Drug Policy Alliance and the Recovery Movement

I had the opportunity to sit on a panel today during a drug policy alliance session on the role of the recovery movement in drug policy discussions. While it was obvious that everyone on the panel could generally agree that the current U.S. policy when it comes to drug use, abuse, and addiction is not working and unsustainable, it wasn’t clear that we had a common roadmap of how to get to a better place.

Some of the panel speakers were in recovery and others weren’t and while most were from the U.S. we had a representative of the Scandinavian approach for a nice little “reality check” and a bit more balance than one normally gets on these things. From student representatives of the Columbia University Students for Sensible Drug Policy to the distinguished William Moyers from Hazeldon, our panel certainly didn’t lack in a breadth of experiences. Still, even our eight member-panel couldn’t appease everyone when it came to diversity (we missed the mark on racial representativeness). The discussion was civil, but definitely showed that there are serious differences that need to be bridged if the decriminalization discussion is to ever get serious.

I’m all for collaboration and I definitely think that we need to end up in a place where drug use is no longer criminalized as it currently is. Quadrupling our prison population in a few decades with approximately 20% of inmates incarcerated for drug offenses is stupid, expensive, and does little to stop the problem we’re trying to deal with as evidenced by the relatively stable rate of use, abuse, and addiction in this country.

But how do we move forward? Do we make these drugs legal for everyone to use or place an age limit on it? Do we pretend that there’s no risk that use of legal substances will go up to meet the rates of alcohol and tobacco abuse or do we prepare for the possibility that it might? Do we completely remove legal sanctions from the discussion or do we keep them for a specific subset of hard to reach individuals?

As far as I’m concerned, until these questions are considered and dealt with, there’s not going to be any change. Unfortunately, from my reading of the panel and crowd today, even at a Drug Policy Alliance conference, the responses to each of those questions is likely to bring up a lot of debate. I guess that means our work is not yet done…

Two Million Dollars a piece – The cost of drug use and violence

The average cost to society of a lifelong criminal = About $2 million

I’ll get into more of this in later posts (I already talked about the cost of addiction prevention versus treatment versus enforcement), but if that cost of drug use and violence doesn’t cry out for a better application of money to prevention and addiction treatment, I don’t know what does.

At that cost, even if a treatment method costs $10k per client, it only needs to work for 1 out of 200 people to break even, and benefit society while doing so. In reality, our success rates are much higher than .5% (1/200) and closer to 15%-25%. When you take into account the fact that average cost of a month in addiction treatment (residential, outpatient treatment is much cheaper) is indeed about $7000-$10,000, it seems silly not to avoid the cost of crime by greatly reducing drug use, and hence criminal behavior.

NIDA, the government’s top agency for drug and alcohol abuse research recommends three months of treatment, but even then, success rates as low as 2% would leave us with a profit by providing treatment. Screw it, even a whole year of treatment would save us money if it succeeded but I can tell you that funding for that kind of addiction treatment length is almost non-existent, especially when compared to the actual need.

So with success rates about 20 to 30 times higher than our break-even point, we would literally benefit, and I’m talking financially, from helping people with treatment as expensive as $100,000 or more (as long as it worked). One of the things I’ve learned in all my work has been that while some individuals are actually interested in helping people, yes, even if they’ve been dirty drug addicts who have commited crimes, almost everyone cares about money. So forget for a second about all the social justice arguments to be made for helping addicts and think about the cost savings to our society… It makes sense.

True, true, not all drug users who would enter treatment would become lifelong offender, but if you’re still keeping tabs, even if only 1/20 or so do, we’re more than breaking even here. In fact, with our prison populations exploding as more and more drug users enter the system, I bet we’re in for some real savings.

Citation:

Dodge, K. A. (2008) Framing public policy and prevention of chronic violence in American youths. America Psychologist, 63, 573-590.

