures of OxyContin still claims that their product doesn’t lose effectiveness over time, thus leading to the greater likelihood of addiction. But this is widely criticized as not true. Del Gallo believes that OxyContin is addictive, and even “highly addictive.”

heroin bottle“Heroin” is a drug that acts like morphine in the human body and is thus called an “opioid.” According to Wikipedia, “Heroin is called a semi-synthetic opioid, meaning that it was created from an opiate that occurs in nature (morphine).” OxyContin and Heroin have two similarities. The first similarity is that both act like morphine in the body and are pain killers (analgesic drugs) and are chemically related. The other frightening similarity is that both were initially touted as safe. “Heroin” made from by the Bayer Aspen Company in Germany. Heroin was thought to be a way to end morphine and opium addition. Heroin was actually a trade name, and it was suggested by the manufacturer to give it to children for things like coughs. Parents did so. After a while, it was realized that heroin was just as bad morphine and opium, and today is outlawed almost everywhere. In 1914 Heroin was only allowed to be dispensed with a prescription in the United States, and was banned altogether in 1924. This comparison between Heroin and modern pain killers has not been lost by others.

SOURCE: http://www.businessinsider.com/yes-bayer-promoted-heroin-for-children-here-are-the-ads-that-prove-it-2011-11

But eventually it became known how bad OxyContin really is. Chasing Heroin, 12:34. It was reported in the news that saying OxyContin was not addictive was deliberate lie. In 2007, after a four year investigation by federal prosecutors, Perdue Pharma admitted to charges of fraudulent marketing, and paid $600 million in fines and settlement. Chasing Heroin, 17:02. They claimed to have remade OxyContin with abuse deterrent properties. By 2009, America was having a problem with opiate overdoses.

Because street heroin is relatively inexpensive compared to getting OxyContin on the street, and because they are from the same drug chemical family, pain killer addiction often become heroin addiction. The pill market was driving the heroin market. The low cost of heroin is a sign that the War on Drugs has been a complete failure. The cost of the drug is a reflection of supply, low cost reflect high supply, and high supply reflects an inability to keep the drugs out of the country. For this reason, with many positive results, Portugal completely legalized drugs and put all the focus on treatment—this is a story that has had considerable success as view from ten years later indicates. While legalizing all drugs is not a political possibility in Massachusetts, the success of a program that completely focused on treatment and completely dispensed with law enforcement’s efforts to limit supply cannot be overlooked.

American Society of Addictive MedicineNumbers on what percentage of our addictive problems are attributed to heroin, or on what percentage of heroin users started off abusing prescription medicine, and in turn, numbers on what percentage of those that abuse prescription medication started off in legitimate pain treatment, are somewhat hard to come by. But according to the American Society of Addictive Medicine, “Of the 21.5 million Americans 12 or older that had a substance use disorder in 2014, 1.9 million had a substance use disorder involving prescription pain relievers and 586,000 had a substance use disorder involving heroin.”

By pure subtraction, that would leave 19.1 million of all substance problems related to something other than heroin addiction or opioid use—while opioids are making the headlines lately, we cannot lose track of the alcohol, crack, cocaine, and meth problem. Also the American Society of Addictive Medicine states, “Four in five new heroin users started out misusing prescription painkillers. As a consequence, the rate of heroin overdose deaths nearly quadrupled from 2000 to 2013. During this 14-year period, the rate of heroin overdose showed an average increase of 6% per year from 2000 to 2010, followed by a larger average increase of 37% per year from 2010 to 2013.” So we do know that 4 or 5 heroin users started off misusing prescription medication—but this does not indicate how many of those that misused prescription pain medication started off legitimately using prescribed medicine or how many illegitimately used opioids from the start. It is known that many misuse prescription opioids right from the start and never legitimately used them, even crushing them and snorting them. Regardless, any approach would have to carefully consider where prescription medications are ending up, and why they are ending up there.

SOURCE: http://www.asam.org/docs/default-source/advocacy/opioid-addiction-disease-facts-figures.pdf

SOURCE: https://www.drugabuse.gov/publications/drugfacts/heroin

In Chasing Heroin, 25:44 there is the story of Mara, whose heroin addiction did not start with legitimate use pain killing medications. It is self-medication for psychological problems. It is also a story about how a $40,000 strict abstinence problem did not work. Mara died from an overdose.

