In response to popular demand, I’ve created this conversation category on drugs and addictions. This overview collects some older posts and summarizes my current thinking. I have been thinking about these issues for over 20 years and my thinking has evolved considerably over time.
Here is an overview of my thinking on drugs and addictions:
- We need to reduce use of incarceration as a response to drug dealing. There has been complete consensus in Massachusetts for as long as I have been in the field that incarceration is rarely an appropriate response to drug possession cases. Most people who are in jail for drug offenses are there for drug dealing. If we want to reduce incarceration, we have to talk about how we are handling young men who deal drugs. See generally my comments under my sentencing reform forum.
- We should get it over with and legalize marijuana. I’ve tended to see marijuana as a sideshow. Our punitive response to marijuana is already very limited. I wasn’t enthusiastic about the decriminalization measure in 2008. I’m still not happy about where we are now — the penalties for youthful marijuana use are less than the penalties for youthful alcohol use. I’d like to see us legalize sale of marijuana and subject it to the same rules that we apply to both alcohol and tobacco. I don’t think that marijuana legalization is a terribly important measure either way, but I think marijuana policy has become a distraction from the real question of hard drug policy. Let’s get marijuana legalization behind us and focus on our response to hard drugs.
- I used to be a strong supporter of drug courts and more generally of intensive supervision as an approach to drug addiction. However, after spending some years working in drug courts, I formed the view that punishment can often make addiction worse, by fragmenting a person’s life with periods of incarceration. Relapse is part of recovery and a few days in jail can turn a slip into a fall. As enthusiasm builds for specialty courts, I am concerned to assure that they serve only serious criminal offenders who would otherwise be in jail and that they use incarceration as a sanction only when necessary to protect public safety.
- I am concerned about the quality of substance abuse treatment. I believe that the quality of treatment in the Commonwealth is very uneven. The most basic cause of poor quality is lack of funding. But the other cause is lack of accountability. There are two structural factors that reduce accountability. First, going back to the previous point, many patients are under court order to accept treatment. In order to keep their beds full, the treatment providers have to keep judges happy — if a patient is unhappy in a compelled treatment placement, the judge is all too likely to blame the patient for a poor attitude instead of firing the provider. Second, most long term care is paid for by a state agency, the Bureau of Substance Abuse services. That means that treatment providers can survive by keeping BSAS and legislators happy, again instead of keeping patients happy. I support a model in which long term care is covered by private insurers and MassHealth and patients can move freely to providers that work hard to make them want to stay.
- A treatment system based mostly on voluntary placement requires a broad system of screening and brief intervention to drive people into treatment. See this earlier summary of my views on drug policy for more on SBI.
- Prescription opioids have become a new gateway into opiate addiction for a much wider set of young people than were previously exposed. We need to get this problem into better focus and respond aggressively. The Senate’s recent legislation is a step in the right direction.
Here are links to some prior postings on drug policy issues.
- Prescription drug legislation (2012)
- Marijuana, cocaine and heroin
- Question two — marijuana decriminalization
- Drug policy recommendations
- Coerced drug treatment — perspective
- Drug policy — part I
There is a lot to talk about in this area and I hope that people will start new topics in this forum.