Should all drugs be decriminalized? A UK debate

Christopher Russell

In a recent UK parliamentary debate, Bob Ainsworth MP, a former Home Office minister in charge of drugs policy, called for the decriminalization of all drugs. Ainsworth, the most senior UK politician to publicly endorse a system of decriminalization, joins respected figures from the medical and research communities in recent months in suggesting that the decriminalization of drugs would significantly improve public health and reduce crime further than is being achieved under the current system of criminalization. Ainsworth argues that that the past 50 years of the War on Drugs has been counter-productive to its intended goals of reducing the availability of drugs and improving public health. Furthermore, he claims that billions of pounds had been spent without preventing the wide availability of drugs, reducing the wide use of drugs, or weakening the illicit drug market. Consequently, Ainsworth proposes that the drug market be taken out of the hands of organized criminals and be placed into the hands of medical professionals and licensed vendors. Such a change in policy would mark a return to UK drug policy prior to the mid-1960’s in which drug use was treated as a health issue, not a criminal issue.

“It is time to replace our failed war on drugs with a strict system of legal regulation, to make the world a safer, healthier place, especially for our children. This (policy of criminalization) has been going on for 50 years now and it isn’t getting better. The drugs trade is as big, as powerful as it ever was across the world. Prohibition isn’t the answer to this problem” he said.

It is important to understand that Ainsworth is not arguing that drugs like heroin and cocaine should be freely available to buy in the same way that adults can buy alcoholic drinks and tobacco products. Rather, he argues that drugs be decriminalized, which is different from legalized. Decriminalizing would likely mean the government would control all aspects of the manufacture, quality, purity, distribution, and trade of drugs, including who will be licensed to provide drugs. Legalization would mean drugs could be traded in the free market, a position which Ainsworth is explicitly against. “I’m not proposing the liberalization and the legalization of heroin so we can all get zonked out on the street corner” Ainsworth said in an interview with BBC’s Radio 4.

Why decriminalize drugs?

The argument for decriminalization is based on the hypothesis that the legal regulated supply of drugs will draw trade away from the illicit market and so reduce crime related to the illicit sale and purchase of drugs; improve the health of users by providing quality-controlled drugs under the guidance and supervision of licensed individuals; increase the uptake of addiction treatment; allow treatment providers to reconnect with a group of drug users who do not typically seek or know about treatment options or have distanced themselves from treatment providers for fear of criminal prosecution; and improve drug education for current and would-be drug users.

If decriminalizing does shift the drug market toward legal vendors, a major benefit could be the medical and addiction research communities’ sudden widespread access to a population of drug users who are notoriously difficult to reach. This access would allow medical professionals and researchers obtain rich first-hand information as to why these people started using drugs and why they use drugs today, to provide drug education, to provide assistance with any problems relating to employment, housing, relationships or physical and mental health. Decriminalizing drugs may therefore better place treatment providers to support those who want help and to minimise harm in those who continue to use. Paradoxically then, while many people believe decriminalization will send a message to the youth that drug use is acceptable as well as maintaining use in current users, proponents of decriminalization argue that, by reconnecting drug users to the health community, legal regulation of drugs will actually increase in the number of people quitting drugs and provide earlier opportunities to deliver educational interventions to ‘would-be’ drug users.

What might decriminalization look like?

While Ainsworth did not describe in detail how drugs should be regulated, Steve Rolles, Head of Research for the Transform Drug Policy Foundation, which campaigns for the decriminalization of drugs, released a ‘blueprint for regulation’ in December, 2009 which described how models of regulation for different types of drug would improve health and decrease crime. The report proposes that cannabis and opium could be sold and consumed on membership-based “coffee shop-style” licensed premises and would likely be subjected to similar trade laws as those currently applied to tobacco products; cocaine, ecstasy and amphetamines could be sold by licensed pharmacists or named purchasers; and psychedelic drugs, including hallucinogens such as LSD or Salvia could be used only under supervision in licensed “drug clubs” or similar venues. Rolles said: “Drugs are here to stay, so we have a choice – either criminals control them, or governments do. By the cautious implementation of a legally regulated regime, we can control products, prices, vendors, outlets, availability and using environments through a range of regulatory models, depending on the nature of the drug, and evidence of what works”.