ANOTHER PATH

Chasing Heroin, 34:36 documents another path towards our drug program taking place a short ferry ride from Seattle, Washington in Bremerton, Washington. The LEAD program is discussed below.

METHADONE TREATMENT (or SIMILAR OPIOID MANAGEMENT DRUGS)

If you read Adams Hinds website “My 4 Point Plan to Confront the Heroin Crisis” or his column “Addressing the heroin crisis in Western Mass,” an 856 word column is missing two words: “Methadone Clinic.” Nor are the words “buprenorphine,” or one of its brand name formulations such as Cizdol, Subutex, Suboxone, Zubsolv, or Bunavail. The phrases “opioid management” is also not used.

Andrea Harrington has never used these term either. Hinds speaks in extreme understatement:

Broaden implementation of proven strategies. Despite a high rate of hospitalizations, treatment facilities are not always available. Affordable and accessible evidence-based treatment should be available to everyone who needs it. That includes medically assisted treatment, treatment beds beyond short-term detox, and sober living homes that keep people from the triggers of past habits. Berkshire Health Systems is investing in treatment beds for up to 30-day stays and a sober living home for women. These are critical additions.

In Del Gallo’s opinion, the lack of treatment facilities is chronic—not merely “not always available.” To be sure, both Andrea Harrignton and Adam Hinds on the right track when they talk about treating opioid addiction as a disease and an epidemic and focusing on treatment. But what is “evidence-based treatment”? Hinds is on tract when he mentions “treatment beds beyond short-term detox” and “sober living homes.” Pointing out that Hinds fails to mention life-long treatment might be quibbling.

But pointing out that Hinds and Harrington have failed to mention methadone clinics (or an alternative treatment opioid management drug) reflects the type of unwillingness to take political chances as compared to Del Gallo.

Just having graduated law school, Del Gallo put his name on a law review article that his law partner recommended he not do-it became one of the most famous law review articles in patent law. Today, books and treatise have been written on Business Method Patents, after Del Gallo discredited the idea that there was a “business method exception” to patent able subject matter. (Click on this link to see just one of them.) But prior to the law review becoming famous and cited in one of the most famous patent cases of all time studied even by business students (let alone law students), Del Gallo had to find in himself to muster the courage sign the law review article and submit it. It has happened over and over again in his life. When the local media blasted Del Gallo for supporting shared parenting, Del Gallo was instrumental in having it put on the ballot and it won by 78% in Berkshire County and in the state representative district representing Northampton. (Against heavy criticism and discouragement, Del Gallo led a fight to have Styrofoam banned in Pittsfield—he inspired the ban on single use plastic bags and Styrofoam in Williamstown.) Del Gallo was a leader in filing a petition for transgendered rights (filing a petition in Pittsfield City Hall) when no others would speak out. Del Gallo was one of the extreme few public officials that advocated decriminalizing marijuana when it was placed on the ballot—the entire Berkshire delegation and all law enforcement were against it. The decriminalization measure won by an overwhelming margin in 2008—Del Gallo was way ahead of the political establishment in knowing that the criminal approach to drug use was a failed thought of yester-year.

The reality is that any comprehensive treatment of opioids is going to have to include a methadone clinic, or a clinic that dispenses an alternative to methadone such as buprenorpine (Suboxone). “Methadone clinic” is a “proven strategy” whose name others dare not utter. Hinds says in his piece: “Last week, I attended the National Summit on Heroin in Atlanta, where President Obama announced new federal action to combat the epidemic.” So he must have been thinking about it. Hinds must have known that at the very epicenter on any discussion of opioids is whether to engage in opioid management programs through clinics that dispense methadone or Suboxone (or something similar). Not talking about methadone clinics (or some other opioid management program such as Suboxone) is like talking about preventing AIDs but not talking about safe sex—it is too central to the discussion for omission.

Hinds made a political calculation not to mention methadone clinics and uses vague expressions (often called “weasel words”) such as “broaden implementation of proven strategies.” Hinds made a political calculation: mention “treatment” which everybody likes, but don’t mention “methadone clinic” which brings protestors. There is no doubt that many people do not believe in methadone clinics from a treatment perspective. They claim that one trades in one addiction for another. Obviously, this dismisses the reality one is already addicted to opioids and abstinence only programs have high failure rates. But if Hinds was of the belief that we should not use opioid management programs but should rely on abstinence, he should have made the case. But failure to take a side on the most central question regarding treatment of opioid addiction demonstrates a lack of political courage and leadership.

