Legislators Panic and Force Addiction Treatment

Making naloxone available with an attached condition during a life and death emergency is not only irresponsible and stigmatizing but cruel.
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The Center for Disease Control reports that drug poisoning from both pharmaceutical and illicit drugs continues to be the leading cause of injury death in the United States. In 2013, 43,982 deaths were due to drug poisoning; 81% of these deaths were unintentional. Drug poisoning continues to be a public health crisis that is in need of a long-term strategy from legislators and the medical field. The public deserves a comprehensive plan that keeps individuals safe from harm.

Grieving family members are demanding a solution and want legislation to combat the problem. They want medical professionals, pharmaceutical companies and legislators to work together to make naloxone, the antidote for opioid overdose widely available and want access to medication-assisted treatment. They want easy access to valid treatment options as well as insurance reimbursement. In addition they want first responders to keep them safe.

While legislators across the country continue to argue and discuss how to address grieving families demands, the Washington Post reports about a small town police chief from Gloucester, MA who may have the most compassionate solution of all; one that takes the needs of those that use drugs into account and respects the needs of the individual. Since this initiative has started, well over 100 individuals have come forward and asked for help. Not only has this program served those of Gloucester, it has served individuals from out of state as well. Over 20 treatment centers across the country have been vetted and are on board to accept those that chose to get care. Treatment costs are reduced so that payments are reasonable and naloxone is readily available. When individuals come to the police station, police do not arrest, they find medical care. Trying to work within the current system, this police department is trying to take a grassroots compassionate approach as they worry if someday down the road others will demand that police arrest instead. Although too early for data the Gloucester model looks promising; people are asking for help on their own.

In complete contrast to what is happening in MA, New York may propose legislation that puts a condition on those administered naloxone in an attempt to reverse an opioid poisoning.

The New York proposed forced treatment legislation initiated by Senator Rob Ortt is particularly troubling. Proposing legislation requiring mandatory treatment for addicts saved by naloxone forces the criminal justice system further into the lives of individuals and would further complicate the dilemma of calling 911 for emergency care. Making naloxone available with an attached condition during a life and death emergency is not only irresponsible and stigmatizing but cruel.

Legislators who state that coerced care is proven to work need to re-examine their claims. It is said with frustration and anger toward the individual who is not seeking treatment and continues to use drugs or alcohol. These statements should not be taken lightly; there is underlying animosity for these individuals that they are suppose to serve. It is the same anger that drove the NY 911 Good Samaritan Law excluding immunity for those that are under community supervision, probation, or parole; legislation that continues to endanger at risk lives.

Forced treatment is not a new concept, laws such as the Marchman Act and Caseys Law as well as mandated drug court treatment all have the same underlying premise: since you refused to get well on your own accord, we will force you to get well.

Although the courts believe that coerced treatment for drug use and addiction
works, none of these initiatives have reduced the overdose rate. Furthermore,
coercion in the treatment of addiction raises many ethical, philosophical, political, cultural and clinical issues that have yet to be resolved. There is no other medical issue in which coercion and punishment is considered standard of care.

Currently, the addiction treatment system is a system that has no strategic long-term plan. Doing more of the same and repackaging it into forced legislation to appease the public does not address the problem.

The medical community is lacking in their understanding of those that continue to use drugs and alcohol. Treatment facilities are riddled with substandard care, abstainice only philosophy prevails and poorly trained staff has little over sight by regulatory or state agencies. The public knows little about the business margins of addiction centers and success claims in institutions are suspect. Currently, harm reduction practices lack support and communities rather not institute needle exchange programs, both of which keep those that use drugs safe.

Instead of improving the treatment facilities and improving medical care, drug courts have stepped into the physician's role. Treatment is chosen, medical information is tracked and monitored, controls and behavior standards are instituted and the courts and criminal justice system measure success. Labeling individuals as addicts when arrested for drugs and coercing individuals into treatment that does not work is a disservice to families. Courts continue to stigmatize those with drug use as criminal first and patient second and view punishment as a standard of care.

Understandably, first responders are tired. The public continues to hesitate to make 911 calls during an overdose situation and first responders may arrive too late. Individuals may try to administer naloxone on their own but may fail to get follow-up emergency care that they may need. First responders are concerned about overdose victims and know that access to quality care is needed. And isn't that the crux of the problem, our medical system is broken when it comes to the treatment and care of those that use drugs.

Legislators would be better advised to improve care and regulate facilities that promise much but do little. Doctors need training, insurance needs to cover care and individuals need to be treated with compassion and respect. Legislators cannot continue to push treatment that does not work and pat themselves on the back that they are doing something. Mandating poor treatment that is unwanted and ill advised will not solve the public health issue.

As more data is collected, the little town of Gloucester may be a model for New York and Senator Ortt to watch; they are opening their hearts and treating individuals with compassion without force, looking for care that match the individual's needs while trying to absorb extra costs. They understand that relapse happens and the threat of arrest is no more. First responders will continue to respond without judgement and offer hope.

For more info and video on the Gloucester Model see the Police Assisted Addiction and Recovery Initiative

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