Rolles also echoed Ainsworth’s sentiments about the futility and counter-productiveness of prohibition in a recent BBC radio interview: “It hasn’t reduced drug use, it hasn’t prevented the availability of drugs, but it has created a whole raft of secondary problems associated with the illegal market, including making drugs more dangerous than they already are and undermining public health and fuelling crime”.

Rolles called on the UK government to consider evidence about the effectiveness of the prohibition policy both in the UK and other countries and health and crime projections under a decriminalized system. Craig McClure, foreword author on the Transform Drug Policy Foundation report and former executive director of the International Aids Society states that several Latin American governments have already realised how their war on drugs have undermined public health goals and fueled crime and have already moved, or are moving, towards decriminalization and a public health model targeting the prevention and treatment of drug misuse.

What next for the decriminalization deabte?

Knowing that drug decriminalization is a sensitive, emotion-laden, divisive idea, and therefore public support from fellow MPs will initially be largely absent, Ainsworth has called for an impact assessment to be conducted on the Misuse of Drugs Act, 1971 – the legislation which introduced drug classification in the UK – rather than calling for drugs to be decriminalized outright.

“I call on those on all sides of the debate to support an independent, evidence-based review, exploring all policy options, including: further resourcing the war on drugs, decriminalizing the possession of drugs, and legally regulating their production and supply” he said. As influential political, medical and scientific forces join to pressure a review of the efficacy of current drug policy, there is a sense in the UK that drug decriminalization is slowly moving from an ideological conviction to an evidence-based alternative to a failing system of prohibition.

Please write your comments about the prospect of drug decriminalization in the box below.

References:

Bob Ainsworth BBC 1 television interview, 16th December, 2010. Accessible at http://www.bbc.co.uk/news/uk-12005824

Bob Ainsworth BBC Radio 4 interview, 16th December, 2010. Accessible at http://www.bbc.co.uk/news/uk-12005824

Transform Drug Policy Foundation (2009). After the war on drugs: Blueprint for regulation. Accessible at http://www.tdpf.org.uk/Transform_Drugs_Blueprint.pdf

Medical and political support for the Transform Drug Policy Foundation’s ‘blueprint for regulation’ (2009) report. Accessible at http://www.tdpf.org.uk/blueprint%20download.htm

NIDA and ONDCP – American policy on addiction research

At this year’s College on Problems of Drug Dependence (CPDD) Annual Meeting, I got to hear, and talk to, some of the most influential players in the American addiction research field. Here are a few highlights from their talks and our discussion:

Dr. Nora Volkow of NIDA talked about a shift from Genome Wide Association Studies (GWAS), which have been the most recent popular advance in genetics addiction research and into more Deep Sequencing work. The hope is that this will allow us to begin untangling some of the GWAS findings that have seemed counter-intutitive or puzzling. Deep sequencing should let us see what genes really are associated with addiction specifically, not just as markers.

Dr. Volkow also brought up the numerous issues of medications for addictions including the Nabi Nicotine Vaccine, Vivitrol (a Nalexone depot that helps opiate users who wouldn’t take it otherwise), and a host of new medications that are being developed or considered. An interesting idea here was the use of drug combinations which are showing great promise in providing enhanced treatment results (similar to HIV treatment that benefited greatly from drug cocktails). These include combining vernicline and bupropion for smoking and naltrexone and buprenorphine for cocaine (that’s not a type even though both have been typically thought of for opiate addicts).

