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How America Overdosed on Drug Courts

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Re: How America Overdosed on Drug Courts

#11

Post by CodeWriter23 »

This article focuses on a single failed case, the actual worst case scenario. And though it is true cases like this exist, it is a tiny part of the story of Drug Court. It gives no credit to Drug Court's immense success. I have personally met dozens if not hundreds of addicts that came into recovery only through drug court, and have achieved long term recovery, and have become productive members of society.

After touting the worst case scenario and ignoring the success, this article puts a little missive in there about how doctors (those mostly with no personal experience in addiction or recovery) prefer opioid maintenance. This is but another marketing message for Suboxone, in the massive PR campaign underway to create an alternative to drug-free recovery through long term addiction to a pharmaceutical product. In the recovery community, Suboxone is referred to as Drug Replacement Therapy (DRT) because that is what it is, switching street dope for dope that comes from your doctor. It gets you high enough to avoid withdrawal, but not so high that you can't move boxes or burgers in an entry-level job. If you do try to get off the Subs, you will experience withdrawal that makes heroin withdrawal look like a walk in the park on a sunny day with a sno-cone and a puppy. This article also fails to mention the suicide rate of people on Suboxone. While I have no hard data on that (ONLY because it has never been studied), I can tell you it happens. It's happened to people I've known. It happens because so long as they are addicted to dope, doctor prescribed or otherwise, the deeply traumatized individual who is an addict remains traumatized. They will never experience the true freedom, healing and wholeness that comes only through deep self-examination and a conversion process of equal or greater magnitude, that leads to self- and social integration. DRT only treats the most visible symptoms of addiction, and does nothing to treat the underlying cause.

While I know not everyone succeeds as a result of drug court, on balance, it is a net positive. Some people need to be re-arrested 2 or 3 times before it takes. And some die. This is an unfortunate reality of addiction. And opioid maintenance IS addiction. It really is up to the individual to work through their trauma, and find the needed support to exist and find a reason to continue living. That cannot be imposed by law, coercion, or prescription.

Bottom line though, research the history of Heroin in the United States. A hundred or so years ago, heroin was touted as the solution for morphine addicts. It was the Drug Replacement Therapy of that time. We have been down this road before and we know where it leads.

Re: How America Overdosed on Drug Courts

#12

Post by DanBC »

worik wrote: post #10
exelius wrote: post #7

Earlier quoted context omitted.

IMO we need to decriminalize drugs, treat addiction as a medical issue, and shift our cultural attitudes away from seeking punishment out of the justice system. But none of those will happen because there are too many people making too much money from the current paradigm. And politicians have worked long and hard to ensure they have no accountability. As long as the place that they're from is aligned to their party…

"none of those will happen because there are too many people making too much money from the current paradigm" Portugal Colorado/Washington/Alaska In the UK they have returned to prescribing heroin to drug addicts In New Zealand there is new law around novel drugs that will make them legally available in shops if they can be proved safe It is happening.

> In the UK they have returned to prescribing heroin to drug addicts

Do you have a cite for that please?

Here's the current English guidance for Drug misuse, opioid detoxification.

http://www.nice.org.uk/guidance/cg52

So, there are a few doctors that have the required special licence needed to prescribe heroin as a treatment for addiction. These special licences are not new, they've existed for a long time. I'm not aware of the numbers of licences going up.

https://www.evidence.nhs.uk/formulary/bnf/current/guidance-o...

Most addicts are not going to get heroin, they're going to get oral meds like suboxone.

Re: How America Overdosed on Drug Courts

#13

Post by phren0logy »

worik wrote: post #9
phren0logy wrote: post #4

>By the time Darren was assigned to drug court, his addiction story carried almost every possible red flag for high-mortality risk: prior overdose, prior treatment failure, a childhood ADHD diagnosis, and a family history of mental illness. Any addiction doctor—or anybody who simply follows evidence-based treatment guidelines—would know exactly what to prescribe for him: opioid maintenance, by far the most effective…

It is a generalisation but a good one. "Getting clean" is a loaded term. Most (not all) people who have "drug" problems actually have police problems. The drugs do them very little harm (impurities are a different story, but not as common as people think) but the police and legal systems do them untold damage. Making the drugs available is by far the best treatment for most forms of drug addiction in the vast majorit…

I can't really agree with your premise. Our current situation is pretty broken, and our drug laws and enforcement have not achieved their stated aims.