 

 

Opposition to methadone clinics is common--we need leaders not afraid to speak up for them.
Person holding sign in opposition to a methadone clinic.

But the transcript of Chasing Heroin shows what happens when people do not stand up for methadone clinics. This dialogue at a city council meeting, plus the narrators comments about the after effects:

TREVOR MERCER: Hi. My name’s Trevor Mercer. Ever since I’ve been on methadone, I’ve come farther in life. I own my own home. I raise my son. I don’t have any issues anymore as far as going backwards. Methadone treatment is what helped.

1st COUNCILMAN: Thank you.

2nd COUNCILMAN: Thank you, Mr. Mercer.

NARRATOR: But the loudest voice against the clinic was having second thoughts by the time he testified.

ROBERT PARKER: When the thing hit the front paper, I was upset, and admittedly now, I didn’t understand the whole issue, and I think we’ve all—

NARRATOR: Robert Parker was dealing with a crisis in his own home. His son was slipping into drug addiction.

ROBERT PARKER: It tore through our family. You know, the first few times, we went running down to the jail, paid whatever the bail was. But it got worse and he slid down further. And finally, when we wouldn’t bail him out anymore, we lost him. He quit communicating with us completely.

I was extremely conflicted about the clinic. I had my son, and at that point, I knew that he may be one of the patients that needed it.

COUNCILMAN: I will call to order the special meeting of the Bremerton City Council—

NARRATOR: Despite his reservations, it was too late. The long campaign against the clinic had swayed Bremerton’s council. In 2011, the council put a halt to the methadone clinic.

When a methadone clinic came to Pittsfield, it was met by strong local resistance.  It is important to have a state senator that is not afraid to stand-up for methadone clinics (or similar opioid management treatments.)

 

Meanwhile, the epidemic continued to spread.

When politicians do not have the political courage to defend methadone clinics, real people like Robert Parker’s son, or Trevor Mercer go without. And this can lead to despair, the inability to function in life, or even death. The reality is that the failure to mention “opioid management” or “methadone clinic” or “Suboxone” was not an oversight or an act of incompetence on the part of Hinds—it was a conscientious political choice. Nor was it about a footnote in a discussion on the opioid problem—rather it concerns a central subject of debate. A discussion of opioid management versus complete abstinence is the proverbial elephant in the room. Failing to discuss it is inexcusable.

Yet because these clinics are controversial, candidates for office are afraid to mention them. Perhaps we can debate where a methadone treatment center should be located, or what better alternatives there are to methadone. But treating the opioid epidemic requires the political courage to say we need methadone clinics (or clinics that dispense similar, but arguably better, type of drugs). To be clear, Del Gallo favors such clinics, and has the courage to say so. This open, clear and unequivocal support of methadone clinics (or other suitable opioid management alternatives) differentiates his candidacy. The only thing Del Gallo would discuss is not whether to have them, but where—so long as the community had them.

As the Chasing Heroin documentary vividly shows, resistance to methadone clinics can be strong. Rinaldo Del Gallo believes methadone clinics (or treatment with a similar drug, perhaps more effective) are an integral fight against opioids. At around 36:00 into the documentary, Frontline’s Chasing Heroin discusses how a methadone clinic has been an effective tool. But the people that were addicted to opioids wanted to use a methadone did not have convenient access to it. Methadone is taken once a day instead of doing heroin five or six times a day, and allows people to function without going into withdrawal. Obviously, we do not want people on Methadone and total abstinence is preferred. But total abstinence from any opioid like substanance does not always work. In fact, it often does not work (which is problem, incidentally, with drug courts). (Methadone is not “meth” or “methamphetamine.”) As the documentary points out, fear can conquer science: it is the role of the State Senator to address that fear and have enough political courage to stand up for methadone clinics which offer methadone or alternatives to methadone.

There are many resources on the Internet that document the failure of the abstinence only/no opioid management approach:

SOURCE: http://projects.huffingtonpost.com/dying-to-be-free-heroin-treatment

(Huffington Post article on Suboxone)

NOTABLE QUOTE: “Like methadone, Suboxone blocks both the effects of heroin withdrawal and an addict’s craving and, if used properly, does it without causing intoxication. Unlike methadone, it can be prescribed by a certified family physician and taken at home, meaning a recovering addict can lead a normal life, without a daily early-morning commute to a clinic. The medical establishment had come to view Suboxone as the best hope for addicts like Patrick.

