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Could Different Drug Policies Have Saved Philip Seymour Hoffman?

The tragic death of actor Philip Seymour Hoffman yesterday has prompted expressions of grief and of praise for his talent. It also, naturally, has prompted discussions of addiction, the impact of pain pill prescriptions on the addicted, even of pain pill restrictions causing more people to turn to heroin.

Philip Seymour Hoffman at the 81st Academy Awards (courtesy Chrisa Hickey, flickr.com/photos/chrisahickey/, via wikimedia.org)
While the latter raises the question about whether different drug policies could make things safer or less damaging or risky for heroin addicts, I haven't heard that question directly raised in the media. Although we don't know how Hoffman would have fared under a different system -- a system that had more options available, we do have information from places that do offer more options, and they are worth examining.

One of those options is heroin maintenance programs (also known now as heroin assisted treatment, or HAT). The most famous such program operated in Liverpool, England, before the conservative Thatcher government, encouraged by the Reagan administration (so we heard), shut it down. But HAT programs current operate in Switzerland, The Netherlands, Germany, Denmark, and the Canadian cities of Vancouver and Montreal. Patients in such programs receive a supply of pharmaceutically-produced heroin from a clinic (for free, though one can infer similar benefits if the heroin were merely cheap). They regularly access health services as a part of their participation. Those who need to inject the drug to relieve their cravings receive instruction on how to do so without damaging their veins, and heroin is made available in other forms as well.

A 2009 paper by leading drug policy researcher Peter Reuter, written for The Abell Foundation in Baltimore, reviewed research done in three of those countries. According to Reuter, Switzerland found a decrease in criminal involvement from 70% of the patients down to 10% after 18 months; and an increase in employment, from 14% to 32%. The health safety results were particularly impressive, including decreased contact with the street drug scene, and with very few adverse events or safety issues.

Many of those findings relate more to indigent addicts than they would to a famous actor. But the final point seems key, very few "adverse events" (e.g. overdoses and so forth) or safety issues, in any of the programs. Again, we don't know how Hoffman would have fared if he had entered a heroin maintenance program instead of buying it on the street. For that matter, we don't know if under legalization, broad or just for the addicted, whether Hoffman would have accessed such services in time, or chose to access them at all. But we know that many people do access these services in the countries that offer them, and that very few of the patients enrolled suffer overdose.

More generally, by prohibiting heroin, even for people who are already addicted to it, we prevent a whole class of possible approaches from every being taken to try to help people -- a whole set of options that people with substance abuse problems might be able to use to manage their problems -- to literally save their lives.

In the meanwhile, there are things to do that are legal even now, at least in a few states that have moved forward with them, with no federal laws standing in the way. These are Good Samaritan policies, that protect people from criminal liability when they seek help in an overdose situation; and use of the antidote medication for heroin overdoses, Naloxone. Meghan Ralston wrote about these in an oped yesterday.

We can also improve the debate. It's not enough to talk about the challenges of addiction and the risk of relapse people can face their entire lives, important as that is. It's a good start that people are starting to recognize the unintended consequences of the pain pill crackdown. But that isn't enough either. It's also important to take the next logical step in the argument, and rethink prohibition.

Oregon Bill Would Make Cigarettes Controlled Substances

An Oregon lawmaker has introduced a bill that would make cigarettes a Schedule III controlled substance. That means it would be illegal to possess or distribute cigarettes without a doctor's prescription.

Rep. Mitch Greenlick (osea.org)
Other Oregon Schedule III drugs include ketamine, LSD, and anabolic steroids.

Sponsored by Rep. Mitch Greenlick (D-Portland), the bill, House Bill 2077, would make violations a Class A misdemeanor with a maximum penalty of up to one year in prison, a $6,250 fine, or both. The same penalty would apply to both possession and distribution.

The bill directs the state Board of Pharmacy to "adopt rules to classify nicotine as a Schedule III controlled substance." It would also require people involved in tobacco transactions keep records and to "forward the records to the State Police if directed to do so by the department." Failure to do so would also be a Class A misdemeanor.

The bill had a first reading last week and has now been referred to the Judiciary Committee.

Eugene, OR
United States

Giving Addicts Heroin More Effective Than Methadone, Study Finds

Treating intractable heroin addicts with a pharmaceutical version of their drug is more cost-effective than providing them with methadone, a common opioid substitute, a study published Monday in the Canadian Medical Association Journal suggests.