That said, the legality of alcohol hardly keeps it from causing lots of people very serious problems. "Drugs do them very little harm" is fantasy, though you are quite right that a felony history and time behind bars only makes things worse.

Re: How America Overdosed on Drug Courts

#14

Post by phren0logy »

nashequilibrium wrote: post #6
phren0logy wrote: post #4

>By the time Darren was assigned to drug court, his addiction story carried almost every possible red flag for high-mortality risk: prior overdose, prior treatment failure, a childhood ADHD diagnosis, and a family history of mental illness. Any addiction doctor—or anybody who simply follows evidence-based treatment guidelines—would know exactly what to prescribe for him: opioid maintenance, by far the most effective…

Why is a psychiatrist on hackernews, just curious?

During my residency, I did some fMRI research and learned a little bit of programming. The structured thinking involved in programming has been a useful skill that I try to maintain.

Plus there's lots of interesting discourse with smart people, which is a rare thing to find on the internet these days.

Re: How America Overdosed on Drug Courts

#15

Post by worik »

phren0logy wrote: post #13
worik wrote: post #9

Earlier quoted context omitted.

It is a generalisation but a good one. "Getting clean" is a loaded term. Most (not all) people who have "drug" problems actually have police problems. The drugs do them very little harm (impurities are a different story, but not as common as people think) but the police and legal systems do them untold damage. Making the drugs available is by far the best treatment for most forms of drug addiction in the vast majorit…

I can't really agree with your premise. Our current situation is pretty broken, and our drug laws and enforcement have not achieved their stated aims. That said, the legality of alcohol hardly keeps it from causing lots of people very serious problems. "Drugs do them very little harm" is fantasy, though you are quite right that a felony history and time behind bars only makes things worse.

What harm does heroin do a person? Pharmacologically it does very little. Addiction is the main harm.

The vast majority of drug users do not have problems (almost every adult uses drugs) except problems with the legal systems.

This is well known and extensively documented. I would encourage you to study what has happened in Portugal over the last decade.

Different drugs have different effects. Alcohol is one of the more dangerous yet is legal and a huge business. More dangerous than cocaine, heroin, ecstasy.

See David Nutt's research from the UK.

http://www.businessinsider.com.au/alcohol-more-harmful-heroi...

http://www.sciencemediacentre.co.nz/2010/08/06/professor-dav...

Re: How America Overdosed on Drug Courts

#16

Post by phren0logy »

worik wrote: post #15
phren0logy wrote: post #13

Earlier quoted context omitted.

I can't really agree with your premise. Our current situation is pretty broken, and our drug laws and enforcement have not achieved their stated aims. That said, the legality of alcohol hardly keeps it from causing lots of people very serious problems. "Drugs do them very little harm" is fantasy, though you are quite right that a felony history and time behind bars only makes things worse.

What harm does heroin do a person? Pharmacologically it does very little. Addiction is the main harm. The vast majority of drug users do not have problems (almost every adult uses drugs) except problems with the legal systems. This is well known and extensively documented. I would encourage you to study what has happened in Portugal over the last decade. Different drugs have different effects. Alcohol is one of the m…

You are kidding, right? Do you know how many people die of opioid overdose every year?

I'm not arguing that criminalization has helped, so let's keep these two lines of thought separate. Is alcohol more dangerous than heroin? Perhaps, and David Nutt's research is very interesting on relative harms, but it doesn't magically make either one totally safe.

Re: How America Overdosed on Drug Courts

#17

Post by dalke »

exelius wrote: post #7
dalke wrote: post #3

Earlier quoted context omitted.

So how do we get there? More mandatory minimums? Less judicial discretion? Since I think the solution is to get rid of the drug courts and move them into the medical system, and not to demand more accountability. Plus, what of accountability for the politicians who set up the policies in the first place?