Yet of the dozens of publicly funded treatment facilities throughout Kentucky, only a couple offer Suboxone, with most others driven instead by a philosophy of abstinence that condemns medical assistance as not true recovery.

SOURCE: http://www.itschemistrynotcharacter.com/awareness/medication-assisted-treatments-need-more-coverage/

 

 

drug court

DRUG COURTS AND DIFFERENCES WITH OPPONENTS

But there is another difference in Del Gallo’s approach to the drug epidemic than his opponents, apart from his willingness to invoke the words “methadone clinic.” Both Andrea Harrington and Adam Hinds have mentioned drug courts. Del Gallo is not opposed to drug courts, but he is very concerned about their proper implementation.

The Frontline documentary Chasing Heroin pointed out the problem with drug courts at around 45:15. Drug court’s first started in the 1980’s and the idea grew. The idea is that by requiring treatment, as opposed to simply referring people to treatment, they will stay in it; its big stick stuff.

As ROBERT DuPONT, M.D., Dir., Natl. Institute on Drug Abuse, 1973-78 states in Chasing Heroin: “You don’t just refer them to treatment; you require them to go to treatment. You got to use that stick to get people in there and get them to stay there so they get well.”

In an April 3, 2016 column she wrote for the Berkshire Eagle, “Why I am running for state senate,” Andreas Harrington states she wants to “Bring a drug court to Berkshire County with the goal of shifting funds from incarcerating people to treating them.” She notes, “There are no awards for convincing a client to take a plea that includes essential treatment instead of going to trial.” Apart from the odd comment about awards for just doing your job, there is a far more serious issue of why people must plead guilty to get drug treatment that they really need; what if they are drug addicted but innocent to the crime to which they were charged?

Adam Hinds is also suggesting drug courts and did so in a column he penned for the Berkshire Edge, “Drug courts are a proven way to compel non-violent individuals with behavioral health conditions to enter evidence-based treatment, community supervision and case management. It is time to acknowledge that while law enforcement has a critical role in containing access to drugs, we have relied for too long on incarceration to address a public health problem.” “Addressing the heroin crisis in Western Mass.,” the Berkshire Edge, April 9, 2016.

Rinaldo Del Gallo, a Bernie Sander progressive, is all for “shifting funds from incarcerating people to treating them” as Andrea Harrington mentions. And Del Gallo completely agrees that “we have relied for too long on incarceration to address a public health problem.” But the question remains, why do we need a “drug court” to implement the plan? The larger problem is that in a time of chronic underinvestment in a major health epidemic that opioids, alcohol, crack and other drug represent, our state coffers are not boundless; why not spend any additional money on treatment, rather than hiring yet more judges and probation officers?

Every time Del Gallo sees a judge, he sees money that could have been spent on a doctor. Every time he sees a probation officer, he sees money that could have been spent on a nurse. Every time he sees a jail, he sees money that could have been spent on a treatment facility. So while Del Gallo is not against a drug court, they should be used out of existing funds, not funds that could have been directed or would have been directed to treatment.

There are in fact many sources that indicate that while highly touted, drug courts have been subject to many articles that criticize them.

“How America Overdosed on Drug Courts” by Maia Szalavitz, Pacific Standard Magazine.

https://psmag.com/how-america-overdosed-on-drug-courts-a813ff745a6e#.fl40l8nlv

“The Wonder Drug: Why are drug courts denying heroin addicts the medicine they need? Suboxone could help heroin addict,” Alec MacGillis, Slate.com

http://www.slate.com/articles/news_and_politics/politics/2015/02/suboxone_could_help_heroin_addicts.html

“Drug Courts are not the answer: Toward a Health Centered Approach to Drug Use.” A publication of the Drug Policy Alliance.

https://www.drugpolicy.org/docUploads/Drug_Courts_Are_Not_the_Answer_Final2.pdf

“Want to go to Drug Court?: Say Goodbye to your rights.” Mike Riggs, August 17, 2012. Reason.com

http://reason.com/archives/2012/08/17/want-to-go-to-drug-court-say-goodbye-to/1

“As Drug Courts Expand, Critics Say They Aren’t Reaching Those in Greatest Need,” July 29th, 2014, Partnership for a Drug Free Kids

http://www.drugfree.org/join-together/drug-courts-expand-critics-say-arent-reaching-greatest-need/

