U.S. drug policy and treatment is shifting, even as opioid crisis surges

dopeweighing-300x200Drug policy and treatment in this country is shifting in notable ways, even as the nation wrangles with a resurgent crisis in opioid abuse and overdose deaths and awaits a political transition that will determine a new response to drug harms.

As an indicator of the changing views on illicit substances, consider that the U.S. House has just approved “sweeping legislation that would decriminalize marijuana and expunge nonviolent marijuana-related convictions,” the New York Times reported. The newspaper said this of the bill, which for now also faces certain failure:

“The 228-164 vote to approve the measure was bipartisan, and it was the first time either chamber of Congress had ever endorsed the legalization of cannabis. The bill would remove the drug from the Controlled Substances Act and authorize a 5% tax on marijuana that would fund community and small business grant programs to help those most impacted by the criminalization of marijuana. The legislation is, for now, almost certainly doomed in the Republican-led Senate, where that party’s leaders have derided it as a superficial distraction from the work of passing coronavirus relief, as lawmakers inched toward bipartisan compromise after spending months locked in an impasse.

“But the bill’s passage in the House amounted to a watershed moment decades in the making for advocates of marijuana legislation, and it laid out an expansive federal framework for redressing the racial disparities in the criminal justice system exacerbated by the war on drugs. ‘The effects of marijuana prohibition have been particularly felt by communities of color because it has meant that people from the communities couldn’t get jobs,’ Rep. Jerry Nadler, Democrat of New York and the chairman of the Judiciary Committee, said in an interview. [He] spearheaded the legislation with Sen. Kamala Harris, Democrat of California and the vice president-elect, [and] described the collateral consequences of a conviction for marijuana possession as creating ‘an often-permanent second-class status for millions of Americans.’”

The marijuana legislation won consideration at an intriguing point in the nation’s long history of dealing with illicit substances, the newspaper reported, adding this context:

“[I]ts passage came as states around the county, including some conservative-leaning ones, have become increasingly open to decriminalizing marijuana amid a growing consensus that the war on drugs has been destructive. Fifteen states have legalized recreational cannabis, and voters in five states last month voted on legalization issues, bringing the number of states where medical marijuana is legal to 35.”

The changing policy on marijuana recognizes not only uncertain evidence that it holds significant harm as a “gateway” substance to abuse of more potent and illicit drugs but also the past prevalence with which law enforcement officers nabbed small offenders, even as bigger and more damaging dealers — potentially including Big Pharma executives and company owners — inflicted more serious harms. As the New York Times reported:

“Forty percent of drug arrests made in 2018 were for marijuana offenses — and just over 90% of those arrests were for possessing the drug, according to a report from the nonpartisan Pew Research Center. A separate report released by the American Civil Liberties Union showed that Black people are more than three times as likely as white people to be arrested for marijuana possession despite comparable usage rates. ‘Marijuana use is either socially acceptable behavior or it’s criminal conduct,’ said Rep. Hakeem Jeffries, Democrat of New York. ‘But it can’t be socially acceptable behavior in some neighborhoods and criminal conduct in other neighborhoods when the dividing line is race.’”

The complexity of decriminalization

The Wall Street Journal reported that efforts by social progressives to decriminalize substance abuse — a policy approach opposed by GOP politicians and conservatives — may run head on into the complications resulting from different options and their concurrent requirements.

In Oregon, after voters in the November election “agreed to end nearly all criminal penalties for drug possession,” state officials are racing to set up substance abuse treatment and recovery programs also mandated in the approved ballot issue. This will be a tough task, the Wall Street Journal reported:

“[P]eople experienced in dealing with drug addiction say Oregon isn’t prepared to offer treatment to anyone caught in possession of an illegal drug, especially in the midst of a pandemic that makes in-person treatment harder at the same time that overdoses are rising. State-funded addiction-recovery centers will operate by phone only, initially, with the first physical locations due to be operational by October 2021. ‘They’ll tell you where to go but they will not offer treatment,’ said Mike Marshall, executive director of Oregon Recovers, an advocacy group for people in recovery. ‘And they will not provide any financial assistance and they won’t put you to the front of the line, which is what a judge can do if you’re in his court.’”

The coronavirus pandemic, with its public health restrictions, including on face-to-face indoor meetings, has forced major changes in addiction treatment, notably pushing online crucial therapy sessions, especially of the group kind, the New York Times reported, separately:

“Though online rehab rose as an emergency stopgap measure, people in the field say it is likely to become a permanent part of the way substance abuse is treated. Being able to find a meeting to log into 24/7 has welcome advantages for people who lack transportation, are ill, juggling parenting or work challenges that make an in-person meeting tough on a given day and may help keep them more seamlessly connected to a support network. Online meetings can also be a good steppingstone for people just starting rehab. ‘There are so many positives — people don’t need to travel. It saves time,’ said Dr. Andrew Saxon, an addiction expert and professor in the Department of Psychiatry and Behavioral Sciences at the University of Washington School of Medicine. ‘The potential for people who wouldn’t have access to treatment easily to get it is a big bonus.’”