IMO we need to decriminalize drugs, treat addiction as a medical issue, and shift our cultural attitudes away from seeking punishment out of the justice system. But none of those will happen because there are too many people making too much money from the current paradigm. And politicians have worked long and hard to ensure they have no accountability. As long as the place that they're from is aligned to their party…

I believe you are agreeing with me. FWIW, I was disagreeing with the previous poster. My "So how do we get there?" was to ask for more details about how to add more accountability to the drug court system to get a more equitable and just system. Your answer, like mine, was to propose removing the drug court system.

As the drug court system was put into place by politicians, it seems that the responsibility lies also with those politicians (and their successors), so if the g'parent poster wants more accountability, then where is their accountability?

Re: How America Overdosed on Drug Courts

#18

Post by worik »

DanBC wrote: post #12
worik wrote: post #10

Earlier quoted context omitted.

"none of those will happen because there are too many people making too much money from the current paradigm" Portugal Colorado/Washington/Alaska In the UK they have returned to prescribing heroin to drug addicts In New Zealand there is new law around novel drugs that will make them legally available in shops if they can be proved safe It is happening.

> In the UK they have returned to prescribing heroin to drug addicts Do you have a cite for that please? Here's the current English guidance for Drug misuse, opioid detoxification. http://www.nice.org.uk/guidance/cg52 So, there are a few doctors that have the required special licence needed to prescribe heroin as a treatment for addiction. These special licences are not new, they've existed for a long time. I'm not a…

My comment was based on my general knowledge. Most recently by reading the book "Chasing the Scream". Look it up, I forget the author.

But your challenge made me go look, and in about 20 seconds (https://duckduckgo.com/?q=prescribing+heroin+for+addiction+i...) I found: http://pb.rcpsych.org/content/29/4/123 and http://www.recoveryfirst.org/englands-heroin-experiment.html...

This is a process, attitudes are changing, they have not changed.

Interestingly I have never heard of suboxone. I do not think it is widely used in my community, where methadone is prescribed to addicts.

I no longer have direct connections to addicts (I found that ruinous to my lifestyle) but 15 years ago in my country any body who wanted could go on a methadone maintenance programme and heroin use almost dies out completely.

It did not completely die out as there was a residual interest among users who were not addicts (yet?) so had no need of a methadone habit which is as useless to a drug enthusiast as a nicotine habit, but much less harmful and much less socially acceptable.

These days I have connections to the treatment community which is different and a lot of interesting things are happening (look up ibogaine). I also campaign in the political sphere for drug legalisation as I have seen the harm done by police and judges to those I love.

Re: How America Overdosed on Drug Courts

#20

Post by ufmace »

phren0logy wrote: post #13
worik wrote: post #9

Earlier quoted context omitted.

It is a generalisation but a good one. "Getting clean" is a loaded term. Most (not all) people who have "drug" problems actually have police problems. The drugs do them very little harm (impurities are a different story, but not as common as people think) but the police and legal systems do them untold damage. Making the drugs available is by far the best treatment for most forms of drug addiction in the vast majorit…

I can't really agree with your premise. Our current situation is pretty broken, and our drug laws and enforcement have not achieved their stated aims. That said, the legality of alcohol hardly keeps it from causing lots of people very serious problems. "Drugs do them very little harm" is fantasy, though you are quite right that a felony history and time behind bars only makes things worse.

I'm curious about a couple of your points here.

First, when people involved in addiction treatment say that drugs cause people serious problems aside from legal issues related to the drug itself, I wonder if they are biased by only seeing the users who hooked badly enough to land themselves in various sorts of rehab/therapy programs. Do we know how many people are using these drugs in a more casual way, suffering little to no real harm from them, and never coming to the attention of the legal system?

Second, you say below in reference to heroin being dangerous how many people die of overdoses every year. I was under the impression that the reason overdoses are so common is that, since it is illegal, there is no regulation or easy way to determine the purity of any given batch of it, so it is easy to accidentally overdose if you get a stronger batch than you're used to. If opioids are really that fundamentally dangerous, why is long-term monitored use of methadone etc not considered to be a bad thing, as opposed to going cold-turkey ASAP?

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