“Drug Courts: Enter at Your Own Risk” Margaret Dooley-Sammuli Senior Policy Advocate, ACLU of San Diego & Imperial Counties. HuntingtonPost.com

http://www.huffingtonpost.com/margaret-dooleysammuli/drug-courts-enter-at-your_b_1151533.html

Here are common problems with drug courts:

CHERRY PICKING PARTICIPANTS: Consider this passage from Pacific Standard Magazine: “The first drug court opened in Florida’s Miami-Dade County in 1989, near the height of the hysteria in this country over drugs, particularly crack cocaine. Both conservatives and liberals found something to love: Conservatives liked the potential for reduced prison spending, and liberals liked the emphasis on therapy. From the start, however, critics voiced concerns about ‘cherry picking, ‘because the courts only allowed into the program defendants who seemed likely to succeed whether or not they received help. This sort of selectivity was built into the system: The federal laws that determine eligibility for grants to create new drug courts (ongoing funding is primarily state and local) require that the courts exclude people with a history of violent crime. Many drug courts also bar people with long non-violent criminal histories. Predictably, this eliminates many of those who have the most serious addictions — the very people the courts, at least in spirit, are supposed to help.”

As Partnership for Drug Free Kids stated: “For serious drug offenders it has been a far better alternative than prison,’ said John Roman, a senior analyst at the Urban Institute, who studies drug courts. ‘The problem is very few people who have those serious problems get into one of these drug courts. Instead, we take all kinds of people into drug court who don’t have serious problems.’ In some cases, people who might have faced a fine for marijuana use in the regular court system are instead moved into the drug-court system. They are often forced to pay for costly treatment programs, and could face jail time if they break the program rules. ‘Once you get that deep into the criminal justice system, it can be really hard to get out,’ Roman said.”

SOLUTION: We need to also treat those that are seriously addicted. Making these people ineligible for long-term treatment through a drug court is ignoring the very problem the court was created to fight.

VIOLENCE EXCEPTION. It can be odd who is and who is not eligible for the program. Suppose one gets in a scuffle at a bar—there is usually an exception to the program for “violent offenders.” But someone who committed a non-violent crime, for instance a person addicted to drugs who commits a burglary might would be eligible. Yet people with addition related violence issues are exactly the type of people we want getting treatment for the benefit of themselves and society at large.

SOLUTION: Obviously, an axe-murder cannot be given parole to go to a drug treatment facility. But people that engage in low-levels of violence (a drunken bar fight) who are highly likely to be on the street again should not be exempt from the very drug treatment program that might prevent future violent episodes. The requirement that the crime has to be completely unrelated to violence needs to revisited for a sensible medium. A woman who slapped her husband should be eligible for the program. A woman that shot him should not.

CHERRY PICKING STATISTICS: Despite cherry picking who can go in the program, including many people who want to take a plea who do not really have an addiction problem, statistics are often given in terms of those who graduate—but many do not graduate.

SOLUTION: We should not be so paranoid of failure that we include people in the drug court program that have no clinical addiction and omit people that have deep addictions. “Liberating’ someone that doesn’t really need treatment is no strength, failing with someone that has a deep seated addiction is no weakness.

INAPPROPRIATE TREATMENT OR RELAPSE PATIENTS: Often, when people fail, they are simply thrown in jail, where they suffer from withdrawal without adequate treatment. The “just lock them up” approach to relapse is one of the biggest criticisms of the program. Drug addiction is an ongoing health problem—we cannot treat relapsing as moral failure. It is supposed that they could design drug courts so that relapse is just viewed as an ongoing health problem to be supervised by the courts—but this is historically never the way it has been implemented, and probably will not be the way it is implemented in Massachusetts. Moreover, many of the people that thrown back into jail have no access to methadone.

SOLUTION: Set up drug court so that a relapse calls for reevaluation and a different treatment program. For instance, an opioid addict many need to be put on an opioid management treatment strategy. As Professor Scott Burris says in the documentary, “But drug courts also represent innovation, experimentation, practicality. They represent the attempt of people who are right there on the street facing the problem every day to do something different, not just keep repeating the same mistakes, to treat people as individuals.” An experimental approach would need to be taken for people who have deep seated problems that includes relapses.

