Saturday, March 27, 2010

Want to talk about the real drug problem?

So when are we going to start talking about the real drug problem in this country? A new issue brief from the CDC on “unintentional poisoning” (that’s what we’re calling drug overdose these days, especially when it involved prescription medication) reports that, in 2006, overdose was the second leading cause of unintentional injury deaths after motor vehicle accidents! 26,400 people died from overdose that year. Even more alarming are the rapid rates of increase --- overdose deaths have increased 5 fold since 1990. What drugs are killing people at such alarming rates? According to the CDC: “the increase in drug overdose death rates is largely because of prescription opioid painkillers.” There has been a ten-fold increase in the ‘medical use’ of painkillers in the past 15 years, and prescription opioids were responsible for more deaths in 2006 than heroin and cocaine combined.

There is no way to address the epidemic of prescription drug abuse with answering hard questions about who is using these drugs (largely middle-aged, white people), who is prescribing these drugs (doctors), and who is profiting from the sale of these drugs (Big Pharma). According to a market industry report, “the global market for pain management pharmaceuticals and devices amounted to $19.1 billion in 2008 and is expected to increase to $32.8 billion in 2013.” That’s a lot of incentive to prescribe opiates. Under the 1914 Harrison Narcotic Act, doctors cannot prescribe narcotics for the treatment of addiction, but they can and do prescribe it for pain. So, we have a set of policies where doctors can, for example, prescribe methadone (an opiate the causes physical dependence) for pain but cannot prescribe it (except in a few highly regulated clinics) to treat addictions. Just to reiterate, doctors can prescribe the medications that cause addiction, but once people are addicted, both addicts and doctors are trapped in a difficult dance over if and how medications will continue to be prescribed.

This confusion in our policies has created a cottage industry of pain management clinics, particularly in states like Florida with less regulation (try googling Florida + pain management). For sure, many people are seeking legitimate help for acute or chronic pain conditions. But clearly, a lot of folks are becoming addicted, and thousands of them are dying each year from overdose. Despite increasingly irrefutable evidence that the real drug problem in this country is prescription medication, the vast majority of our drug policies in this country are still aimed at punishing those involved with illicit drugs. I’ll leave you with questions: When does a medication become a drug, and what is the difference between the two anyway?

Wednesday, March 24, 2010

alcohol: the other drug

There is a really interesting new study out from the CDC on the health behaviors of adults that includes information about the Americans' use of alcohol.  According to this study, 61.2 % of us drink, while only 5% are heavy drinkers.  So here’s a mind-altering substance that is widely consumed and affects far more people than most illicit drugs but is regulated entirely differently. I’m not saying that there isn’t room for improvement in our policies surrounding alcohol, but they are far saner than many of our drug policies.  Alcoholism is a serious problem, but unless someone commits a crime while drunk, we generally don’t lock up alcoholics but refer them to treatment.   

One of things that I found most intriguing about the study was the finding about consumption, abstinence and education. Drinking levels increased as education level increased: people with masters, doctorate, or medical degrees are much more likely to drink than those without a high school diploma. 

 Not surprisingly given the correlation between income and education, richer Americans were more likely to drink than those living below the poverty level.  Moreover, poorer people who used to be regular drinkers were more likely to have quit drinking than richer ones.  Perhaps, then, it isn’t surprising that alcohol is regulated, while other drugs, which are perceived to affect communities of color, are criminalized.  When it comes to our drug policies, it’s hard not to see racial disparities in our approaches.

Sunday, March 14, 2010

racial disparities in sentencing persist

A new study from the U.S. Sentencing Commission suggests that racial disparities in sentencing have actually increased since the loosening of federal sentencing guidelines.  According to the report, since the 2005 Booker ruling that gave federal judges more discretion, Black men have received sentences at least 10% longer than those imposed on white men.  The report cautions that these statistics can't explain why these disparities exist, but it seems to me that the U.S. history of racial oppression and mass incarceration of men of color is one place to start looking for answers.  This report comes at a time when the U.S congress is considering legislation that would reduce disparities in sentencing between powder and crack cocaine, which has long been recognized as leading to racial disparities in drug-related sentencing.  Drug law reform is desperately needed, and reformers are right to take aim at mandatory sentencing that leads to racial disparities.  However, this new report suggests that we need to play close attention to states like New York that have recently reformed the harsh and ineffective Rockefeller drug laws (requiring mandatory sentencing for drug-related offenses) with judicial discretion.  Judges, like the rest of us, are not free from racism, and dismantling the racist prison industrial complex cannot rest on judicial discretion alone.  This latest study is just more evidence that reforming our drug policy must go far beyond over turning mandatory sentencing.  It's time to think more deeply about how to reorient all of our public policies to reduce the harm associated both with drug use and the racism inherent in the "war on the drugs."