Maybe prohibition is the way to go?

For years I’ve been writing comments like this about drug policy:

Any drug policy will have problems, probably serious problems. The important questions are:

  • Which problems are we most unwilling to live with?
  • Which problems are we most willing to tolerate?
  • What strategies will help us achieve these goals while maintaining concern for all problems?

Of course, of equal importance is our willingness to regularly re-assess policy to improve our response and address unanticipated problems.

These are really hard questions.

And, it’s been frustrating to read lots of people treating it as though there are simple and obvious answers.

The intersections of addiction, capitalism, medicine, crime, and government, with all their variations, limitations and flaws make this a very difficult problem. We tend to underestimate the existence of unintended consequences and overestimate our influence.

It’s good to see a pretty influential writer at Vox interrogate his own beliefs and assumptions.

By the time I began as a drug policy reporter in 2010, I was all in on legalizing every drug, from marijuana to heroin and cocaine.

It all seemed so obvious to me. Prohibition had failed. Over the past decade, millions of Americans had been arrested and, in many of these cases, locked up for drugs. The government spent tens of billions of dollars a year on anti-drug policies — not just on policing and arresting people and potentially ruining their lives, but also on foreign operations in which armed forces raided and destroyed people’s farms, ruining their livings. Over four decades, the price tag for waging the drug war added up to more than $1 trillion.

. . .

Then I began reporting on the opioid epidemic. I saw friends of family members die to drug overdoses. I spoke to drug users who couldn’t shake off years of addiction, which often began with legal prescription medications. I talked to doctors, prosecutors, and experts about how the crisis really began when big pharmaceutical companies pushed for doctors and the government to embrace their drugs.

. . .

Looking at this crisis, it slowly but surely dawned on me: Maybe full legalization isn’t the right answer to the war on drugs. Maybe the US just can’t handle regulating these potentially deadly substances in a legal environment. Maybe some form of prohibition — albeit a less stringent kind than what we have today — is the way to go.

Read the whole thing here.

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Changes coming to Michigan’s public funding system for addiction and mental health services?

There an article in Bridge magazine that does a great job bringing us up to speed on proposed changes to the funding system. (This is just a portion. Please go read the entire article here.)

For over a year, intense review has taken place across Michigan on a critical matter. How it is resolved will say much about our state.

On one side are powerful private insurers, who think about ways to increase profits. On the other are consumers of mental health service and their families and advocates, who think about survival.

The issue began in February 2016, when Gov. Rick Snyder proposed transferring $2.5 billion of Medicaid mental health money from governmental Community Mental Health Services Programs (CMHSPs) to the state’s 11 private Medicaid HMOs (also known as Medicaid Health Plans, or MHPs). The latter contract with the state to manage “physical” health care of many Medicaid beneficiaries.

The governor’s proposal was put on hold after public outcry. Since then, the state has done three major reviews of the issue. Each time, the governor’s plan was rejected.

First, Lt. Gov. Brian Calley formed a 120-person work group in early 2016. It recommended the publicly funded mental health system remain under CMHSP management.

Next, 45 affinity group sessions were held across the state last fall. Two-thirds of these were for service recipients and families, attended by over 700 people, who stated overwhelmingly they didn’t want MHPs controlling their mental health care. Additionally, the 15 affinity groups for service providers and payers yielded no recommendation supporting the Governor’s proposal.

Finally, the Department of Health and Human Services (DHHS) appointed a 23-person workgroup to develop reports to the Legislature, delivered this January and March. Again, it was recommended that CMHSPs lead publicly funded mental health care and MHPs lead publicly funded care for other medical conditions. It was further recommended that joint CMHSP-MHP programming for shared enrollees be strengthened. These reports had over 70 recommendations, many targeted to improving the state’s mental health system.

You would think that would settle the matter.

However, there are rumblings in Lansing that legislature may not follow the recommendations of these 3 workgroups.

If this concerns you, call your State Senator and State Representative.

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Vancouver OD deaths keep rising

From the Vancouver Sun:

More than 20 temporary supervised injection sites opened in Vancouver, Victoria and across the province and a mobile medical unit was deployed — although medical staff have since been withdrawn — in the Downtown Eastside, all of them kitted out with life-saving naloxone and trained staff. More than 3,000 overdose events have been safely managed since late December.

Despite these measures, more than 100 people have died due to drug overdose so far this year in Vancouver, a pace that would see 400 people dead by the end of the year. There were 216 overdose deaths in Vancouver last year and 922 in the province, roughly five times the number for an average year.