Diacetylmorphine AKA pharmaceutical grade heroin (wikimedia.org)
The study analyzed data from the North American Opiate Medication Initiative (NAOMI ), a 2005-2008 study that compared the use of diacetylmorphine (heroin) and methadone in street addicts. In the NAOMI study, researchers selected 250 subjects in Vancouver and Montreal who had been strung out for at least five years and had twice previously failed on methadone maintenance. Participants were randomly chosen to take either heroin or methadone.

Researchers in this study examined the cost-effectiveness of the two approaches in one-year, five-year, 10-year increments, as well over the lifetimes of the users. The study found that those using methadone generated an average lifetime social cost of $1.14 million, while those using heroin had a cost of $1.1 million, a difference of about $40,000 per user. An estimated 60,000 to 90,000 Canadians are addicted to heroin or other opioids.

"If you are on treatment, you're basically well-behaved," principal investigator Aslam Anis, a health economist at the University of British Columbia told the Canadian Press Monday. "When you're not taking treatment, for instance when you relapse, you're doing all kinds of bad things, criminal activity, getting into jail. The cost benefit is through an indirect effect," said Anis, through fewer robberies and other crimes, which have an adverse impact on victims and drive up criminal justice system costs.

"People who take (medical) heroin are retained on the treatment for longer periods of time and they have shorter periods of time when they relapse," Anis said. "And when you add it all up, you find that you've actually saved money."

"Methadone can be a very effective medication for some people, but it doesn't work for everybody with heroin addiction," said coauthor Dr. Martin Schechter, an epidemiologist at UBC's School of Population and Public Health. "And there is a subset of folks who go in and out of treatment and ultimately end up back using street heroin. They would be unlikely to be attracted into yet another methadone program," he said.

"But giving them injections of medically prescribed heroin in a clinic setting staffed by doctors, nurses and counselors gets them back into the health-care system. It also cuts the risk of infection with hepatitis C and HIV from needle-sharing. So diacetylmorphine is a medically prescribed heroin that we show in the study was more likely to keep people in treatment. And we know that keeping people in treatment is a very important predictor of success."

No matter what this or any other study finds, the Conservative Canadian government is opposed to harm reduction measures, such as safe injection sites and heroin maintenance therapies. Still, said Schecter, the government needs to face reality.

"The fact is that these people are taking heroin right now. They're in the back alleys in the Downtown Eastside, they're buying the heroin on the street, contributing to the black market and crime and violence," he said. "And they're not in any treatment and they're costing the system lots and lots of money. So our proposal says rather than having them do that in the back alley, why don't we attract them into a clinic where they will be in contact with doctors and nurses and counselors, we stabilize them by getting them out of a life of crime."

So, is anybody listening in Ottawa? Probably not, but the current government won't be in power forever.

Canada

How should employers handle workers who use medical marijuana where legal? (Poll)

Location: 
The Wall Street Journal wants to know what you think. Should employers create policies for workers with medical marijuana prescriptions? How should the conflicts be balanced?
Publication/Source: 
The Wall Street Journal (NY)
URL: 
http://online.wsj.com/community/groups/health-care-us-550/topics/how-should-employers-handle-workers

Ecstasy found to Help Alleviate PTSD among Military Veterans

Researchers are gaining ground in the combat against posttraumatic stress disorder (PTSD) in an unlikely way.  Touted as “the party drug,” ecstasy, or MDMA, may just be the saving grace for hundreds of thousands of veterans suffering from PTSD.

According to a study by the Rand Corporation, in 2008 one in five soldiers returning home from Afghanistan or Iraq showed symptoms of PTSD. All in all, nearly 300,000 returning soldiers were affected. Letting individuals with PTSD go untreated is detrimental to both the individual and to society as a whole, as it has been linked to higher incidences of depression, health issues, violence, marital problems, drug use, unemployment, homelessness and suicide among veterans. And although each active military service member is provided with $400,000 in military life insurance coverage, that provides little comfort to families of a PTSD-afflicted veterans.

The Study

In the first controlled study published in the Journal of Psychopharmacology in July, 2010, ecstasy was used in combination with psychotherapy to treat patients suffering from PTSD.  The subjects tested in the trial were patients with symptoms that were not improving with standard psychotherapy and antidepressants. According to Time Magazine, government-approved drugs such as Paxil and Zoloft typically administered to PTSD patients are only effective in about 20% of cases. Therapy has a higher success rate in alleviating symptoms; however, one-fourth of all patients drop out when asked to recall painful or stressful memories.

