(renamed "Drug War Chronicle" effective issue #300, August 2003)
Issue #51, 7/24/98
"Raising Awareness of the Consequences of Drug Prohibition"
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TABLE OF CONTENTS
In a surprise addition to a speech on welfare this week (7-20) New York City Mayor Rudolph Giuliani announced a plan to "phase out and do away with methadone maintenance programs in the City of New York" over the next 2-4 years. There are currently around 35,000 people in New York City who are on methadone maintenance.
"Methadone is a terrible, terrible perversion of drug treatment because it leaves a person dependent," said Giuliani. But many others, including medical professionals, and even the Office of National Drug Control Policy, strongly disagree.
Joycelyn Woods, president of the National Association of Methadone Advocates, told The Week Online "Studies show that people who are administratively discharged from methadone programs (forced off due to pre-determined time limits) have a relapse rate of almost 90%. It is not like the people in these programs haven't tried other forms of treatment. Methadone is usually the last resort after numerous attempts. These people have years of failed treatment behind them. For them, methadone is the only thing that works."
Woods continued, "Of all of the issues involved in addiction and drug policy, methadone is one of the few with broad consensus. Even the Drug Czar's office is actively calling for increased access. By making methadone unavailable in New York, you're essentially telling tens of thousands of people that we would rather spend our time and money chasing you down and putting you in jail than allow you this medicine which is helping you to stabilize your life. You have to be an idiot to say what the Mayor said yesterday. He obviously has no idea what he's talking about."
And Woods was not alone in her criticism. "He said what?" said Dr. Don Des Jarlais, director of research for the Chemical Dependency Institute of Beth Israel Medical Center when questioned about Giuliani's statements by The New York Times. "From a public health standpoint, that has to be one of the more ridiculous things for any public official to have said over the past 30 years."
On Tuesday, Dr. Des Jarlais told The Week Online, "If these programs were cut off, you are probably looking at an 80% rate of relapse into heroin addiction. Of the population in methadone treatment, it's likely that 40% are HIV positive and at least 90% are positive for Hepatitis C. So sending them back out on the street would be a public health nightmare. The good news is that there is strong support for methadone maintenance, even among Republicans. And earlier this year, a National Institutes of Health consensus conference strongly recommended methadone, even high-dose methadone as a treatment for heroin addiction. When the science is that definitive, it is difficult for politics to overrule."
Des Jarlais noted that the Mayor of New York lacked the legal authority to shut down most of the programs, which are financed primarily with state and federal dollars. "It's clear that the mayor spoke mainly out of ignorance. When all of this gets hashed out, and the facts and the science are publicly discussed, I think that his error will become clear. Even to him."
(See our interview with Dr. Robert Newman, one of the leading authorities on methadone maintenance, item 9, below.)
A coalition of activists from across New York State is moving to form a "Marijuana Reform Party" in this fall's elections. They are supporting a slate of five candidates for statewide office in order to achieve official ballot-line status in the state, taking their inspiration from the Grassroots Party of Minnesota, which made a similar effort in 1994.
"We are confident that we can get the 50,000 votes we need to get the ballot line, that's only 1% of the total vote," Thomas Leighton, the MRP candidate for Governor told The Week Online. Our biggest challenge is gathering the 15,000 signatures we need to get on the ballot to begin with. We only have a few more weeks, and need everyone who can in New York who supports this issue to join our petitioning drive."
New York state has a long history of smaller independent political parties playing important roles in "fusion" election campaigns. Organizers believe that with a ballot line of its own, the MRP will be able to gets its agenda into the political discourse, influence close elections, have more of a voice in the state legislature, and bring the marijuana issue further into the mainstream.
"Leighton for Governor" Campaign Manager Aaron Wilson told the Week Online, "There are all sorts of opportunities this approach could create. For example, there are many elected judgeships in the state that go uncontested each election. We could run candidates for local D.A. and Sheriff's offices, just to force a debate on the prohibition issue. The coin of the realm in New York is votes, and with even a small number of votes we will be able to get heard and effect changes in the laws."
The MRP campaign is being supported by a range of drug reformers in all parts of New York, including members of ReconsiDer, New York CAN (Rob Robinson, one of NY-CAN's activists is a candidate), college marijuana activists out of school for the summer, and the Rochester Cannabis Coalition. For more information or to contact the MRP, you can visit their web site at http://ww.MarijuanaReform.org.