COERCION INTO TAKING PLEAS: Forcing someone to take plea sounds great if they are really guilty, but many people opt in just to avoid jail time and do not have problems. Much more importantly, genuinely innocent people might take the deal in order to get drug or alcohol treatment they desperately need. In the documentary, chasing heroin, Prof. SCOTT BURRIS, Temple Univ. Law School said, “Drug courts represent in some ways a violation of fundamental human rights in that people must essentially plead guilty and give up their due process rights in order to participate in drug court.”

SOLUTION: USE ADJOURNMENTS WITHOUT FINDINGS OF FACT, BUT INSTEAD REQUIRING AN ADMISSION OF GUILT: In New York, they have something called “Adjournment Contemplating Dismissal.” They adjourn the case and you make no admission of wrongdoing. If you do what the court tells you—like get drug treatment or anger management, the case goes away. We a similar procedure here in Massachusetts, but it is seldom used. Instead, we use “Continuation with a Finding” or “CWOF” which is a highly deceitful name because you actually have to admit you did the crime. When one violates the terms of your release, under the CWOF you go straight to punishment—you have already “admitted to facts sufficient.”

Consider this passage from Chasing Heroin, at 49:50.

NARRATOR: In this courthouse in Seattle, defendants must waive their right to a trial if they want to participate in drug court. If they fail the program, they’re at the mercy of the court.

Judge CHERYL CAREY:If you are not successful with the program, you’ve given the courts the right to find you guilty of the charge beyond a reasonable doubt.

JAMIE KVISTAD: Now, their other choice is prison. So I mean, they’re kind of between a rock and a hard place. They have given up their right to challenge the evidence. All that happens is the judge reads the police report, and then sentences them to the crime.

This is a problem with a solution. Through the use of adjournment without admitting to facts sufficient (i.e., admitting to your guilt), we can have a smarter implementation of drug courts.

AN UNENLIGHTENED INSISTENCE ON ABSTINENCE INSTEAD OF OPIOID MAINTENANCE, OFTEN ENDANGERING THE LIVES OF PEOPLE BEFORE DRUG COURTS: Consider this excerpt from Pacific Standard Magazine about the plight of a boy: “By the time Darren was assigned to drug court, his addiction story carried almost every possible red flag for high-mortality risk: prior overdose, prior treatment failure, a childhood ADHD diagnosis, and a family history of mental illness. Any addiction doctor — or anybody who simply follows evidence-based treatment guidelines — would know exactly what to prescribe for him: opioid maintenance, by far the most effective treatment, known to lower the death rate of opioid addiction by between 66 and 75 percent. Maintenance is the indefinite use of an opioid medication such as methadone or buprenorphine, typically combined with counseling. The World Health Organization has called it “essential medicine,” and the National Institutes of Health, the Institute of Medicine, and the White House Office of National Drug Control Policy have all endorsed it in various consensus statements. Even the National Association of Drug Court Professionals describes it on its website  as a ‘best practice.’ In 2000, after a defendant in a California drug court died of overdose after being denied maintenance, the state passed a law requiring drug courts to allow it.

But many drug court judges vociferously oppose the practice and require patients to become completely abstinent as a condition of participation or graduation. They believe that maintenance simply amounts to swapping one drug addiction for another. This critique betrays a fundamental misunderstanding of opioid pharmacology and addictive behavior. Left to their own devices, most addicted people take escalating and irregular amounts of their drug, creating a roller coaster of highs and lows that often precludes normal functioning. They’re either in withdrawal, actively seeking drugs, or wasted.

By contrast, maintenance evens out the highs and lows. If you take the same dose of an opioid at the same time daily for long enough, you become completely tolerant to it and experience no high or impairment at all. This is a unique property of opioid use; alcohol, for instance, doesn’t work this way, which is why it makes no sense to say, as critics frequently do, that swapping heroin for methadone is like swapping vodka for gin. On opioid maintenance, patients can drive, attend school, work demanding jobs, and experience the ordinary emotions of family life. Methadone and buprenorphine each have unique pharmacological properties that make them particularly useful for maintenance, but heroin itself is prescribed in Canada, the United Kingdom, and Switzerland for people who do not benefit from the other drugs. If stable maintenance dosing is achieved, it does not leave people numbed out or stoned, and is no more impairing than Prozac.