Dr. Tom McLellan, who I personally believe is one of the most informed and thoughtful people we have when it comes to addiction research in this country, talked about our need to expand the reach of treatment to the drug abuse earlier in the problem cycle. While about 25 million people are considered drug addicts in this country, more than 65 million are drug abusers. By finding ways to reach those people in primary care (as in doctor offices) settings before they develop the full blown addiction we’re used to talking about we can do better. He also mentioned the idea of anonymity in recovery playing a role in the continued stigmatization of addiction, a topic I’ve written about recently.

Stay on the lookout for more amazing new addiction research knowledge!

Addiction stories: Alcohol, marijuana, crime, and John’s life

The following story was shared by a young reader. I was first drawn to it because it mirrored mine to a large extent. Fortunately, John decided to pull out before he let his life go down as far as I allowed myself to go. For that, and for his courage in sharing his story, I applaud him.

John’s addiction story

My name is John and I am an alcoholic and a raging drug addict. I’m seventeen years old and only used for about 2 and a half years, but that was more than enough for my life to fall to pieces because of my addiction.

When I was fourteen I got a little drunk for the first time. I hated the way the alcohol tasted, and I hated how it made me so sick. The effects were nice, but I wished that I could get them without having the unpleasant side effects.

I found a solution to this problem at age 15 with marijuana. Within my a few months of my first time smoking, I was getting high multiple times every single day. My friends were changing rapidly because the ones who really cared didn’t approve of my heavy usage. I responded to this by getting new friends. Around this time I also became addicted to stealing in order to support my addiction and also in order to look cool by having a lot of money. My friends and I would get high and drunk and then go out at night and steal hundreds and hundreds of dollars from people’s unlocked cars.

I began selling pot at age 16. Dealing was a new experience for me. I won’t lie and say it wasn’t fun – it was, definitely. But the rush of making heaps of money and being loved by all your peers becomes an addiction in itself. I was dealing pretty heavily, for a high schooler selling pot – some days I would sell a thousand dollars worth of it at school. Afterward, I lived what I thought was a carefree and safe lifestyle; I smoked weed with friends all day, and eventually we moved onto harder drugs.

My usage increased heavily and I began using other drugs as well. I slowly began trying all the things I said I would never do, and before long, my life was absolutely governed by cocaine, alcohol, prescription medications, and lots and lots of pot. I got really into cocaine a few months into it – and then everything changed. Walls fell down; suddenly opiates weren’t anywhere near as scary to me, hence my common run-ins with Vicodin, Valium, Percocet, and Oxycontin. None of the prescription pills had the same kind of power coke had over me, though; my teeth still chatter sometimes when I start craving the rush of that manipulative white powder going up my nose. Cocaine is a pretty serious drug, and I was hooked before I even realized what was happening. This is unlike my experience with getting hooked on pot and booze; with those, I could recognize the kind of path I was going down, but I just couldn’t stop. There is a reason coke is called a “hard drug” – because you’ll fall for it. Hard. People go into with the mindset that they can handle it. Maybe some people can. I, however, am not one of those people – the second I pop a pill or blow a line, all I can think about is getting more to keep my buzz going.

Of course I also began getting into trouble with the law. February 16, 2009, I was arrested for the first time after picking up a couple ounces of weed. I met some buddies in town to smoke, but they didn’t inform me that they had vandalized a building at a school earlier. Before I knew it we were being followed by policemen. They caught up with us, encircled us in cop cars, causing a roadblock, and searched all of us. They immediately found my bag of weed and cuffed me, along with all my buddies. I played the innocent child, though, and got off with a possession charge.

The second arrest took place only four months later. I was back to my old dealing ways – by now I was suicidal, addicted to all kinds of drugs, and had no faith in other people. I got high and brought an ounce of weed with me to school, and was found by the school officer in a bathroom stall, selling a few grams to a 14 year old. I was arrested with intent to sell, endangering a minor, possession on school grounds, and possession of marijuana. Also, I was expelled from school. I began saying I was going to kill myself to gain some sympathy, at which point I was placed in a 2 week long mental ward. After that, it was off to rehab for me, where I had sex, did drugs, lied and stole.