Candidates and parties in other parts of the country are taking on the drug issue as well. In Orlando, Florida, Democratic Congressional candidate Al Krulick (http://www.vote-al.org) is challenging incumbent Bill McCollum, the sponsor of H.R. 372, the "sense of the house" resolution against medical marijuana; Krulick's key campaign plank is ending the war on drugs. Nationally, the Libertarian Party (http://www.lp.org) is fielding many candidates who are actively opposed to drug prohibition.
David Lee Herrick, a former sheriff's deputy in San Bernardino County, California, and co-director of the Orange County Cannabis Co-op, was sentenced last week (7/17) to four years in prison for distributing medical marijuana. Herrick, 48, began using marijuana for a back injury that he suffered on-duty as a deputy sheriff. He was convicted in May for distribution. At the trial, jurors were not allowed to consider Proposition 215, as Orange County Superior Court Judge William Froeberg ruled that the medical marijuana law does not apply to cannabis clubs.
Reprinted with the permission of California NORML
OAKLAND, CA July 21, 1998. The Oakland City Council approved the first reading of a medical marijuana ordinance designed to protect the Oakland Cannabis Buyers Cooperative from federal prosecution, and reaffirmed its support for the city's policy guidelines allowing patients to grow up to 6 pounds per year of marijuana.
The Oakland ordinance, proposed by Oakland CBC attorney Robert Raich, would allow the city to officially designate the Oakland club to enforce the state's medical marijuana law. Supporters argue that the ordinance will protect the club from a federal injunction aimed at closing the club, on the grounds that the federal controlled substances act exempts duly designated city officers.
Medical marijuana patient George McMahon, one of seven patients who legally receive marijuana through a special FDA program, testified that the Oakland guidelines were consistent with the federal government's own approved dosage guidelines, displaying a one-half pound tin of government-supplied marijuana, which he said contained his own supply for one month.
Councilmembers Nate Miley and John Russo defended the guidelines as a reasonable attempt to protect the most seriously ill medical marijuana patients from unwarranted police harassment, saying it would not interfere with legitimate marijuana enforcement activities.
Medical marijuana advocates applauded the council's action. "This proves again that good medical cannabis policy is good public policy," said Robert Raich. "The city council has acted to protect patients as well as the public health and safety of all Oaklanders."
(To reach California NORML, contact Dale Gieringer at (415) 563-5858, [email protected].)
5. Action Alert from the Drug Policy Foundation: Oppose Harsh New Mandatory Minimums -- Urge Congress to Vote Against H.R. 3898, the "Speed Trafficking Life in Prison Act of 1998"
The House Judiciary Committee approved H.R. 3898, the "Speed Trafficking Life in Prison Act of 1998," on July 21 by a vote of 21-6. The vote was largely along party lines, with Republicans arguing for stiffer penalties and Democrats warning that the bill would "result in clogged courts and more prison overcrowding for relatively minor offenses," according to Congressional Quarterly.
In a press release following the vote, DPF's Public Policy Director, H. Alexander Robinson, objected to the "race-based rationale" for the bill, as evidenced by a June 9 memorandum distributed by Rep. Bill McCollum (R-FL).
The memo states, in part, "Over the last eight years, Mexican drug organizations have replaced motorcycle gangs as the major methamphetamine producers ... and have saturated the western U.S. markets." Rep. Sheila Jackson-Lee (D-TX) was concerned by this reasoning, saying: "I do not want to be part of a bill that specifically targets a minority group."
H.R. 3898 would cut in half the amount of methamphetamine required to receive a five- or 10-year mandatory minimum, making federal sentences for crack cocaine and methamphetamine equivalent. The bill would institute the following new sentences:
* a 10-year mandatory minimum sentence for possessing or trafficking in 50 grams of methamphetamine (formerly 100 grams); and
* a five-year mandatory minimum sentence for possessing or trafficking five grams of methamphetamine (formerly 10 grams).
Thanks to an amendment by Rep. Maxine Waters (D-CA), the bill would also require the U.S. Sentencing Commission to analyze the impact of the increased penalties and present the results to Congress within one year.