The Science behind Ecstasy and PTSD-afflicted Military Veterans

The theory behind this very controversial treatment is that ecstasy releases a large amount of mood-regulating chemicals, serotonin and dopamine, in the brain. Patients who have taken ecstasy are more open in therapy sessions and able to talk about otherwise agonizing events.  The results showed that after two months of therapy 83% of the patients that were given ecstasy showed tremendous signs of improvement and were no longer being classified as PTSD patients.

This pilot study has opened a psychedelic door in the pharmaceutical world. There is hope yet for veterans suffering from posttraumatic stress disorder.

Feature: Drug War a Devastating Failure, Scientists and Researchers Say in Vienna Declaration

A decade ago, scientists, researchers, and AIDS activists confronted a sitting president in South Africa who denied that AIDS was caused by HIV. They responded by declaring at the 2000 Durbin AIDS conference that the evidence was in and the matter was settled. Now, with the Vienna AIDS conference coming up later this month, they are at it again -- only this time the target is the war on drugs.

http://www.stopthedrugwar.org/files/vienna2009demo1.jpg
HCLU-organized demonstration outside UN anti-drug agency, former SSDP executive director Kris Krane inside cage (drogriporter.hu/en/demonstration)
Their weapon is the Vienna Declaration, an official conference statement authored by experts from the International AIDS Society, the International Center for Science in Drug Policy, and the British Columbia Center for Excellence in HIV/AIDS. The document is a harsh indictment of the global drug war that calls for evidence-based policymaking. It demands that laws which criminalize drug users and help fuel the spread of AIDS be reformed.

The authors of the Vienna Declaration want you to sign on, too. You can do so at the web site linked to above.

"The criminalization of illicit drug users is fueling the HIV epidemic and has resulted in overwhelmingly negative health and social consequences. A full policy reorientation is needed," they said in the declaration.

Arguing there is "overwhelming evidence that drug law enforcement has failed to meet its stated objectives," the declaration lays out the consequences of the drug war:

  • HIV epidemics fueled by the criminalization of people who use illicit drugs and by prohibitions on the provision of sterile needles and opioid substitution treatment.
  • HIV outbreaks among incarcerated and institutionalized drug users as a result of punitive laws and policies and a lack of HIV prevention services in these settings.
  • The undermining of public health systems when law enforcement drives drug users away from prevention and care services and into environments where the risk of infectious disease transmission (e.g., HIV, hepatitis C & B, and tuberculosis) and other harms is increased.
  • A crisis in criminal justice systems as a result of record incarceration rates in a number of nations. This has negatively affected the social functioning of entire communities. While racial disparities in incarceration rates for drug offenses are evident in countries all over the world, the impact has been particularly severe in the US, where approximately one in nine African-American males in the age group 20 to 34 is incarcerated on any given day, primarily as a result of drug law enforcement.
  • Stigma towards people who use illicit drugs, which reinforces the political popularity of criminalizing drug users and undermines HIV prevention and other health promotion efforts.
  • Severe human rights violations, including torture, forced labor, inhuman and degrading treatment, and execution of drug offenders in a number of countries.
  • A massive illicit market worth an estimated annual value of US $320 billion. These profits remain entirely outside the control of government. They fuel crime, violence and corruption in countless urban communities and have destabilized entire countries, such as Colombia, Mexico and Afghanistan.
  • Billions of tax dollars wasted on a "War on Drugs" approach to drug control that does not achieve its stated objectives and, instead, directly or indirectly contributes to the above harms.

"Many of us in AIDS research and care confront the devastating impacts of misguided drug policies every day," said Julio Montaner, president of the International AIDS Society and director of the BC Center for Excellence in HIV/AIDS. "As scientists, we are committed to raising our collective voice to promote evidence-based approaches to illicit drug policy that start by recognizing that addiction is a medical condition, not a crime," added Montaner, who will serve as chairman of the Vienna conference.

"There is no positive spin you can put on the war on drugs," said Dr. Evan Wood, founder of the International Center for Science in Drug Policy. "You have a $320 billion illegal market, the enrichment of organized crime, violence, the spread of infectious disease. This declaration coming from the scientific community is long overdue. The community has not been meeting its ethical obligations in terms of speaking up about the harms of the war on drugs."