According to a 2012 study, only about a third of all drug courts permit participants to start maintenance as the treatment component of their program, and many oppose it. For example, the handbook for the Manhattan Treatment Court, which serves the city that has America’s largest number of heroin users, tells those hoping to enter the program, “You must agree to move from methadone to abstinence in order to participate.” In a hopeful sign, the Office of National Drug Control Policy announced in February that it would refuse to fund drug courts that apply for grants if they have such policies. They cited a lengthy exposé by the Huffington Post, which examined widespread problems with drug treatment in Kentucky, including a drug court judge who refused to allow maintenance, dismissing it as a substitute addiction, even though he admitted he was not “an expert on what works and what doesn’t work.”

SOLUTION: Implement a drug court that allows for opioid management therapy such as methadone or Suboxone. Suboxone, apart from making sure an addict does not suffer withdrawal, blocks “the high” on heroin, because it has a blocker that stop that.

The Drug Policy Alliance also makes these points in their executive summary:

DRUG COURTS HAVE NOT DEMONSTRATED COST SAVINGS, REDUCED INCARCERATION, OR IMPROVED PUBLIC SAFETY. Oft-repeated claims to the contrary are revealed to be anecdotal or otherwise unreliable. Evaluations are commonly conducted by the creators of the programs being evaluated, and the result is research that is unscientific, poorly designed, and cannot be accurately described as evidence. Drug courts often “cherry pick” people expected to do well. Many people end up in a drug court because of a petty drug law violation, including marijuana. As a result, drug courts do not typically divert people from lengthy prison terms. The widespread use of incarceration – for failing a drug test, missing an appointment, or being a “knucklehead” – means that some drug court participants end up incarcerated for more time than if they had been conventionally sentenced in the first place. And, given that many drug courts focus on low-level offenses, even positive results for individual participants translate into little public safety benefit to the community. Treatment in the community, whether voluntary or probation-supervised, often produces better results.

SOULTION: For drug courts to work, we have to stop throwing people out for failing a drug test, missing appointment, or a knuckleheaded mistake. Obviously, there is a point where some is such a complete failure, they may have to be subject to the criminal justice system for their non-drug offense crime (such as burglary). But Del Gallo knows people that were burglars because they were drug addicts, and who would have benefited from such programs.

DRUG COURTS LEAVE MANY PEOPLE WORSE OFF FOR TRYING. Drug court success stories are real and deserve to be celebrated. However, drug courts also leave many people worse off than if they had received drug treatment outside the criminal justice system, had been left alone, or even been conventionally sentenced. The successes represent only some of those who pass through drug courts and only a tiny fraction of people arrested. Not only will some drug court participants spend more days in jail while in drug court than if they had been conventionally sentenced, but participants deemed “failures” may actually face longer sentences than those who did not enter drug court in the first place (often because they lost the opportunity to plead to a lesser charge). With drug courts reporting completion rates ranging from 30 to 70 percent, the number of participants affected is significant. Even those not in drug court may be negatively affected by them, since drug courts have been associated with increased arrests and incarceration in some cases.

[NOTE: Pacific Standard Magazine writes, “Worse, defendants who start but do not complete drug court often serve longer sentences, meted out by judges as punishment, than they would have had they simply taken a plea and not tried to solve their drug problem. That strikes many critics as a manifest injustice. ‘This is intensifying the drug war on half of the people, ‘ says Kerwin Kaye, an assistant professor of sociology at Wesleyan University. ‘It’s not stopping the drug war, it’s continuing it by other means.’”]

SOLUTION: We should never punish people for doing the right thing. People who fail the drug court program should not be worse off for it than if they never tried. It is not only immoral, it is self-defeating. Given that it is a hard path to be clean, many people would opt-out of drug court if the inevitable long-term result would likely be worse than if they never went to drug court. Again, we should use adjournments contemplating dismissal, and the only failure consequence should be that you are tried in regular criminal court.

DRUG COURTS HAVE MADE THE CRIMINAL JUSTICE SYSTEM MORE PUNITIVE TOWARD ADDICTION – NOT LESS. Drug courts have adopted the disease model of addiction but continue to penalize relapse with incarceration and ultimately to eject from the program those who are not able to abstain from drug use for a period of time deemed sufficient by the judge. Unlike health-centered programs, drug courts treat as secondary all other measures of improved health and stability, including reduced drug use and maintenance of relationships and employment. Some people with serious drug problems respond to treatment in the drug court context; not the majority. The participants who stand the best chance of succeeding in drug courts are those without a drug problem, while those struggling with compulsive drug use are more likely to end up incarcerated. Participants with drug problems are also disadvantaged by inadequate treatment options. Drug courts typically allow insufficiently trained program staff to make treatment decisions and offer limited availability to quality and culturally appropriate treatment.