WHAT YOU CAN DO
"As your constituent I urge you to oppose H.R. 3898, the 'Speed Trafficking Life in Prison Act of 1998.' This legislation promises to be costly to taxpayers, removes necessary discretion from federal judges, and will result in more low-level offenders clogging the courts and unnecessarily filling our prisons. This bill promotes the failed policy of mandatory minimum sentencing for drug offenses, which is not cost-effective according to the Rand Corporation. Its study, Mandatory Minimum Drug Sentences: Throwing Away the Key or the Taxpayers Money, concluded: 'in all cases, conventional enforcement is more cost-effective than mandatory minimums, and treatment is more than twice as cost-effective as mandatory minimums.' (p. xxii)
"Also, Rep. Bill McCollum (R-FL) is scapegoating Mexicans in his promotional material for the bill, and I am concerned passage of this bill will have a disproportionate effect on Mexican-American communities.
HOW TO Call Your Representative -- Calling your representative is the most effective way to make your views known to them. You should:
* Find out who your representative is by calling the U.S. Capitol Switchboard at (202) 225-3121. Have your zip code ready to give the operator.
* Speak with the legislative assistant who is working on drug policy or criminal justice issues.
* Keep the message simple. Urge your representative to oppose H.R. 3898 for the reasons outlined above. Ask for a return letter explaining your representative's position on the legislation and mandatory minimum sentencing for drug offenses.
Fax, Write a Letter, or E-mail Your Representative -- Call the Capitol Switchboard then call your representative s office to get the fax number.
You can also go to the ACLU's web site,
Letters can be sent to: The Honorable (name of your representative), U.S. House of Representatives, Washington, DC 20515. Finally, please don't use email unless you have already called or faxed.
(You can find the Drug Policy Foundation and subscribe to their alert list on the web at http://www.dpf.org.)
- Kris Lotlikar
U.S Senators Dick Durbin and Carol Moseley-Braun are calling for the General Accounting Office to broaden its investigation of drug search procedures at the nation's busiest airport. The two Senators released figures stating that of the 104 strip searches conducted in 1997 at O'Hare international airport, 77 of those involved female suspects. "Our country should be conducting a war on drugs, not a war on women," Senator Moseley-Braun told Reuters. Senator Durbin also commented, "These searches are far more successful at stripping women of their dignity than stripping our nation of its drug supply." The Treasury Department, which has oversight authority over the Customs Service, is conducting its own internal investigation and stated that they would also support the GAO investigation.
The figures released also suggested a trend of racial discrimination in the strip searches. The data shows that almost twice as many black women were searched as white women. O'Hare airport officials deny the claims, stating they do not "target" a certain group of people. "It's never based solely on race, ethnic origin or gender," stated Cherise Miles, spokeswoman for Customs in Chicago to the Illinois Daily Herald. "It could be nervous behavior, it could be the way a person is dressed. It could be where they're coming from." Ed Fox, a Chicago attorney, has filed a lawsuit representing 18 black women subjected to searches in which illegal substances were not found. "I'm pretty confident many more black women were strip searched than what they're admitting to," he stated to the Herald. "They are clearly targeting black women for strip searches without reasonable suspicion. It's purely for harassment."
Effectiveness of the searches is also being questioned. Only 27 of the 104 strip searches turned up drugs. Drugs were found on 25% of the white women searched and only on 17% of the black women. Senator Dick Durbin commented, "It's very difficult to justify what they are doing based on their results." William Spain, spokesperson for the ACLU of Illinois, sees hope in the Senators' concern. He told The Week Online, "For far to long most of our lawmakers have only aided and abetted the worst excesses of America's unwinnable War on Drugs. It is encouraging that a few of them of finally waking up to the fact that so many innocent citizens are routinely stripped of their liberty and dignity as a result of destructive drug policies."
- In Bogota, Columbia a U.S. helicopter crashed, killing seven police officers. This was the third fatal crash involving U.S owned helicopters in less than a month. The UH-1H helicopter was part of a sortie of "Hueys" donated by the U.S, to aid the war on drugs in South America. Wreckage was found on Sunday in Urada province, a banana growing region which has long been a battleground for leftist rebels and the state.
- 12 officers in Mazomanie, Wisconsin spent Sunday destroying wild growing hemp from all over Dane County. The task force, which was made up of members of the Dane County Narcotics and Gang Task Force, worked most of the day collecting, cutting and burning the crop. "Most of the marijuana is left over from hemp farming during the two World Wars," Sheriff Sgt. Mark Twombly told an AP reporter. Industrial hemp contains THC in amounts far too small to produce intoxication.