Stating that governments and international organizations have "ethical and legal obligations to respond to this crisis," the declaration calls on governments and international organizations, including the UN to:

  • Undertake a transparent review of the effectiveness of current drug policies.
  • Implement and evaluate a science-based public health approach to address the individual and community harms stemming from illicit drug use.
  • Decriminalize drug users, scale up evidence-based drug dependence treatment options and abolish ineffective compulsory drug treatment centers that violate the Universal Declaration of Human Rights.
  • Unequivocally endorse and scale up funding for the implementation of the comprehensive package of HIV interventions spelled out in the WHO, UNODC and UNAIDS Target Setting Guide.
  • Meaningfully involve members of the affected community in developing, monitoring and implementing services and policies that affect their lives.
  • We further call upon the UN Secretary-General, Ban Ki-moon, to urgently implement measures to ensure that the United Nations system -- including the International Narcotics Control Board -- speaks with one voice to support the decriminalization of drug users and the implementation of evidence-based approaches to drug control.

"This is a great initiative," enthused Ethan Nadelmann, executive director of the Drug Policy Alliance. "It is the most significant effort to date by the sponsors of the global AIDS conference to highlight the destructive impact of the global drug war. It is nicely coordinated with The Lancet to demonstrate legitimacy in the medical community. And it is relatively far reaching given that the declaration was drafted as a consensus statement."

"This is aimed at politicians, leaders of governments, the UN system, and it's aimed at housewives. We are trying to do basic education around the facts on this. There are still politicians who get elected vowing to crack down on drugs," said Wood. "While the declaration has a global aim and scope, at the end of the day, the person who is going to end the drug war is your average voter, who may or may not have been affected by it," he said.

"This was needed a long time ago," said Wood. "The war on drugs does not achieve its stated objectives of reducing the availability and use of drugs and is incredibly wasteful of resources in locking people up, which does little more than turn people into hardened criminals," he said.

The authors are hoping that an official declaration broadly endorsed will help begin to sway policy makers. "It will be interesting to see what kind of support it receives," said Wood. "Former Seattle Police Chief Norm Stamper has endorsed it, and we have a 2008 Nobel prize winner for medicine on the web site. There are high level endorsements, and more are coming. Whether we touch a nerve with the news media remains to be seen. I am hoping it will have a big impact since this is the official conference declaration of one of the largest public health conferences on the planet."

"We have reached a tipping point in the conversation about drugs, drug policy, drug law enforcement, and the drug war," said Stamper, now a member of Law Enforcement Against Prohibition. "More and more, science has found its way into the conversation, and this is one step to advance that in some more dramatic fashion. I've heard much from the other side that is emotional and irrational. This is one effort to create even more impetus for infusing this dialogue on drug policy with evidence-driven, research-based findings."

That the AIDS conference is being held in Vienna adds a special fillip to the declaration, Wood said. "Vienna is symbolically important because it is where the infrastructure for maintaining the global war on drugs is located," said Woods, "and also because of the problems in Eastern Europe. In Russia, it's estimated that one out of every 100 adults is infected with the AIDS virus because Russia has not embraced evidence-based approaches. Methadone maintenance therapy is illegal there, needle exchanges are severely limited, the treatment programs are not evidence-based, and there are all sorts of human rights abuses around the drug war."

With the AIDS conference set to open July 18, Wood and the other authors are hoping the momentum will keep building up to and beyond. "It is my hope that now that the Vienna Declaration is online, large numbers of people will come forward and lend their names to this effort," he said.

The Vienna Declaration is one more indication of just how badly drug war orthodoxy has wilted under the harsh gaze of science. It's hard to win an argument when the facts are against you, but as the declaration notes, there are "those with vested interests in maintaining the status quo." The declaration should make their jobs that much more difficult and bring progressive approaches to drug policy that much closer.