SOLUTION: This does not mean we should not abandon the idea of drug courts. We need to stop penalizing relapse with incarceration but first turn to opioid maintenance. (If that repeatedly fails, the person should be simply tried for the underlying crime.) Measures of improved health, maintaining employment, and maintenance of relationships needs to also be a part of the picture. Obviously, we need sufficiently trained medical people making evaluations, as in a Section 35 proceeding.

“In 2008, when voters in California were considering a proposition designed to use less punishment and more treatment in handling drug offenders, Governor Jerry Brown recommended voting against it because, he claimed, less-punitive sentencing would hurt drug courts. “We know that the hammer of incarceration is often what is needed,” he said, “to assist an addict to get off his dependency.” Del Gallo believes that this is the wrong approach. We need drug courts, but drug court’s that look at addiction, also drug and alcohol addictions as long term problems needing life-time solutions.

SOURCE: https://psmag.com/how-america-overdosed-on-drug-courts-a813ff745a6e#.fl40l8nlv

DRUG POLICY ALLIANCE RECOMMENDATIONS

Based on these findings, the Drug Policy Alliance recommends better aligning drug policies with evidence and with public health principles by:

  • Reserving drug courts for cases involving offenses against person or property that are linked to a drug use disorder, while improving drug court practices and providing other options for people convicted of drug law violations;
  • Working toward removing criminal penalties for drug use to address the problem of mass drug arrests and incarceration; and
  • Bolstering public health systems, including harm reduction and treatment programs, to more effectively and cost-effectively address problematic drug use.

Rinaldo Del Gallo agrees. While he will not out of hand reject drug courts, they raise many serious questions. Del Gallo believes drug courts can be a part of the solution, but they better be implemented correctly.

SEATTLE LEAD MODEL in the BERKSHIRE, HAMPDEN, FRANKLIN, HAMPSHIRE DISRICT

Seattle started a program that has much promise: LEAD, an acronym for Law Enforcement Assistance Diversion. The Frontline Documentary, Chasing Heroin praised the program. According to the documentary, a University of Washington Study found that lead was remarkably successful. The philosophy of the program is treatment and assistance on demand, and no incarceration. It is an alternative to dealing with such problems with Drug Courts.

LEAD describes its program as such:

Law Enforcement Assisted Diversion (LEAD) is a pre-booking diversion pilot program developed with the community to address low-level drug and prostitution crimes in the Belltown neighborhood in Seattle and the Skyway area of unincorporated King County. The program allows law enforcement officers to redirect low-level offenders engaged in drug or prostitution activity to community-based services, instead of jail and prosecution. By diverting eligible individuals to services, LEAD is committed to improving public safety and public order, and reducing the criminal behavior of people who participate in the program.

SOURCE: http://leadkingcounty.org/

Rinaldo Del Gallo believes that a program like LEAD might be used in Berkshire County and the surrounding towns in the district.

HOUSING FIRST

Del Gallo also believe in “housing first.” People do not see the link between alcoholism, drug abuse, depression, and even criminal conduct, but understanding homelessness is key to fighting these problems. If we want people to sober up or get off drugs, they need to be able to wake up in the morning and not be on a park bench.

Del Gallo wants to implement a “housing first” approach to fighting addiction and despair. It has worked in Denmark, and it will work here.

SOURCE: http://sciencenordic.com/housing-first-homeless-people-norway

Also see, http://www.english.umd.edu/interpolations/3466

MAKING NARCAN AFFORDABLE

Naloxone is sold under the brand name “Narcan” It blocks the effects of opioids and can prevent the effects of overdose, saving lives. According to Wikipedia, it is on the list of essential medicines. Del Gallo favors giving Nalozone not only to medical first responders, but police officers, as they have in New York. Reports the New York Times: “Part of the appeal for law enforcement officials has been the ability to deliver the drug through a nostril of an overdosing person using an atomizer attachment.”

Del Gallo agrees with Bernie Sanders that efforts need to be made to pressure the manufacturer to lower prices, which in recent months has nearly doubled.

SOURCE: http://www.nytimes.com/2014/12/01/nyregion/prices-increase-for-antidote-to-heroin-overdoses-used-by-police.html?_r=1

SOURCE: http://thehill.com/policy/healthcare/247659-sanders-pushes-for-lower-price-for-heroin-overdose-drug

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