- In England this week, a night watchman discovered two thousands grams of marijuana on a Royal Navy destroyer. Ironically the HMS Newcastle was returning from a six-month tour of duty combating drug-running in the West Indies. After the whole crew was fingerprinted, two men were caught and found guilty of conspiracy to import drugs. Six other men have also plead guilty for their role in the smuggling ring.
In a letter to the Wall Street Journal (6/24), Nobel Prize winning economist Milton Friedman, an octogenarian responding to the Journal's anti-legalization editorial suggesting that he and other "libertarian economists" divulge whether or not they had ever used drugs:
"I have not done so during the past 85-plus years. But I make no guarantees for the future."
Dr. Robert Newman, President of Continuum Health Partners, a healthcare system that includes Beth Israel Medical Center, where methadone maintenance began over 30 years ago and which still operates the largest program in the world, had a slightly different take on the mayor's statements than that provided in our lead article above. Dr. Newman spoke with The Week Online:
WOL: Dr. Newman, you've obviously heard Mayor Giuliani's statements regarding methadone maintenance, and his desire to see these programs eliminated. What are your thoughts?
Dr. Newman: Let me first say that my anger over this issue is not directed in the least at Mayor Giuliani, but rather at the methadone establishment. And when I say establishment, I don't mean the experts like Dr. Des Jarlais here at Beth Israel, or patients' advocates like Jocelyn Woods at NAMA. I mean the majority of providers, who have a total monopoly over distribution and whose desires to maintain that monopoly drive their actions. Nor do I include all providers in my criticism. My own hospital, after all, Beth Israel Medical Center, is the single-largest provider of methadone in New York, and perhaps in the country, with over 8,000 patients.
The attitude of the majority of those who represent the establishment as it relates to methadone treatment is my way or the highway. They have fought tooth and nail to encourage and maintain every government regulation that is now in place that constrains the distribution of methadone. Their way has given us the current situation in which seven out of eight heroin addicts have absolutely no access to this treatment, and under which only government-approved "comprehensive programs" can exist.
Why are they upset by Giuliani's statements? It is not unreasonable and doesn't take too much cynicism to believe that at least part of the answer relates to the desire to protect their turf. They have been so thoroughly invested in maintaining control over the treatment of the 15% of heroin addicts who have access to their programs that they have been willing to write off the other 85%. Since they never looked for or even permitted serious discussion of ways to try to reach the 85% that can't be accommodated in their programs, I think they have little credibility when they profess such concern over the 15% that have been lucky enough to get admitted.
Now why is it that of all medical treatments, of all long-term drug regimens, methadone is the only one that is totally under the control of government-approved and largely publicly funded, bureaucratically-managed programs? Why on earth can't someone who has been on the program for years, who is gainfully employed and raising a family, who is otherwise drug-free, get methadone from his or her doctor? Why do such people -- and there are many, many people who are living normal, productive lives with the help of methadone -- why must they be required to show up at a clinic daily, or at least several times a week? Why are they required to continue with often-unnecessary counseling in order to stay in the program? For that matter, why can't any patient receive methadone from the physician of his or her choice?
There has been a concerted effort to keep community-based practitioners out of the prescribing of the medication. It's also true that providers' budgets depend upon the comprehensiveness of all these services, and the requirements that these services be provided to and accepted by every single patient. It has nothing to do with the needs or wishes of the patient, and these requirements have become the primary obstacle for people who would otherwise, by all measures and appearances, be living very ordinary, very healthy lives. I know some lip service has been given to "pilot studies" to allow a tiny handful of patients, always under the watchful eye and the control of the programs, to get methadone from generalist physicians. But the numbers that could be accommodated are meaningless!
WOL: So, when Mayor Giuliani says, for instance, that there is no reason why people in these programs shouldn't be required to work, just like other welfare recipients, you would agree with that?
Dr. Newman: Absolutely. Without getting into any sort of discussion of welfare policy itself, which is an issue in which I am certainly not holding myself out as an authority, I believe that people in methadone treatment should be treated the same way as everyone else. Besides, it is a little-known fact that fully half of the people who are on methadone maintenance are employed, and thus never even enter the welfare debate at all!
