At the end of July, President Obama signed the Comprehensive Addiction and Recovery Act of 2016 (CARA). The bill contains sections on making sure first responders have access to naloxone, a medication which can prevent death during an overdose, and provisions on curbing the overprescription of addictive painkillers in the first place, as well as plans for other programs. If the bill gets funding, and that may be a very big if, some of these ideas, as well as similar state-level initiatives, could mean fewer overdose deaths and fewer opioid addictions in the future. These are important pieces of the puzzle, but we are still left with the question of what to do for the millions of Americans who are currently addicted to opioids that are controlled or outright illegal.
This intersection of our legal system and chemical dependency presents some unique challenges that don’t seem to have obvious solutions. Incarcerating addicts has been one of the primary strategies for many years and it is clearly not working, if the end goal is to get people off these drugs. It’s estimated that up to 15% of the 2 million Americans who are incarcerated have a history of heroin addiction alone, and as many as half of all prisoners use drugs in general.
Our legal system also does not have a great track record when it comes to promoting treatment for substance abuse as an alternative to incarceration. Alcoholics Anonymous (AA) is frequently mandated by courts for people whose alcohol abuse has led to a drunk driving or domestic violence conviction. However, the success rate of AA is only 5-10%, meaning that our legal system is sending people for a treatment that will fail roughly 90% of them. And it’s not for lack of a better alternative; there are other types of treatment, including medication, which would likely offer more people better success rates. But our courts continue to embrace AA in spite of the low success rate, lack of scientific basis for the program, and constitutional issues with forcing people to attend a religious-inspired group.
There seems to be better understanding, now, about what works and what doesn’t in terms of treating opioid addiction. Medication Assisted Treatment (MAT) relies on both medication and behavioral therapy to treat addiction. MAT utilizing buprenorphine for addiction to opioid pain relievers was found in one study to have a success rate of 61% after 3.5 years. The CARA calls for this type of “evidence based prescription opioid and heroin addiction treatment” and the Department of Health and Human Services (HHS) has taken steps to make buprenorphine available to treat more patients. But these are very recent developments in an epidemic that has been claiming lives for years.
The longer the opioid problem persists in the U.S., and the more people who remain addicted to prescription or non-prescription opioids, the more overdose deaths we will see. Even with an understanding of how to treat this type of addiction, it’s still unclear how our national, state, and local legal systems are supposed to balance the need to get addicts into functional treatment with the “War on Drugs” paradigm. Our drug laws, law enforcement agencies, and courts were not designed to deal with a health issue, and pretending that chemical addiction to substances, which were supposed to be medicines, is simply a crime problem has not been working. It seems that if the U.S. is serious about ending the opioid epidemic we may need more than new drugs, new treatments, and new laws, we may need a whole new way for our country and our legal system to deal with drugs and drug-related crimes.
Alexis Chapman is a Political Consultant and Writer specializing in all types of policy analysis, from international law to local ordinances. She’s lived in Australia, Ghana, Vermont, Hawaii, and Texas and has worked for small and large NGOs, state legislature, industry associations, and a variety of publications. She is a regular contributor to Political Storm.