Some participants praise the connection and intimacy they can experience in treatment sessions offered through technologies like Zoom, while others say in-person therapy is irreplaceable, especially for the big morale support that can be gained, for example, by simple acts like handshakes and hugs. Still, the newspaper noted:

“It is too early for data on the effectiveness of online rehabilitation compared to in-person sessions. There has been some recent research validating the use of the technology for related areas of treatment, like PTSD and depression, that suggests hope for the approach, some experts in the field said. Even those people who say in-person therapy will remain superior also said the development has proved a huge benefit for many who otherwise would have faced one of the biggest threats to recovery: isolation. The implications extend well beyond the pandemic. That’s because the entire system of rehabilitation has been grappling for years with practices some see as both dogmatic and insufficiently effective given high rates of relapse.”

A change in approach

Indeed, there is growing concern about how the coronavirus pandemic has helped allow yet another spike in the opioid abuse and drug overdose crisis. This will be one more huge challenge for the incoming Biden Administration to tackle, with urgency, experts say. As the online politcal and public policy news site Politico reported:

“Biden will take office at a crucial moment in the fight against drug addiction. Some states are contending with double-digit spikes in overdose deaths, sparse public health workforces are already stretched thin fighting the coronavirus and widening budget deficits brought on by the pandemic could force states to make painful cutbacks to public services. More than 76,000 people died of a drug overdose between April 2019 and April 2020, according to the most recent preliminary federal data, the most ever recorded during a 12-month period. Federal health officials say the drug crisis has only been amplified by months of social isolation, high unemployment, and the diversion of resources to combat the virus. ‘Since the pandemic hit, we have not been able to control the opioid epidemic,’ said Nora Volkow, the long-serving director of the National Institute on Drug Abuse, in an interview. ‘Our vulnerabilities have just gotten worse.’”

Biden, whose own family has experienced the pain of substance abuse issues (with his son Hunter), is expected to change up approaches tried by the Trump Administration. As Politico reported:

“Biden, who has stocked his team with addiction experts with extensive backgrounds in public health, will emphasize new funding for substance abuse treatment and prevention, while calling to eliminate jail time for drug use. It’s a departure from his tough-on-crime approach as a senator — and from President Donald Trump’s frequent focus on a law enforcement response to the drug crisis, which experts said undercut necessary public health measures … Biden …  has called for record investments in drug prevention and treatment while also holding drug companies accountable for their role in the opioid epidemic. But his $125-billion treatment plan could face resistance in a bitterly divided Congress that for months has failed to agree on a coronavirus relief package, even as infections soar and jobless claims rise.”

C’mon, now. In my practice, I see not only the harms that patients suffer while seeking medical services, but also the damage that can be inflicted on them by dangerous drugs, notably powerful prescription painkillers.

An unending nightmare

Opioid abuse became a proven gateway, paving a destructive path, including with spiking overdose deaths, as abusers turned from addictive and detrimental Big Pharma products, especially synthetic painkillers like fentanyl, to illicit street drugs, notably heroin. Doctors, nurses, hospitals, pharmacies, insurers, and Big Pharma, absolutely, all had a role in the long and terrible rise of the opioid epidemic. Overdoses have killed an estimated 750,000 Americans since 1999, with the share of opioid-related fatalities rising sharply throughout that period, federal officials report.

The nightmare has not ended, and new approaches may be needed. This may be notably evident, as a big and complex legal effort to resolve thousands of lawsuits by states, counties, cities, and other levels of government, as well as Indian tribes, has not reached a much-desired “global” settlement with Big Pharma firms that plaintiffs have faulted for their role in the opioid crisis. Instead, federal prosecutors, Big Pharma, and the Trump Administration have caught heat for a recent deal, now finalized, that allowed the owners and executives of Purdue Pharmaceuticals, the makers of OxyContin, to elude criminal charges for now.

The company has admitted that it misstated attributes of its potent and addictive drug and that the company engaged in misleading and aggressive advertising, marketing, and promotion of OxyContin — a hype that became a tragic Big Pharma model for peddling opioids. The company will move out of family control, while the firm, its owners, and executives pay relatively small fines, and prosecutors and a bankruptcy court accept a plan for Purdue to eventually pay billions of dollars to governments and parties harmed by the company and its wares.

Families victimized by deaths, debilitation, and addiction assailed the Purdue deal for letting the plutocratic Sackler family off the hook for the destruction wrought by their company. The family also apparently will keep a big chunk of fortune, estimated to be as much as $13 billion.

Yes, this was a sprawling and complex case, so, arguably, authorities extracted the best deal possible without risking the unpredictability of a long civil trial. Still, having a corporation plead to bad behavior as a legal abstraction while the people who were involved — and who deny wrongdoing — do not hardly seems to satisfy human plaintiffs hope for resolution and justice.

It also is true that, as a nation, we have been digging around for some time for a better and best policy on drug use. Research has shown that marijuana is not a shrieking menace, nor is it harm free, especially for the young and old. Experience has provided the country with harsh lessons about the inequities that flourish in trying to deal with substance abuse with a simplistic take of launching a “drug war.” We have much work to do to combat substance abuse, better dealing with addiction and other related challenges with mental- and public-health thinking. Experts, too, need to help society and those in need with improved care for those with drug problems.

Patrick Malone & Associates, P.C. listed in Best Lawyers Rated by Super Lawyers Patrick A. Malone
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