A few days after getting out of treatment, I was using again. I remember feeling like an empty shell – I would stay up for days at a time, stealing, lying, and using people to get my drugs and liquor. My family thought I was sober at this point, and I began at a character-based boarding school in August.

I brought a lot of pot with me and resisted everything the school was trying to offer me. Once the pot ran out, I began huffing up to 2 cans of computer duster every day, along with a daily dosage of booze and a whole lot of cough medicine.

I hit bottom on November 16, 2009. As far as I’m concerned, that’s the most important day of my life – that was the day I finally decided I had had enough. I called up my mother, crying and saying I was really done this time, but she didn’t believe me (who could blame her). So I then called up an old friend who I knew was heavily involved in a 12-step group. This man is my sponsor today. We work our program together, and maintain daily contact.

At almost 90 days sober, I can honestly say I have never been so grateful and serene in my entire life. If you’re reading this and you can relate to my story, please know that there is a way out of the twisted insanity that is drug addiction and alcoholism. I should be dead right now, but I’m still here – as far as I’m concerned, that’s proof enough for me to believe in a loving Higher Power. As long as I remember to help other addicts, talk to my sponsor, work my 12 step program, and remain honest, I don’t have to drink and drug today. And to me, this is a miracle.

A little insight

John’s story mirrors that of many other addicts: Early innocent use followed by the dissolution of self-imposed rules about what one will, and won’t, engage in. Cocaine might seem scary at first, but after a lot of weed, alcohol, and some ecstasy, it might just lose that edge. As I’ve talked about in other posts, there are quite a few common personality issues that make it even less likely that a future addict will say no to increasing degrees of abuse.

Once again I want to make a point that I think it important: Drugs are the road, but not the problem per se when it comes to addiction. The vast majority of people who try drugs don’t get addicted to them – What we need to get better at is understanding the process by which those who do, develop problems. This includes earlier identification, better targeted prevention, and more effective treatment. That’s my take on all of this at least.

Know before you speak – Why etiquette is important

You know, I try to write this blog from a completely objective point of you, but guess what – I’m a person, so things take on a personal tone once in a while.

There’s nothing I hate more than readers who come to this site, read a single post, and then decide they know who I am, or what I’m about. It’s taken me more than 13 years to get to this point in terms of my knowledge, experience, and viewpoint on drugs, addiction, and policy issues. It all started with 8 years of some personal “experimentation” with the behaviors I’m talking about. I’d love to say I was doing it for science, but the last three years were far from enjoyable for many around me. Since then I’ve studied statistics, neuroscience, public-health, and psychology. And I’m not done. Staying in the academic world, I keep educating myself on issues related to addiction from every field I have access to.

So please, if you have opinions, share them, but if you want to insult me, make sure you know what you’re talking about, because I’ll tell you if you don’t. Personal attacks are easy to make through an internet connection, but being stupid will leave an obvious stain and will cause me to either remove your comment or just reveal how ridiculous it is. I don’t like making personal attacks on people – not in posts, not in comments, and not in real life. Don’t tell me how you do, or don’t, want me to die because I probably don’t care how you go and I certainly don’t want the experience to be bad.

I know blogs are a little loose, but let’s keep this at least somewhat professional, okay?

NY Times and Dr. McLellan – Two giants, great story about addiction

When the NY Times picked a focus for their most recent story on addiction policy and research, they couldn’t have asked for a better representative than Dr. McLellan who after decades of addiction research is now helping to form U.S. drug policy.

The man is one of my personal idols and believes, like I do, that addiction is a mental health issue and not a moral one. He is married to a cocaine addict and has recently lost one of his sons to a suicide by pills and alcohol.

Please check out the rest of this story for a glimpse into the man who is now our #2 Drug Czar! Finally there is someone at the helm that truly understands the nature of addiction.