As I alluded to, a big part of what makes it difficult for methadone patients to work is the absurd requirements, the hoops they are made to jump through. In a lot of places in the country, where there are clinics at all, they are spread so far and wide that people end up spending half a day, every day, just traveling back and forth. Now, this speaks, I would argue, to the remarkable level of commitment that these people have to avoiding relapse, to insuring that they are not going to feel compelled to go to the street for relief. So we end up with many, many people, traveling great distances to clinics which often are open for only a short time every day, just so someone can hand them a cup of medicine. We need to open up the system so that people can live more normal lives, much as they would if they were on any other long-term medication regimen.
WOL: So there's nothing inherent in methadone treatment which would compromise someone's ability to lead a normal life?
Dr. Newman: Absolutely not! There are patients who are earning six-figure salaries, people who have been on methadone for years and who function normally and productively in every way.
The question is, do they need to be required to undergo continuous counseling? Do they need to be watched by a paid counselor to ensure that they are taking their medication? Of course not. What they need is freedom from absurd restrictions put into place by one bureaucracy, government, at the behest of another bureaucracy, the methadone establishment. But the methadone bureaucracy, in that wonderful self-serving tradition of all bureaucracies, considers these people too sick to function without the constant help of the people whose livelihoods depend upon the system. Is that to say that many people who are in methadone treatment don't benefit from counseling? Of course not. But these determinations are not being made based upon patients' individual needs. Again, only a monopoly could sustain a system like this.
In addition, and I think this is the problem rather than the views attributed to the Mayor, we have a situation where many of the providers themselves behave as if they don't believe in or understand the treatment. Three-quarters of the programs in existence knowingly keep patients on sub-optimal dosages of methadone. Now, if I, as a doctor, were to systematically prescribe a sub-optimal dosage of any other medication, I'd lose my business and probably my license to practice. But in the monopoly that controls methadone distribution, no one is at risk of losing their business, at least until a politician focuses on the expenditure and questions its justification.
Further, more than half of the clinics in operation push patients toward total detox, many after only six months. And if you ask them is there any evidence, is there a single scientific study, which shows that pushing people off of this medication will be successful? Do we have any indication that the majority will not relapse into heroin? That they will not go to the street and buy whatever they can get their hands on to relieve their suffering? That they will not be right back where they started, along with the increased risk of AIDS and other diseases? And they'll say, no. But we simply don't believe in allowing people to stay in for more than six months. And they can do this, they can randomly endanger and destroy people, because they have absolute power. They're the only game in town, and they know it.
WOL: But if the providers are dependent upon their patients, why would they be so eager to push people out of the programs?
Dr. Newman: Oh, the slots don't go empty. Each clinic is allowed to treat only a specified number of patients, and there are so few slots for so many addicts that there's always a waiting list. There's no necessity to do it right, to operate in the best interest of the patients, to care what patients think. There's zero "power" for consumers in this field of medicine, because the demand is so much greater than the availability. Again, I stress that this orientation is not universal, and I pride myself on the compassion, common sense and caring that is reflected in the staff of Beth Israel.
So here comes Mayor Giuliani, or some other politician, and sees methadone not as just another medication like, say, insulin, but as a very big line-item in a budget that goes to a big bureaucracy, and he questions it. There's nothing whatsoever surprising or inappropriate about that! And he looks at the people who have been in these programs for years and what he sees is a group of people who are still required by regulations and by the views of the clinicians to receive intensive counseling, who are still required to be urine-tested (in many programs, under direct supervision of the staff -- they are not even trusted to pee into a bottle without someone "monitoring" them!).
There can be only one conclusion: our government regulators and -- most significantly -- the treatment providers believe they are no better off, no more trustworthy, no less "junkies" than when they started the program. Seeing that, why shouldn't the mayor conclude that there is no progress being made? Why should we expect the mayor to challenge the medical judgment of the experts, the folks who provide methadone treatment? I sure haven't heard many of my colleagues say, "Let's demand the government stop requiring us to impose counseling on patients who no longer need or want it; let's demand an end to this wasteful and demeaning requirement that patients pee in a bottle so they can prove to us that they are not using drugs."
