Want to Help an Addict? Call the Cops.
Last month, the Centers for Disease Control and Prevention released data on drug-related deaths in the United States in 2016. The numbers are staggering. Approximately 64,000 people died of overdoses, a 22 percent increase over 2015. More than 60 percent of deaths involved opioids, a class of extremely addictive drugs that include pain medications like Percocet, Vicodin and OxyContin, as well as heroin.
Heroin and synthetically manufactured opioids are responsible for over two-thirds of opioid-related deaths. Fatalities involving fentanyl, a synthetic opioid, more than doubled from 2015 to 2016. Further, this problem isn’t confined to opioids. Fatal overdoses involving cocaine and methamphetamine also rose significantly. Drug overdoses are now the leading cause of death in people under 50 years of age and are killing at a faster rate than HIV did at the peak of that epidemic. In Cuyahoga County, Ohio, where I live, heroin and fentanyl were responsible for more deaths in 2016 than homicides, suicides, and automobile accidents combined.
About 3 million people in the U.S. are dependent on opioid drugs, including 500,000 who are addicted to heroin. The current epidemic appears to have begun in the 1990s, with liberalization in medical attitudes toward the use of opiates for management of mild to moderate pain, along with underestimation of the risks of opioid abuse and aggressive marketing of opioid drugs.
The massive increase in legally prescribed opioid drugs was accompanied by the ready availability of cheaper alternatives like heroin and Chinese-manufactured fentanyl, both of which arrived from Mexico. The internet has proved an extraordinarily efficient and difficult-to-police conduit for drug dealers and clients to connect whether via text messages to known dealers, the “dark web” or anonymous social media sites such as Whisper.
An educational “full court press” is desperately needed. Physicians must better understand appropriate and effective ways to manage pain, parents need to understand signs of drug abuse in their kids and it is imperative that we educate and inform our children about the mortal dangers of substance abuse and addiction beginning at early ages. Greater policing and interdiction of the supply of illicit drugs is essential.
Prevention is the best medicine. An individual who never tries an illegal drug, and avoids abusing legal ones, will never become addicted. But what about the millions of Americans who have already crossed that threshold?
Drug addiction is commonly called a brain disease, and there is value to this model. Substance abuse produces changes in the brain, resulting in altered thought patterns, modified emotional responses and adaptations that make it extremely difficult for addicts to stop using drugs. But facts on the ground suggest that discontinuing drug use remains within the realm of personal choice.
Most substance-addicted individuals eventually stop using on their own without treatment. Unfortunately, however, this decision comes too late for too many. Addicts often become infected with deadly viruses like HIV and hepatitis C or suffer severe end organ damage such as liver cirrhosis. Their lives are frequently ravaged or even ended by the lifestyle they lead. The effects of addiction on family, friends and other personal relationships can be devastating.
Drug treatment is essential to protect addicts from themselves. The supreme challenge is getting these individuals to voluntarily enter and remain in treatment. Many must be coerced. This truism means that the judicious application of the criminal justice system has obvious advantages as a tool. Enlisting courts to mandate treatment, including the use of anti-addiction medications, offers the potential to benefit the addicted, their families and society at large.
In acceptance of this reality, at least 37 states and the District of Columbia have passed laws that allow addicts to be involuntarily committed. While such laws may be a step in the right direction, they can be difficult to apply in practice and are often inadequate for the purposes of forcing addicts to enter and remain in treatment.
There are now over 3,000 “drug courts” in the United States. Drug courts can substitute treatment and rehabilitation for incarceration, provide rigorous monitoring and supervision, offer graduated incentives and impose escalating sanctions. Such methods appear to be more effective at bringing about recovery than conventional approaches like mandatory prison time or standard probation. Coupling drug courts and mandated rehabilitation with the administration of anti-addiction medications represents a potentially powerful approach to managing addiction.
The United States has been confronted with a deadly and unprecedented opioid epidemic. Most users deny they have a problem or are otherwise unwilling to enter therapy in a manner timely enough to prevent the most serious consequences of their addictions. However, wise and creative use of the criminal justice system can help us bring these individuals into treatment and recovery.
Dr. Roger D. Klein is the principal at Klein and Klein Co., L.P.A. and Roger D. Klein, MD JD Consulting. He is an expert for the Federalist Society Regulatory Transparency Project. Dr. Klein graduated from Yale with both an MD and JD.