Europe: Norwegian Committee Calls for Heroin Prescription Trials, Harm Reduction Measures

A blue-ribbon committee in Norway has called for heroin prescription trials and expanded harm reduction measures, such as expanding safe injection sites. The Stoltenberg Committee presented its findings in a 49-page report (sorry, Norwegian only) issued last month.

http://www.stopthedrugwar.org/files/norwegianfjord.jpg
Norwegian fjord (courtesy Erik A. Drabløs via wikimedia.org)
The committee was created last year by then Health Minister Bjarne Hakon Hanssen to review the situation of hard drug users in Norway. It was tasked in particular with evaluating whether the government should allow a trial heroin prescription program because the notion was so controversial in Norway. The committee did not address soft drug use.

Committee head Thorvald Stoltenberg is a well-known and well-respected political figure in Norway, having served in the past as foreign minister. He is the father of the current prime minister. He is also the father of an adult daughter who is a former heroin addict.

Current Health Minister Anna-Greta Strom-Erichsen agreed with the committee's call for more harm reduction and expanded treatment services, but wasn't ready to sign off on prescribed heroin just yet.

"I agree with the committee that services for the most vulnerable drug addicts must be better," she said in a press release. "The committee wants greater degree of coordination of services. This is a task that is central to the work of collaborative reform, which is especially important for people with drug problems," she added.

But heroin prescribing is "a difficult question" on which the government must move carefully, Strom-Erichsen said. "The government has not reached a conclusion on the question of heroin assisted treatment. Regardless of the conclusion to this question, there is a need for an intensified effort for people with drug problems, including medical treatment, "she said.

The committee report will now form the basis for a broad dialog on its recommendations among government officials, local officials, drug users, relatives, and other interested parties. After that, the Health Ministry will send a proposal to parliament.

While the committee report is quite moderate by international standards, it represents a major break from traditional Norwegian responses to hard drug use and an embrace of the harm reduction philosophy.

Opiate Maintenance: Prescribing Heroin to Hard-Core Addicts Keeps Them Off Street Smack, British Study Finds

In research findings reported in The Lancet, scientists monitoring the Randomized Injectable Opiate Treatment Trial (RIOTT) reported that allowing addicts who have failed to get off heroin to use injectable "medical grade" heroin resulted in lower levels of street heroin use than in addicts given either oral or injectable methadone. The research was done by Professor John Strang and colleagues from the National Addiction Center's Institute of Psychiatry at King's College in London.

Up to 10% of heroin addicts fail to respond to conventional treatments, for reasons that are unclear. In recent years, scientific evidence suggesting that providing medicinal heroin, known as diamorphine in the United Kingdom, under supervision is an effective treatment for chronic heroin addiction, has only increased. This study adds to the mounting evidence.

The RIOTT study chose as subjects chronic addicts who were receiving oral maintenance doses, typically of methadone, but were continuing to regularly inject street heroin. Subjects were provided with oral methadone, injectable methadone, or injectable heroin over a half-year period. At the end of the study, 80% of the subjects remained in treatment, with the highest figure for those using heroin (88%), followed by injectable methadone (81%) and oral methadone (69%). Among subjects who had 50% or more negative samples for street heroin -- the authors' measure of measurable improvement -- 66% of medicinal heroin users avoided street smack, while only 30% of injectable methadone users did and only 19% of oral methadone users did.

"We have shown that treatment with supervised injectable heroin leads to significantly lower use of street heroin than does supervised injectable methadone or optimised oral methadone," the authors said in a press release announcing the findings. "Furthermore, this difference was evident within the first six weeks of treatment."

Noting that the UK government's 2008 Drug Strategy had called for rolling out prescription heroin and methadone to clients who don't respond to other forms of treatment, contingent on the results of the RIOTT study, the authors said the results were in and it was time to act. "In the past 15 years, six randomized trials have all reported benefits from treatment with injectable heroin compared with oral methadone. Supervised injectable heroin should now be provided, with close monitoring, for carefully selected chronic heroin addicts in the UK," they concluded.

"Our scientific understanding about how to treat people with severe heroin addiction has taken an important step forward," said Professor Strang. "The RIOTT study shows that previously unresponsive patients can achieve major reductions in their use of street heroin and, impressively, these outcomes were seen within six weeks. Our work offers government robust evidence to support the expansion of this treatment, so that more patients can benefit."

You can watch Professor Strang discuss the findings here.

Feature: Schwarzenegger Trying to Gut California Methadone Funding in Budget Move

With California facing a $19 billion budget deficit, Gov. Arnold Schwarzenegger (R) last month proposed saving the state $53 million by cutting off Medi-Cal funding for methadone maintenance for most heroin addicts. That would cause the loss of more than $60 million in matching federal funds. The move was fiercely resisted by methadone advocates -- including a former drug czar -- and public policy analysts, and the proposal was defeated last week in committee votes in the state Senate and Assembly.

