Can there be a silver lining to a drug epidemic that is so extreme it is deemed a public health emergency? As prescription opioid (painkiller) addictions drive individuals to heroin, there just might be.
Heroin use has surged recently — seizures of supply increased by nearly 70% over the last few years in New York (the epicentre for imports into the United States). In Boston, overdoses increased by nearly 80% between 2010 and 2012. This has followed a rising trend in prescription opioid addictions — 4 out of 5 users are addicted to prescription painkillers when they first try heroin. Turning to the street opioid is often a move of desperation; prescription opioids are now harder to abuse, more expensive, and harder to obtain than heroin. In other words, heroin provides a cheaper, easier to score, and stronger high.
This surge in use is changing the face of heroin; the Office of National Drug Control Policy’s director recently described the drug as a former “inner city problem” that has become classless, affecting “all populations and all ages.” To be blunt, white people — many with high paying jobs and fancy apartments — are now doing 8 to 10 bags a day.
This has the nation’s attention. With a changing demographic, our perceptions of drug abuse are shifting — from viewing addiction no longer as a crime implicating incarceration, but as an illness implicating treatment.
The response here in Massachusetts paints the clearest picture of this 180 degree turn on drug policy:
The Commonwealth is heralded as a beacon of hope for healthcare reform. Since enacting an Affordable Care Act-like law in 2006, Massachusetts saw death rates fall by up to 4.5% in just four years, particularly in counties where many were newly insured. The state now has the lowest rate of uninsured residents in the country.
Yet Massachusetts left one set of patients out to dry — those with substance use disorder (SUD). In fact, Massachusetts is the only state in the nation that incarcerates innocent individuals when inpatient beds are unavailable (i.e., those who have committed no crime but are deemed to be a danger to themselves or others).
Let’s imagine you are a Massachusetts resident with an alcohol or drug addiction. You are likely insured, but cannot or have not obtained treatment. Anyone who suspects you to be suffering from SUD can file a petition to have you committed (e.g., police officer, physician, spouse, relative) — thus triggering a summons to appear in court. A failure to appear before a judge results in automatic issue of a warrant for your arrest — not for a crime, but for suffering from an untreated illness.
We know that incarceration does not treat, and may well exacerbate, SUD. In fact, substance abuse is disproportionately prevalent in prisons, affecting 80% of inmates.
Now, eight years after Massachusetts’s healthcare overhaul — legislators are starting to take notice. Once again, healthcare is following the money.
In Massachusetts, the methadone business is booming. After prescription opioid manufacturers raked in $11 billion in profits in 2010, the largest line of methadone clinics saw an increase in net income of over $US4 million between 2011 and 2012, up from a deficit of $US46 million in 2010. The company’s deputy chief clinical officer attributes profits to healthcare reform: “We’ve pretty much convinced the country now that this is a health care issue. This isn’t about bad people trying to become good. This is about ill people trying to get well.”
Perhaps not coincidentally, Massachusetts legislators are viewing SUD in a new light. Governor Patrick recently approved $20 million in treatment funding — a tiny, but significant, step towards keeping the innocent out of jail. The state’s House and Senate are addressing the issue as well. For example, pending bills propose limiting incarceration for SUD to 10 days (currently a patient can be jailed for up to 90) and increasing insurance coverage of SUD treatment by both public and private plans.
Lawmakers are acting in accordance with public support; 83% of those polled in 2013 agreed that treating, rather than criminalizing, SUD would reduce crime. Budgetary constraints are also at play; the Commonwealth spends over $US47,000 per year on each inmate.
Perhaps, as heroin addiction becomes a (very public) white person problem, Massachusetts will lead the nation not just in healthcare reform, but also in recognising SUD as an illness just like any other. That, indeed, would be a silver lining to a devastating public health problem.
This post originally appeared in Harvard Law’s “Bill of Health” blog. It has been reprinted with permission from the author.
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