Substance Abuse and the Legal System

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How Many Chances Should a Drug User Get?

Recently, a letter to the editor in a newspaper from the managing director for policy at the Drug Policy Alliance asked the rhetorical question above. He’s a psychiatrist with a background in public policy and bioethics, and he wrote to the paper after reading that a patient with endocarditis was denied necessary surgery because of intravenous drug use. He called it abandoning a patient. Endocarditis, an infection of the heart, is life-threatening but treatable. Just as drug use has been compared to having cancer—a disease that we treat even if the person has smoked, when smoking is a known carcinogen—the psychiatrist argues that a known drug user shouldn’t be denied care. Should someone with a second heart attack be sent to hospice instead of being treated, just because he didn’t take his medication after the first one, he asks? He notes that several illnesses are accompanied by behavior that is self-destructive. And when the writer asks about how many chances drug users should get, he answers his own question: “The same number as a smoker with cancer, a drunken driver in an accident, and a father after a heart attack. The same number you would want for your loved one.”

Felons Becoming Lawyers

There’s one area in which the legal system is surprising a number of people—allowing former drug addicts who have been incarcerated to become lawyers. Yes, you read that right. If you watch 60 Minutes, you may have seen the segment where a man robbed banks, spent years in prison and went on to become one when he was released. But Tara Simmons seems to be one of the first people suffering from substance use disorder to get her law license. As an article about felons becoming lawyers explains, “Whether people like Ms. Simmons should be allowed to practice law is a hot question these days. Acceptance for those with less-than-impeccable pedigrees seems to be rising.” Ms. Simmons had to appeal after her application to even take the bar exam was rejected. And even if you pass in a similar situation, it may be difficult to be sworn into the bar. A former cocaine trafficker who did time spent $25,000 “going through the process.”

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Relapsing Shouldn’t Be a Crime

Along these same lines, an editorial in The New York Times used the case of Julie Eldred to discuss the argument noted above—sending people to jail for relapsing because she broke her probation when she tested positive for fentanyl. That’s what often happens in the U.S. justice system, the paper noted. But her case is now being heard by the Massachusetts Supreme Court. Wil it change drug policy? That remains to be seen. Her lawyer is challenging the notion that it’s OK to require people with a substance use disorder not to use drugs while on probation, and of sending them to jail if they do. The prosecution rebutted the disease model of addiction as her defense. Using that very disease model, the editorial goes on to give a cogent argument for keeping addicts who relapse out of jail. The argument in favor is that those who suffer from a substance use disorder cannot choose rationally and consistently because their ability not to relapse is impaired by brain changes due to chronic drug use and the colossal force of addiction. Policies like the one that caught Julie Eldred in their net are part and parcel of the criminalization policy. While not everyone suffering from substance use disorder should be freed from all consequences, the consequences should be fair, says a professor of public policy.

Treatment of Opioid Use is Not a Mystery

In response to the editorial mentioned previously, a clinical professor of population health felt the need to point out a few facts about the fight against the opioid epidemic. People with opioid use disorder who are successful in overcoming it take methadone or buprenorphine and undergo behavioral therapy and counseling, he says. And sometimes it doesn’t even take doing both for them to succeed. He, too, complains that we criminalize the patient, the disease, and the treatment when we don’t have to. The writer is also the former chief of addiction medicine at the notorious Rikers Island prison, by the way, which was a big part of the movie “The Night Of.” Another writer, a director of the Program in Addiction Medicine at the Yale School of Medicine, had a great thought: “We need to teach addiction with the same attention to genes, physiology, cells receptors, transmitters and scientific evidence as we do cancer to try to capture trainees’ interest.” For more information or to find a Rehab in California, please contact Summit Estate at (866) 569-9391.