But California gives the governor the power to veto individual budget items, so advocates are not resting yet. Instead they are reaching out to the administration in hopes they can enlighten it and persuade the budget axe-wielding Schwarzenegger to aim elsewhere.

Schwarzenegger isn't the first top-tier elected official to go after methadone maintenance. Back in 1999, then New York City Mayor Rudy Giuliani vowed to wean all of the city's methadone patients off it in three months. While Giuliani acted for ideological rather than budgetary reasons -- he said he wanted "drug freedom," not drug dependence -- the pugnacious mayor later changed his tune, admitting the idea was "maybe somewhat unrealistic."

http://www.stopthedrugwar.org/files/harm-reduction-superheroes-vancouver.jpg
superheroes for harm reduction: ''Methadone Man'' public awareness campaign during last February's Olympics in Vancouver. You're needed everywhere, Methadone Man.
Currently, nearly 150 methadone clinics provide the heroin substitute to some 35,000 addicts, 55% of whom are on Medi-Cal. Advocates and treatment providers said that clinics would be forced to close if the proposal passed, affecting not only the Medi-Cal patients, but also patients who paid out of their own pockets or through private insurance to be able to get maintenance methadone.

"Methadone isn't a cure," said Roxanne Baker, president of the National Alliance of Methadone Advocates (NAMA), "but much like thyroid medication, as long as you keep taking it, it keeps your disease in check, and opiate addiction is a disease. When you mess with your brain with painkillers, it then doesn't produce the endorphins it should. It's not a matter of will power, it's a disease. You need something to replace those endorphins, whether its methadone, suboxone, or even prescription heroin, although I doubt we'll ever see that here."

Enacting the proposed cuts would be "a disaster," said Baker. "There would be no methadone programs left. More than half the patients statewide are on drug MediCal, and they wouldn't even have a place to go. A lot of these people have their lives in order. This is somebody's brother, somebody's aunt, somebody's mom. Please don't take this from us."

Last week, Clinton-era drug czar Gen. Barry McCaffrey flew into the state to hold a press conference denouncing the cut. "Dumping tens of thousands of opiate addicts back on the street would be an immediate disaster to law enforcement, and to the families of people who have become stable, functioning adults" thanks to methadone, said McCaffrey, who has a consulting firm and serves on the board of directors of an organization that treats chemical dependency.

Legislators were listening, not only to McCaffrey, but to the methadone treatment community. A Senate Budget Committee hearing last week proved tough going for Schwarzenegger's representatives.

"This measure would eliminate the drug MediCal program with the exception of the perinatal and youth funding," said John Wardlaw from the state Department of Finance. "This is not an easy reduction in any way. We are at the point where we are making very difficult reductions."

Committee Chair Denise Moreno Ducheny (D-San Diego) wasn't buying it. "How much federal funding are you giving up?" she asked.

"Sixty-six million dollars," Wardlaw said.

"We save $53 million and lose $66 million?" asked Ducheny.

"That is correct, ma'am."

Ducheny just stared at him for a few uncomfortable moments before moving on to the next witness.

"There would be cost shifts in the area of corrections and child welfare services," Greg Tallivant of the legislative analysts' office told the solons. "The day the clinic closes, those people have to do something. If they can't make it to the next methadone clinic, heroin would be the next choice. You would see people arrested. You would see prison costs and child welfare costs go up."

Assemblyman Mark Leno (D-San Francisco) was visibly irritated by the proposal. "There is a complete lack of interest in any cost-benefit analysis here," he said. "This is reckless and cavalier. It doesn't really make much sense. We have 171,000 people addicted to drugs. This will increase our crime rate; it's a recipe for disaster on our streets. Does the governor have no interest in this or does he not believe that this will impact the safety of our children and communities? We've already zero-funded the base Proposition 36 program. The outcome of this is to have drug offenders with no jail and no treatment."

"This is really a short-sighted proposal that shifts costs from funding treatment to funding law enforcement, jails, and prisons," said Jason Kletter, a member of the Bay Area Addiction Research Team (BAART), which is in turn a member of California Opioid Maintenance Providers (COMP), a nonprofit organization representing opioid maintenance treatment centers. "It is a public safety issue, to say nothing of the humanitarian crisis it would provoke," he said.

