Mental Health Matters: A call to decriminalize drug use, fund proper treatment
August 2, 2017
We're in the midst of one of the worst epidemics ever to visit this country, but rather than treat it as the public health crisis it is, as a nation we are either ignorant or indifferent.
I'm speaking of the opioid epidemic, a national problem visiting every state in the union, and a local tragedy anywhere you care to look.
It's estimated that in 2016 some 62,000 Americans died of a drug overdose, a 19 percent increase over 2015, the largest yearly increase ever. For Americans under 50, drug overdoses are the leading cause of death.
There is no sign that this humbling, humiliating, national scourge will recede spontaneously. It's predicted that in 2017 more Americans will die from drugs than died in the Vietnam, Iraq, and Afghanistan wars combined.
Presently, about 10 percent of Americans with opioid problems get treatment. If 10 percent of diabetics or people with cancer received treatment America would qualify as a failed state.
Why, in light of all we have learned about the medical and brain-based nature of addiction in the past 25 years do so many still see addiction as a moral failing, a perverse personal failure?
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Ignorance is one answer. It takes time before advances in science seep into public and political consciousness.
Another is economic, the fact that billions of dollars are awarded to criminal justice agencies to pursue a war on drugs.
The stigma of addiction is another, both the stigma that addicted people ascribe to their behavior, and the stigma stemming from criminalizing addictive behavior.
Drug addiction is a mental disorder with both biological and psychological causes. It is also the only mental disorder, which is classified as a criminal offense.
Think of it like this: A 43-year-old man develops crushing chest pain and rushes, or is rushed to the hospital for life-saving treatment. Another 43-year-old man overdoses on heroin at a party, and others in attendance, fearful of the possible criminal consequences of calling 911, do nothing; the man dies.
Yet naloxone or Narcan is a life-saving treatment for opioid overdoses. I wrote a column about naloxone three years ago. Recently, a number of states have passed "Good Samaritan" laws allowing the involved individuals to avoid criminal prosecution when the authorities respond to an opioid overdose call.
Previously, when the authorities responded to an overdose call, if the overdosed person survived, both that person and those who made the call would likely go to jail.
Even now, if you notify paramedics about a probable opioid overdose, but the next-door neighbors called the police to report a disturbance, the overdose victim and you may end up in jail for possession.
Or you have a son or daughter who is a serious drug abuser with emotional problems. You stay awake at nights worrying that he or she will overdose and die.
In most states, a mental health professional can commit a suicidal person to a treatment facility for observation. If that person is also addicted to drugs that may kill them, chances are they will go to jail where they will receive little or no mental health care.
Only a handful of states allow hospital commitment for even the most serious and potentially lethal substance abuse problems, yet another legacy of drug criminalization.
If you're an opiate addict you avoid care, rightly fearful, in many circumstances, that your "criminal" use of drugs will land you in jail or that undereducated, moralizing treatment providers will provide substandard care or worse.
In the era of alcohol prohibition 100 years ago, alcohol addicts had the same concerns that illicit drug users have now; the authorities could and would put you in jail for drinking alcohol. Once drinking was legalized and regulated, some of the stigma and many of the reasons for avoiding medical care were removed. Society learned that compassion and caring for alcohol addicts decreased the morbidity and mortality from the disorder.
We can predict similarly positive results with drug addiction, and, indeed in countries that have decriminalized drug use and emphasized treatment the results have been encouraging. Early results from similar programs in several American counties have been similarly promising.
There is a terrible lethal legacy of criminalizing drug use, a legacy that continues to this day.
If we are serious about ending this dark stain on the American soul, we will decriminalize drug use and fund appropriate treatment. To do less will surely lead to further unnecessary cost, moral and economic.
Incline Village resident Andrew Whyman, MD, is a clinical and forensic psychiatrist. He can be reached for comment at firstname.lastname@example.org.
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