Scotland’s ORT Outcomes

MethadoneScotland invests a very large portion of their treatment resources into ORT and recently released a report on their outcomes. Pretty underwhelming.

… the Report on People in Treatment study reveals that more than two out of every three users who go into treatment admit continuing to use illegal drugs after three months.

Where information was available, the report painted a bleak picture of addicts’ success in holding down jobs or maintaining family relationships.

The number of people reporting being in work after three months of drug treatment actually fell from just 12 per cent to an even more pitiful nine per cent.

The report also reveals that in almost a third of cases – 29 per cent – the Government appears not to know where drug addicts’ children were living.

Children were only living with the addict after three months of treatment in 30 per cent of cases.

In 41 per cent of cases, their status was simply “living elsewhere”. The remainder were “unknown”.

The full report is available here.

 

The truth is dangerous

Michele Leonhart official photo. Found at http...
Michele Leonhart  (Photo credit: Wikipedia)

How hard is it for the DEA to have an honest conversation about drugs? Below is testimony from the director. Note the incoherence.

“Is crack worse for a person than marijuana?” Polis asked Leonhart.

“I believe all illegal drugs are bad,” Leonhart answered.

Polis continued, asking whether methamphetamines and heroin were worse for a person’s health than marijuana.

“Again, all drugs, they’re illegal drugs,” Leonhart started, before being cut off by Polis.

“Yes, no, or I don’t know?” Polis said. “If you don’t know, you can look this up. You should know this as the chief administrator for the Drug Enforcement Agency. I’m asking a very straightforward question: Is heroin worse for someone’s health than marijuana?”

Leonhart ducked again, repeating, “All illegal drugs are bad.”

Since assuming the head position at the DEA, Leonhart has made controlling prescription drug abuse the top priority, a stance she had laid out so aggressively that it led one Democratic senator to block her confirmation.

I imagine she’s concerned about getting trapped, but come on! Reasonable people can disagree on drug policy, but only if we don’t respond to disagreement by being unreasonable.

Residential?

The Senate's side of the Capitol Building in DC.
The Senate’s side of the Capitol Building in DC. (Photo credit: Wikipedia)

From the United States Senate Caucus on International Narcotics Control:

11. Finding: Traditionally, U.S. Presidents – through ONDCP – have divided drug demand reduction into two main categories: prevention and treatment. However, the Obama Administration has added a third area: recovery. For the first time ever, in its 2010 National Drug Control Strategy, ONDCP focused on the need to invest in recovery. Treatment for drug abusers usually takes place during a fixed period of time. However, recovery is a lifelong process.

Recommendation: The private sector should foster the development of businesses that positively affect the lives of people in  recovery by increasing employment opportunities for them.

12. Finding: Residential treatment is a commonly used form of treatment. However, many states are facing a shortage of residential treatment beds. The shortage of beds is especially true for women with children seeking treatment. Last year, there were only 80 family-based treatment programs in the United States. Many of these programs have limits on the age of children women can bring with them as they receive treatment, further limiting access to care for women with children. The federal government does not have a precise measure for determining the shortage of residential drug treatment spaces.

SAMHSA administers a survey – the National Survey on Substance Abuse Treatment Services – of specialty treatment facilities, including residential facilities. This survey includes questions to determine the proportion of facilities that offer residential services and the number of beds available in such facilities. However, the survey is not able to provide an estimate of the demand for these beds. Most facilities do not track and record such information.

Recommendation: Across the country, there needs to be real time reporting on the demand for beds in residential treatment. There also needs to be a more rapid response in areas with bed shortages to ensure treatment is available when individuals request it.

13. Finding: Residential treatment programs are costly which often leads to individuals not receiving long enough treatment to stop their substance abuse dependency. Some residential treatment programs, such as the Delancey Street Foundation, are self-funded. The Delancey Street Foundation sustains itself by the work of residents who live on the premises and complete work in areas such as catering, holiday decor and moving services.

Recommendation: In the current difficult fiscal climate, residential treatment programs should look to the Delancey Street Foundation as a possible funding model that is self-sustaining without relying on federal,  state and local funds.

Sound familiar?

[Thanks Matt]

Marijuana penalty reduction proposals in New York

Cannabis Sativa in a Cage
(Photo credit: Mrs Logic)

New York Governor Andrew Cuomo has proposed big changes in marijuana policy in his state:

“There’s a blatant inconsistency. If you possess marijuana privately, it’s a violation. If you show it in public, it’s a crime,” Cuomo said. “It’s incongruous. It’s inconsistent the way it’s been enforced. There have been additional complications in relation to the stop-and-frisk policy where there’s claims young people could have a small amount of marijuana in their pocket, where they’re stopped and frisked. The police officer says, `Turn out your pockets.’ The marijuana is now in public view. It just went from a violation to a crime.”

New York City prosecutors and Police Commissioner Raymond Kelly, whose offices handled almost 50,000 such criminal cases last year, endorsed the Democratic governor’s plan. Mayor Michael Bloomberg said the bill largely mirrors the city police directive issued last year for officers to issue violations, not misdemeanors, “for small amounts of marijuana that come into open view during a search.”

Possession of less than 25 grams was reduced in state law to a violation in 1977, subject to a ticket and fine. If the pot is burning or in public view, it rises to a misdemeanor that leads to an arrest. Cuomo’s proposal differs from pending Assembly and Senate bills because it leaves public pot smoking as a criminal misdemeanor.

Cuomo acknowledged the existing approach disproportionately affects minority youths, with 94 percent of arrests in New York City, more than half of those arrested younger than 25 and 82 percent either black or Hispanic. He also defended keeping smoking pot a crime. “I believe the society does want to discourage the use of marijuana in public, on the street. Smoking a joint, I think, is a different level of activity than just being in possession of it,” he said.

According to advocates for decriminalizing it, 14 states, including Oregon and Massachusetts, have lowered penalties for possessing small amounts of marijuana to civil fines in a movement that began in the 1970s. Since 1996, 16 states, including California, have legalized its use for medical conditions, though New York has not.

To me, this policy strikes a good balance. I’m not a fan of the term decriminalization. Some articles have referred to the proposal as penalty reduction. I like this better. Though I’m not sure there is a universally accepted definition of decriminalization, but it generally refers to reducing possession from an offense generally punished by incarceration to an offense generally punished by fines.

To me, the term decriminalization implies that offenses like speeding are not crimes. (Am I missing something? If so, set me straight.) Penalty reduction just seems more accurate.

I’ve seen a lot of posts and articles commenting that this is a “good start” or “a step in the right direction.” I wish people would be a little clearer and more complete with these thoughts. What is the end they have in mind? Legalization? Legalization of what? Legalization of all quantities? Legalization of all drugs? Legalized sales? Legalized marketing? Legalized manipulation of the drug and consumption methods to intensify the effect? Is the model alcohol and tobacco?

It feels a little cheap and easy to make these pronouncements without taking responsibility to flesh out what you really mean.

Another question that these stories beg is this. It appears that, if passed, this bill would seek to get enforcement entities to follow the intent of NY’s 1977 marijuana law. Could enforcement entities come up with a way to circumvent this law too? What motivates enforcement entities to behave this way—what explains the disconnect between the apparently clear legislative intent and the law enforcement practice? Was it limited to marijuana laws, or do they take a similar approach with other laws? Was it limited to New York City, or was this practice common in NY State?

UPDATE: One more thought. What lessons can we learn from the K2 and Spice controversy? Even if you have a point of view that predisposes you to dismiss the matter, you should be interested in what kind of policy is sustainable and this appears to be an opportunity to learn something about the limits of the public’s tolerance for a legal drug.