And, the provincial context from David Juurlink:


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A tweet to ponder


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Sentences to ponder

Shared by my friend Chris Budnick. (emphasis his)

“During the 1920s and 1930s a growing number of physicians and public health professionals came to view addiction as a manifestation of psychopathy or some other form of twisted personality, to support mandatory institutionalization of addicts, and to refuse to supply addicts (especially the nonmedical type) with opiates. The average doctor came to think of the average addict as somehow beyond the pale, an unstable and compulsive personality better left to the management of the police or other authorities. This hardening of attitudes resulted at least in part from the fact that physicians were exposed to an increasingly lower-class type of addict; witnessing the transformation first hand, they did not much like what they saw. In previous decades, however, when addicts were drawn primarily from the middle and upper classes and often were addicted through medical practice, attitudes of both doctors and laity were generally more tolerant. Willis P. Butler, a crusty, nonagenarian physician who in 1919 established a morphine maintenance and treatment program in Shreveport, Louisiana, likes to illustrate this point with an anecdote. One day a prominent citizen walked up to him and denounced his addicted patients as ‘hopheads’ who ought to be run into the river. Irritated, Butler took the visitor aside and confided that the man’s own 75-year old mother, an asthma sufferer who had been addicted for more than 20 years, was a regular patient at the clinic. Once he overcame his surprise and shock, the erstwhile critic became one of the program’s staunchest supporters. The moral of this story is one of the central themes of this book: what we think about addiction very much depends on who is addicted.

Dark Paradise: A History of Opiate Addiction in America by David Courtwright (1982)

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It’s beginning to feel like big tobacco all over again (part 2)

Claire McCaskill ratchets things up a notch:

A leading Democratic senator is investigating the nation’s top opioid manufacturers to determine whether they contributed to overuse of the painkillers at the center of a deadly addiction crisis that has led to nearly 200,000 overdose deaths in the past 15 years.

Sen. Claire McCaskill of Missouri on Tuesday asked the manufacturers of the nation’s five biggest selling prescription opioid products for internal information including marketing plans, sales records and contributions to third-party advocacy groups.

. . .

McCaskill’s letters to Purdue Pharma, Johnson & Johnson’s Janssen Pharmaceuticals, Insys Therapeutics, Mylan and Depomed specifically ask for information about any payments the companies made to 17 third-party advocacy groups — including the Pain Care Forum, a little-known but powerful coalition of drug companies and nonprofit groups highlighted in the Politics of Pain series.

At least 13 of the other advocacy groups mentioned in her letters have belonged to that coalition organized by the chief lobbyist for OxyContin-maker Purdue Pharma, according to the Center for Public Integrity and AP’s review of its membership directories.

The AP/Center for Public Integrity series found that members of the Pain Care Forum met with some of the highest-ranking health officials in the federal government, while quietly working to influence proposed regulations on opioids and promote legislation and reports on the problem of untreated pain.

President Trump also just announced that Chris Christie will run the White House Opioid Commission:

President Trump will soon sign an executive order that creates a commission to tackle the opioid epidemic and has reportedly put New Jersey Gov. Chris Christie in charge of it.

Christie is a strong choice, given that just this February, he signed into law one of the nation’s most comprehensive laws to combat the growing opioid and heroin crisis.

New Jersey’s law reduces the supply of drugs that patients getting their first opioid prescription can obtain from 30 days to five days, which as research has shown plays a huge role in whether a person gets hooked. It also will require doctors to talk to patients about how addictive the drugs are. For addicts whose doctors have recommended treatment, the law also mandates that insurers offer 180 days of coverage without preauthorization.

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Voice Your Opinion on Funding changes for Michigan’s Addiction and Mental Health Services

historyDo you recall the post about potential changes to Michigan’s public funding for addiction treatment and mental health services?

Well, the final report came in and it looked a lot like the interim report that my earlier post reported on. Basically, no major changes, but try some pilots to increase integration with physical health care.

This seems sensible, given the uncertain future of medicaid expansion.

But, it’s not over yet. I received the following from the Michigan Association of Mental Health Boards.

We need you, within the next two weeks (prior to April 10, when any 298-related change to the FY18 budget will be nearly wrapped up), to contact the House and Senate Appropriations Committee members. We also need you to ask members of your Board of Directors, your staff, and your community partners to make those same contacts.  These contacts are critical to support the solid recommendations contained in the 298 Report, and to counter the efforts by others opposed to the public management of the state’s publicly sponsored behavioral health and intellectual/developmental disability services and supports system.
Legislators are hearing from the private sector on this issue; see the attached Crain’s Detroit Business article (March 9, 2017) where DHHS budget committee chairs raise questions about the lack of MHP pilots in the 298 process.  We must raise our concerns to those suggestions.
Click the link below to log in and send your message:

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