WOL: But the mayor has couched this in terms of a moral rather than a budget issue. In fact, as you know, the vast majority of funding for methadone in New York City comes from the state and federal governments.
Dr. Newman: But the city is spending at least some of the money here, and so it does come up as a budget item. In addition, given the strong negativism towards methadone even (perhaps especially!) among those who prescribe it, it's no surprise that public sentiment also is against it -- so criticizing this treatment is politically attractive. The point is that if there were no programs, if methadone was treated more like other medications that doctors can prescribe to people who will benefit, the politicians wouldn't even waste time on it.
As radical as it sounds to the methadone establishment, I strongly maintain that doctors are quite capable of responsibly treating patients -- even those with the disease of addiction. Certainly, this has been the experience overseas, where many countries have thousands of former heroin addicts receiving methadone from general practitioners.
WOL: Barry McCaffrey, the U.S. Drug Czar, recently came back from visiting with his counterparts in Europe and said unequivocally that we need to expand methadone maintenance in this country, but he added the caveat that it should be tightly controlled. His concern, and it's one that is shared by a great many people apparently, is that methadone not be diverted to the black market. Aren't you concerned that easing restrictions on methadone would lead to an
Dr. Newman: Actually, the logic there is completely backwards. A long time ago in this country we had a huge and deadly black market in penicillin. There was an enormous illicit demand from people who couldn't get it through legitimate channels because of inadequate supply. The street market for methadone is an exact analogy, and reflects the fact that people who need it can't get it legitimately. Heroin is vastly easier and more convenient to get!
Why are people buying black market methadone? Because they're trying not to do heroin. If anyone who needed it were able to get it from a licensed physician, and not just those who were lucky enough to have their name come up on the waiting list, we'd most likely see an end to the street trafficking, just as penicillin's black market came to a total halt as soon as supplies were sufficient to meet the clinical demand.
Imagine the black market in Viagra if it were accessible only to 15% of those who might want and need it -- and those 15% had to jump through hoops to get it from "comprehensive impotence programs"? And talk about NIMBY, and the fears that the "Viagrans" would mug us and rape our mothers and grandmothers! Wow!
WOL: The mayor, in his comments as well as in the days immediately after, made a point of mentioning a couple of abstinence-based drug treatment programs by name, programs like Phoenix House and Day-top Village, saying that abstinence-based treatment is inherently superior to methadone, and that this is what we should be aiming at. Being that these programs don't offer methadone, is it possible that there is another economic dynamic at work here?
Dr. Newman: (Laughs.) Well, certainly that's possible. And if methadone were to be eliminated as a treatment option it would very likely mean more patients, and more income for those programs. But I'm not going to speculate as to their influence on the mayor, or their motivation. And for sure I would never denigrate any other treatment approach that offers help and hope to those in need, especially in as notoriously difficult and deadly a problem as addiction.
The fact is, however, that methadone maintenance has been found throughout the world to be the single most effective treatment for heroin addiction known to science. And that's not just me talking. It has broad backing in the medical community. Furthermore, even if one believed a different treatment approach is "better" -- whatever that means -- there is no way whatsoever that the tens of thousands of methadone patients in New York City could be accommodated in any alternative treatment setting; they'd all go back to shooting dope, stealing, killing themselves, getting and spreading AIDS, etc. That's not speculation or bragging or anything else but simple reality.
I certainly value a substance-free recovery, but I see that as no better and no worse than recovery accomplished with the assistance of a dose of medication each day. If it were your son, would you care in the least? Boy, I sure wouldn't! My only prayer would be that he survive, and get out from the clutches of heroin dependence and all the horrors that that entails, including the ever-present threat of death. Heroin is tough to kick under any conditions.
With methadone, people are able to resume their normal lives, outside of the restrictions placed on them which I've mentioned, and be productive and healthy. If that doesn't constitute success in medical as well as social terms for the individual and the community, than I don't know what does. If you are a diabetic, you are pretty much destined to need insulin for the rest of your life. If you go off of it, you're going to have problems, plain and simple. And yet, insulin is rightly understood to be a very successful treatment. The same is true of the wonderful support that AA offers to alcoholics, support that ideally (according to AA advocates) continues life-long.
WOL: But can you truly equate heroin addiction with diabetes? People only become heroin addicts after first making a choice to try heroin.