"We think if this happened many clinics would close, and the folks who lose access to care would likely relapse and cost the system much, much more in a short time," said Kletter. "We see relapse rates of 80% within a year when clinics close, so it wouldn't even be like we'd be kicking the can three or four years down the road."

"This would have the biggest impact on programs that have a high percentage of Medi-Cal beneficiaries in treatment and would be unable to stay open because more than half their patients, and thus, their revenues, are gone," said Kletter. "You would have a fundamental dismantling of the system."

The cost incurred would be staggering, Kletter said."If 80% relapse in same year, we know that the state will incur $700 million to $1 billion in new costs in the criminal justice system," he said, citing a study from the 1990s that found each dollar invested in treatment produced a seven-dollar return. "The state wants to save $53 million by eliminating drug Medi-Cal and will also turn away more than $60 million in matching funds. That's $115 total program cost. A seven-to-one return on that is close to a billion dollars. "With 80% relapse, we could end up seeing $700 million in new criminal justice and prison costs."

"It's a terrible proposal," said Glenn Backes, a Sacramento-based public policy analyst who works with the Drug Policy Alliance at the Capitol. "California Democrats in both houses have said so. The Senate Republicans didn't do a cost-benefit analysis; they just said we can't afford to give out subsidized health care."

But in reality, the situation is even worse, said Backes. "They've killed Proposition 36 funding, drug courts are being slashed. According to the governor's finance director, that's 171,000 patients. The cost-benefit for this is worse than nil. If only one out of a thousand relapses and goes to prison, you've already lost money because prison is so much more expensive than treatment. If only one out of a thousand gets Hep C, the taxpayer loses. If only one out of a thousand gets HIV, the taxpayer loses."

It's easy to lose the human side in all the numbers, Backes said. "If only one out of a thousand ODs and dies, that's 170 California families who have lost a loved one."

And the battle continues. "While both the Senate and the Assembly budget committees have rejected the governor's proposal, in California, the governor has a line item veto," said Kletter. "We are continuing to try to work with the administration to explain the impact of this kind of proposal and get them to understand it is a public safety and cost-shifting issue. We haven't had any direct meeting with them yet, but that's next on our agenda. We want to educate them about them dire consequences of this sort of action."

Even if advocates many to salvage the drug Medi-Cal program, they would be well-advised to be searching for alternative funding sources, and how better than to take money from the drug war? Tough times call for creative solutions, and Backes has one: Use federal Byrne Justice Assistance Grants to fund treatment instead of drug task forces. Every dollar funding more drug war arrests costs $10 additional in spending for courts and prisons, he said.

"Historically, Byrne grant funds have been given to task forces to increase arrests," Backes noted. "The Drug Policy Alliance position is that Byrne funds would be better spent on almost anything other than doing low-level drug sweeps. We would rather see that money go into treatment for people in the system."

Britain's New Prime Minister Thinks Drugs Should Be Legal

David Cameron He probably won't admit it now, but Britain's new prime minister thinks drugs should be legal. David Cameron, whose Conservative Party (the Tories) ousted Labor in last week's election, told the UK paper The Independent that the United Nations should consider legalization. He also wanted Britain to revive its former practice of providing heroin maintenance for addicts, and to open safe injection sites too. According to The Independent, which did the interview in 2005 when Cameron was vying for the Conservative's leadership spot, Cameron favored "fresh thinking and a new approach" toward British drug policy, adding "we have to let 1,000 flowers bloom and look at all sorts of treatment models." Cameron started off well as a parliamentarian, initially backing the government's downgrading of cannabis (marijuana) penalties from schedule B to C. But as a tabloid-driven hysteria over marijuana in the UK unfolded, Cameron (and The Independent) did a foolish about face. Still, Cameron's past comments are on the record, and his personal instincts on the issue at least seem to be good ones. I am not going to hold my breath waiting for the Tories to roll out legalization proposals, Cameron's past statements notwithstanding. But Labor under Gordon Brown was abominable on the drug issue, so whatever left-leaning Britons may miss about the former Labor government, they likely won't miss the drug policy. If Cameron does want to do something about this, Britain's Transform Drug Policy Foundation has a "Blueprint for Regulation" report ready and waiting.

Drug War Issues

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