People tell me my idea for reforming our criminal justice controls on drug use by setting up a use tolerant system with coach and extra-legal control measures will meet tough resistance from the prohibitionists. Of course that is true and in Kill the Drug Trade I acknowledge the political wind blowing against the idea.
But, that wind is weakening rapidly as America listens to the debates over marijuana, and increasingly has the chance to see what’s happening with harm reduction.
Most who read the posts on my blog site know about harm reduction. A new example of it is Maryland’s Overdose Survivor Outreach Program, about which prominent addiction psychiatrist Sally Satel recently wrote. There the overdose survivor is linked up in the emergency room with a “recovery coach,” who will work with them toward getting treatment. Usual forms of treatment to which they are steered include counseling, along with medically assisted addiction treatment. MAT is done with methadone or the less risky buprenorphine. The other medicine sometimes used here is called naltrexone. Unlike the others, naltrexone doesn’t produce a high. Instead it prevents opioids from producing one. It blocks the effects of opioids. Coaches also help their clients in following up and assisting them in making court appearances and accessing social services.
I have written before about the LEAD program in Seattle, which is now being used in other U.S. cities as well. Instead of being taken into court, the low-level drug violator is given the option of counseling at a non-profit organization in the city. There, in addition to counseling, the arrestee is helped to clean up his act with better nutrition, housing and sometimes employment. The city spends several hundred thousand dollars per year on this, but has discovered it so improves neighborhoods it saves even more dollars in policing costs and social issues.
In Chillicothe, Ohio, Satel states, police try to connect addicts to treatment by visiting their homes after an overdose emergency. And, she says, in Gloucester, Mass., heroin users can walk into the police station, hand over their drugs, and walk into treatment within hours, without arrest or charges. It’s called the Angel Program. A similar approach is not used in Macomb County, Michigan. They call it Hope Not Handcuffs.
Injection sites are coming too. So far the supervised consumption site idea initiated in Vancouver, B.C. has been resisted in the U.S., but we should start to see them soon. They save lives by providing a clean place to inject and a nurse to keep an eye on the proceedings. If overdose signs appear, the nurse is equipped with oxygen and naloxone. Data collected in Canada show serious reductions in drug abuse as well as overdose deaths. Users of these facilities are not cajoled or coerced toward treatment, but some have testified to moving to rehab because of the respect they were shown there. Moreover, access to clean needles has reduced the spread of disease—HIV and Hepatitis C.
In the U.S., several jurisdictions such consumption sites have been endorsed notably in King County, Wash., Baltimore, Boston, Burlington, Vt., Ithaca and New York City in New York, Philadelphia and San Francisco. As Satel puts it: “Drug-war weary police officers and harm reductionists would rather see addicts opt for treatment and lasting recovery, but they’ll settle for fewer deaths.”
These developments, along with clean needle exchanges, now allowed in many parts of the country are signaling an acceptance like we have never seen before–that drug addiction is a disorder and should be treated as a disorder rather than as a crime. The primary purpose of harm reduction was always to save lives, but they have also taught us that addicted people respond positively to more respectful and helpful treatment. they respond by reducing irresponsible use and by moving toward rehab.
There is an unmistakable change taking place in the attitude of America. Criminal law never worked to reduce drug use, and it wasn’t necessary either. Tolerance with counseling and a helping hand does work. And, thanks to prohibition with its ever present black market making drugs available to minors, has become increasingly necessary.
My idea, it turns out, is just an extension of the harm reduction techniques already proving so workable. Maybe the opposing winds will start blowing the other way one of these days.
© All rights reserved to Dave Finch 4/10/2017
For more information about my proposed use tolerant system visit Reform Drug Policy Project.