Dr. Newman: Granted, in most cases there is a behavioral aspect to becoming a heroin addict, but at the same time there is growing evidence that some people have a genetic predisposition to such addictions, so there's also an uncontrollable risk factor that is at play. And regardless, there are innumerable diseases and conditions that have behavioral components. Do we in the medical community turn away heart attack victims who are obese through overeating? Or cancer victims who smoked? We can certainly disapprove of those behaviors, but we don't punish people in an advanced society by withholding effective treatment for illnesses they brought on themselves.
WOL: Is that, to some degree what the methadone establishment is doing?
Dr. Newman: To the extent that providers treat their patients in ways that would be unacceptable in dealing with other types of patients, yes. But again we are back to the problems inherent in a monopoly over a life-and-death medication.
In New York City, it's estimated that there are over a quarter of a million people who are addicted to heroin. But there are only about 35,000 methadone slots. Now, because the establishment has fought tooth and nail to make sure that doctors cannot prescribe this medication, to make damn sure that they were the only providers -- and the government is certainly not going to increase funding for drug addicts by a factor of seven or eight -- over 85% of the addicted are shut out and will be shut out to their dying day! It amounts to saying, "We are not going to allow you to get methadone except through us -- and if you die, you die!" I respect pride in one's own therapeutic efforts, but this kind of attitude is arrogant. I'ts immoral. It's sick.
WOL: That's a pretty stinging indictment, especially coming from a major provider.
Dr. Newman: You're not the first one to tell me that. And I'd like to make clear yet again, because it bears repeating and emphasizing, that not every provider is high-handed and self-serving. I know the staff of Beth Israel best, of course, but the same is true of lots of other programs, I'm sure, and that is the commitment to do as good a job as possible, given the restrictions. And I'm not saying that some programs, for some patients, are not superior to the prospect of having a doctor prescribe methadone.
Certainly there is an element of control that would be given up. But I also oversee one of the finest centers for the treatment of breast cancer in the world, and yet I would never say you have to come to Beth Israel or one of its partner institutions, and if you can't you should go untreated rather than be allowed to get care in a less "comprehensive" center of excellence. That would make the best the enemy of the good. That's what we're doing by insisting on exclusive reliance on programs to prescribe methadone. It's arrogant. It's costing lives. And it results in politicians looking at the treatment as it's been mandated and questioning whether it's justified and should be continued.
This week in Plano, Texas, 29 indictments were handed down in connection with a heroin distribution "ring" said to be responsible for the deaths of at least seventeen mostly young, mostly affluent members of the community over the past four years. Among those indicted were at least fourteen Plano residents, all under 23 years old, who were themselves users and part of the extended circle of acquaintances of those who died. If convicted, each of these young people faces at least twenty years behind bars.
Reaction in the community, at least as reported in the media, is mixed. Many people have taken the hard-line attitude that such punishment will "send a message" to Plano's young people that the community disapproves of such behavior, even if their only connection to drug dealing involved "scoring" a hit or two for a friend and fellow-user, or, just as likely, scoring regularly for fellow-users as a way to finance their own habits. Others seem shocked that these kids face life-destroying sentences as punishment for, essentially, their own addictions. On ABC TV's 'Nightline,' the question was asked, almost incredulously, whether incarceration was a sensible solution for kids who, but for the grace of God, could just as easily have wound up as one of the seventeen dead "victims."
Busting addicts who re-sell small amounts of their drug of choice to pay for their own addictions, and thus staving off painful withdrawal, is nothing new. What is unusual here is that the young people involved are not underprivileged and black but well-to-do and white. The drug war, it seems, besides disproportionately impacting minority communities, also serves to highlight the racism pervasive in our society. An eighteen year-old African American who is addicted and sells drugs is a criminal, a pariah and a menace. But when that 18 year-old is white and middle-class, he is a kid with a problem. And suddenly, the thought of making him pay for his addiction by putting him in a cage until he is a hardened and embittered middle-aged man does not seem to make much sense.
