My daughter’s prom date nearly 15 years ago was a young Eagle Scout whose sister went to a Christian college, and whose father was a successful financial analyst and investment counselor living in a million dollar white middle class home.  Mom stayed at home, raising the young man, with his older brother and sister.  That young man is now a heroin addict several times incarcerated and in and out of rehab programs.  He has been repeatedly near death, and his family helpless to save him.

As the Government Stalls, Children Continue to Die.

27,000 addicts die each year by opioid overdoses.   Massive amounts of cheap quality heroin have flooded all economic levels of society, now taking down white middle class kids.  Kids end up homeless, arrested, and becoming repeat offenders.  They also end up repeatedly hospitalized and eventually one of the 27,000 dead each year.

Addictions have stolen the lives of American youth for years.  The minority community has suffered most.  But the resolve to address the problem seems to arise only when rich white kids start to die.  Like me, you probably know a kid who grew up in a good middle class family with every advantage who is close to death from heroin addiction.

Here’s the standard incarceration model:  Arrest, cold turkey, release, and relapse.  Judges and legislators are finally coming to see:  drug addiction is not treated by incarceration.  People can’t be scarred out of an uncontrollable, lifelong illness.  You can treat heroin addiction.  You cannot cure it.  Hence the case for methadone dispensing treatment centers in towns and cities overwhelmed by the number of “criminal” addicts.  These centers are few because of community fear of the addicts who congregate at the dispensaries.  Fear again overcomes logic and science.  The problem worsens and more kids die.

The Current Crisis Started with Prescription Opiates.

A drug company, Purdue Pharma, took a long standing opiate, Oxycontin and packaged it to the FDA with a time-released additive.  The time-release, Purdue Pharma argued, greatly reduced the addictive components of the original drug.  That was a lie.  The sad part is that doctors bought the lie wholesale, and the drug flooded the market as “safe.”  One Oxycontin tablet was powerful enough to replace eight Vicodin a day.  In 2007 Purdue Pharma’s top executives were required to pay $634.5 million for understating the addictive risks of Oxycontin. Executives Guilty.   But the harm was done.  When doctors finally understood the need to stop handing out the drug, many addicted patients turned to a flood of heroin that had entered the U.S. from South America.

Another Dark Market Force of Addiction

Marijuana production in Mexico dropped with the drug’s decriminalization in the U.S.   Poppies have been planted instead, and the amounts are so great that a $4.00 hit on the U.S. streets is available readily.  Most heroin is now coming across the Mexico – U.S. border, with a ramp up in of production by the cartels. PolitiFact.  Mexico’s Sinaloa state, birthplace of Sinaloa boss Joaquín “El Chapo” (Shorty) Guzmán, is continuing to pump out heroin in massive quantities.  The invasion is as lethal as an invading army of terrorists, yet the U.S. and Mexican governments do not seem ready to take the war directly to the poppy fields.  The interdiction rate is a few percent of the probable volume of shipments.  [PolitiFact, supra] Tens of thousands of our children continue to die each year. 

Heroin Addiction is a National Epidemic Requiring Massive Response. 

In the last few years, Tom Frieden, M.D., Director at the Center for Disease Control, has been one of the clearest and most insistent voices for change in U.S. Drug Policy.  He has informed the White House and Congress that heroin addiction is a national epidemic of crisis proportions.   Belatedly, the Obama administration has grasped the need to act.  It has proposed $1.1 Billion in funding for the expansion of heroin addiction treatment centers.  These centers may provide rational alternatives to treating heroin addiction as a crime requiring incarceration.  https://www.whitehouse.gov/the-press-office/2016/02/02/president-obama-proposes-11-billion-new-funding-address-prescription

You Do Not Reason with an Illness.  You Treat It.  

Drug addiction is not a moral issue.  It is a public health issue.  It is also a biological reality.  The opiates stimulate the deep limbic pleasure centers, causing a release of the intense good feeling produced by dopamine.  This hormone literally takes over the regulatory control of the prefrontal cortex, or rational decision making brain.  It is as if the addict has been given a different brain that operates independently of any conscious willpower. http://www.npr.org/sections/health-shots/2016/01/11/462390288/anatomy-of-addiction-how-heroin-and-opioids-hijack-the-brain

You do not reason with other kinds of illnesses, for example diabetes, cancer or heart disease.   What is the morality case against being ill?  The same must be true of heroin and meth addiction.  Some individuals are genetically more susceptible to addiction, and when exposed to the drug, especially if early in life, the likelihood of lifelong dependency is great.  The idea of using incarceration as the first response is based on a false assumption that the “offender” is not ill, but morally deficient.  If incarceration were the answer, we would see a dramatic reduction in addictive behaviors.  Instead we see a consistent yearly increase.  There are currently 2.5 million Americans addicted to opioids and heroin.  [See NPR Link, supra.]

So it comes down to this.  If we do nothing, or continue the current policies, more children will die. We can try to scare people to stay clean by the threat of incarceration or try to keep them clean with the reward of a felony conviction being removed from their record.  Sometimes that works.  At least 50 per cent of the time, it doesn’t.

The solution starts with providing enough state and federal funding to create quality treatment centers throughout the United States, and especially in underserved poor minority communities.  Research money needs to focus on the unique physiology, genetics, and wiring of the addicted brain, and treatments should focus not just on cognitive therapy and 12 step programs, but the use of medications to mitigate the addictive compulsion.

Punishment and Threats Are Not Solutions. 

We may need to accept that some persons will never be free of addiction, and that at best we can hope to improve and extend their life spans.  These young people are human beings with families.  They are in misery and their families suffer with them.  Mitigating the suffering may be the best we can do for many.  We should let governors apply federal funds within their own states without “one size fits all” federal regulation. 

Police and the Courts should take a flexible approach to removing addicts from the streets not for punishment,  but for their safety and treatment.  This approach can borrow from communities who have already experimented successfully with alternatives, such as Seattle’s LEAD program.  See ABC News.

We Need More Addiction Treatment Centers and Options 

People are not statistics.  Data does not measure the daily worry and sadness of a mother or father who have no idea where on the streets their child might be each night.  Data does not measure the hopeless despair of an addict caught in a cycle of guilt and shame.  What is the price of a child’s life? How do you quantify the slow agony of watching someone you love move closer to death each day?  The solution begins with shifting resources from criminalization to treatment.  Police must be given options to route drug users into treatment facilities without arresting and booking.  But that option will only work when we create quality affordable treatment centers accessible in every community.

POST SCRIPT Aug. 30, 2016:  NEW YORK TIMES Opinion and Surgeon General Letter

After I wrote and posted this article, My Beloved last weekend delivered a letter to me she received from Vivek Murphy, M.D., U.S. Surgeon General.  The letter, sent to thousands of physicians in the U.S.,  is a call for doctors to be aware that they have been manipulated by pharmaceutical companies to over-prescribe opioids.  The unintended result of over-prescription was the release of drug dependency on an epidemic scale.  The letter urges physicians to take a pledge of prescription responsibility by visiting Turn the Tide.org.  The letter also urges doctors to identify addiction as a disease and to shift the discussion from condemnation to treatment.

Then, as I drove home tonight from work, I heard The Michael Smerconish Program on Sirius XM, POTUS, address this very letter, and a N.Y. Times Opinion piece published this same date, 8/30/16.  The opinion states the case:  we’re in an epidemic of disease cutting through every strata of society, and incarceration is not the answer.  Here is the link to the Times Opinion:  Doctors Will Play a Critical Role in the Opioid Epidemic.