But regardless of the ethnicity of those involved, the Drug War, working as designed, punishes even those who most of all simply need help. There is very little in the way of filtering mechanisms built into mandatory minimum sentences that would separate out the big-time criminal from the desperate addict. And while it is argued that weight requirements, the parts of the law which say that you will get x-number of years for possessing or selling x-number of grams, are meant to serve this purpose, that is really not the case. Because over the past few years of drug war hysteria, the reach of conspiracy laws have expanded to the point that now, almost anyone who is even tangentially involved in anything that looks like a "system" of distribution can and will be held responsible for enormous amounts of drugs, real or imagined, no matter what their actual role in the crime. Even if, as appears to be the case with some of the defendants in Texas, they were simply scoring for friends in an effort to finance their own pathetic addictions.
In response to DRCNet's media alert about this story this week, I received a call from a British activist, a woman who has spent the past eleven years advocating for the rights and the health of people living with AIDS and people living with heroin addiction in England. She wanted an answer to the following question: "Why is it," she asked, "that people in the States are so irrational, to the point of insanity it seems, when it comes to drug addicts? I've been told that it springs from some religious fundamentalism peculiar to America, but as a religious person myself, I rather doubt that Jesus would've sought to punish the most vulnerable among us. What would ever make people think that locking people up for their whole lives to punish them for their addiction is either moral or pragmatic?"
She had me. And although I have never believed as some do that fundamentalism is at the root of our punitive drug war, it is clear that the United States treats its addicts with a harshness and a self-righteousness unequaled in other Western democracies. It is also true that there is an element of religious fundamentalism in the U.S. which is largely absent in those nations.
In considering these facts, and in looking for the connection between them, it occurs to me that while fundamentalism is not the cause of our national obsession with punishing drug users, and in fact such treatment seems quite irreligious, it is likely that to some extent at least, the two spring from the same place. That is, some people flock to religion, just as others become willing to abusively punish, in response to a world which seems to be spinning out of control. It is a reaching for certainty... for moral authority. And it is borne of frustration and a seeming inability to make sense out of chaos.
But while religion, and the fervor that it can incite, has been used by some over the course of history as a weapon against the non-believing, religion is, in its essence, a beautiful and empowering institution. The drug war, on the other hand, and the senseless rush to destroy those who are in reality the weakest among us, operates in a blind-spot. It is a dragon chasing its own tail inasmuch as it expends most of its energies attempting to stamp out that which it has itself created.
In Plano, seventeen kids are dead primarily because they had no idea of the purity level of any particular batch of heroin. They did not, could not under a system in which labels and information are an impossibility, have any idea of the dosage they were using, or whether this bag was more or less pure than the bag they bought the last time. It is also very likely that few of the kids who were taking heroin in Plano had any idea what to do for a friend in case of an accidental overdose, and it is a near-certainty that they had never heard of and had no access to Narcan, a drug which arrests overdose nearly instantly. And, judging by the response of law enforcement this week, it is easy to imagine that at least some of the seventeen might have been saved if their compatriots were not afraid to go to authorities for help the moment they realized that something was terribly, terribly wrong.
The fact that they were addicted would have been bad enough, and the profit margins insured by prohibition undoubtedly led to the "marketing" of the drug on the streets and in the schools of their community. But there was absolutely no reason for seventeen kids to die. So while it is perhaps debatable as to whether, or to what degree the Drug War encouraged their addiction, there can be no doubt that our drug policy has insured that they did not live long enough to recover from it.
So now, in the prosperous town of Plano, Texas, seventeen kids are dead of overdose in four years, and fourteen more are facing the destruction of their futures by incarceration. And listening in the media to the police and the DEA and even to many of the residents of that town, they would've gladly indicted a hundred more if they could've made cases against them. This is our response. It is a response borne of fear and of anger and of a sense that the world is somehow spinning out of control. But it lacks insight, and compassion, and reason. And it hasn't worked in a thousand other towns. And it won't work once again.
Before hanging up, the activist who called from London had this plea for me, and for the organization for which I work: "Help the addicts themselves to organize and to be heard. They understand, and they can make others understand, that they are not monsters but are vulnerable people, many of whom have known nothing but pain for the entirety of their lives. Help them to convince people that with a little help, addicted persons are capable of helping themselves. I think that their vulnerability can be very powerful in helping them to communicate this. And I think that this will change people's attitudes and reduce their level of fear and hatred. Because, even after all that I've seen, I truly believe that people, at their core, are primarily good."
And I hung up. But I doubted, somehow, that this hopeful philosophy was anywhere to be found in the message that the Drug War sent to the surviving kids of Plano, Texas.
Adam J. Smith
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