Drugs and addictions overview

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:

  1. 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.
  2. 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.
  3. 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.
  4. 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.
  5. 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.
  6. 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.

See this link for my previous published works on drug policy.

There is a lot to talk about in this area and I hope that people will start new topics in this forum.

Published by Will Brownsberger

Will Brownsberger is State Senator from the Second Suffolk and Middlesex District.

9 replies on “Drugs and addictions overview”

  1. Not sure whether this comment belongs here or with the post on the bill the Senate just passed. I was glad to see some provisions in the Senate bill to ease access to treatment without prior authorization from insurance companies, but I can’t really tell how much this bill will increase access to treatment overall, or to a range of community-based treatment options as well as inpatient treatment. Is that something that has to be accomplished through the budget process?

    I’m concerned that the bill focuses so much on opiate addiction. The last few months we have heard a lot about heroin and prescription pain medication. Just last summer, though, we were hearing a lot about ecstasy. I’m concerned when legislation seems to be too headline-driven. I think our public policy should facilitate access to treatment for any drug a person uses once they decide they don’t want to be using it anymore.

    I welcome your help understanding the legislation and also your insight on how state residents can participate in the process going on this week. Thank you!

  2. I appreciate your progressive thinking on these drug and addiction issues. All of your points are well made, and I wish our new mayor shared your views.

  3. I appreciate your views on our current drug policies.

    We need to legalize marijuana and treat it as we do Alcohol and Tobacco. Regulate and Tax it.

    I am not too optimistic however with our current leadership.

    Thank you.

  4. Let’s step back for a moment, please, away from the specifics of State House bills to consider what got us here.

    When a society chooses to outlaw private vice, it turns what was a personal problem of a family or other small group into one that citizens at large have to handle. Whether it’s the criminal justice system, school systems, or social agencies, public funds are spent and personnel are mobilized in pursuit of unachievable public policies. We have trouble paying for these activities which public servants undertake with only marginal effectiveness.

    Massachusetts has a lot of problems, among the least of which I would argue are the consequences of substance abuse. We all know what they are. And while we have to be compassionate, we don’t have to make criminals of people who are not dangers to society, or if they are it’s because their vices are outlawed.

    If people are drugged up to the point of being incapacitated and dangerous, perhaps there are reasons why their lives are on hold that go beyond any personal failings or character disorders.

    It’s not Satan, its the System that creates superfluous lives that need narcotics to feel as good as they are told they should feel. Lives that are going nowhere because there’s nowhere to go. Our energies should be directed not at drug policies, but at economic policies that suck up transactions from communities into far-away corporations, robbing communities of the fruits of their labors. When communities are hollowed out, empty lives naturally follow.

    Let’s not be afraid to denounce prohibitions as both counterproductive and as completely missing the point about causal factors of drug abuse. Our communities are being plundered by “legitimate” interests and we need to resist their power and influence.

  5. To Geoff, I agree that our prohibition does worsen some of the consequences of addiction, but the sad fact is that the social consequences of addiction are very real and not caused wholly by prohibition. People with addictions often do bad things as a result of their need and their intoxication. And their need knows necessary limits — in other words, even if cocaine and heroin were legal and easy to get, many people with addictions would steal to obtain increasing doses. Persons addicted to crack will keep using in a binge until they run out. People with opioid addictions can only use so much in one sitting without overdosing, but they can steadily build to an unaffordable habit.

  6. To Rachel: We are feeling our way on how to increase access to treatment. I think the bill has some good ideas on it, but it is still very much a work in progress. The House will take a look at it and there will be a conference committee, so the scope of change and the mechanisms are still in flux.

    I agree that we need better information on what is really happening out there — as you suggest, the recent fentanyl related overdoses have pushed opioid addiction into the headlines. But there are lot of indicators that the opioid addiction problem has spread widely over the last few years.

  7. Thanks for your response, WB. I will be in touch with my House Rep. and try to follow the process. I’m glad at least that access to treatment is on the Legislature’s radar. The more community-based options, the better.

  8. I believe that Drug addiction and our current polices create three overlapping destructive issues for society. One is for the individual who gets addicted, and two are destroying out civil society and democratic institutions. I also think this discussion needs to be made in a larger context that is being ignored.

    When an individual gets addicted, it is a problem for that person, his family and likely the rest of us, because the addict gets into trouble. Our response has been generally to criminalize and marginalize addicted people basically forcing them into a dead end life. I do not know what we can do about addicts to limit the damage they do, but I do know that rather than jailing them, we really need to come up with a long term, and effective supervision system to help them stay clean, and support them when they relapse rather than jail. Jail is not treatment or a solution. It is however a symptom of a growing police state.

    Two, We have warped our justice system, it is increasingly militaristic in its outlook. It also has stacked the deck against defendants in favor of jailing. Young mostly non violent dealer defendants also need a different system to keep them out of jail. As a small business employer, I once hired a non violent pre-release convict on his way to probation, and he was responsible, happy to be working and checked on every few hours. As soon as he graduated to probation supervision, he got into his old bad habits and got fired. The moral of this story is that the state needs to make probation work better, and put the resources into it so that the kids on it have a authority figure who is both a watcher for society and a resource to guide these undisciplined young people to a successful and more productive life. I also believe that the emphasis in policing on SWAT, and zero tolerance and long term jail mostly wrong. I actually favor very short jailing for non-violent crime with long term supervision.

    Three, But this leads to my last point which is that because of the way we run our government institutions, and our politicians are very risk adverse. Politicians would rather go for the simple, tough on crime, make it easy to get a conviction route to drug and crime control because it is a sure thing and easy to explain in a sound bite to voters. It does not open the system up to the “Willie Horton” criticism of letting people out of jail. Which has meant that we jail to many people for to long.

    This has lead in my opinion, have a pseudo-police state in this country. It does not allow for open discussion of big issues, a la Occupy Wall Street, which was suppressed by homeland security and local police even though it was not violent as a threat to the system. We also do not have accountability for people in charge of major institutions for the most part, only for those who are directly culpable of wrong doing. EG banking failures, mortgage crisis, Big Dig. Getting back to the drug issue, in the same way we have a lack of accountability for major economic beneficiaries from the drug trade, banks and wall street for example, how can we begin to fix our drug policy without examining the whole of the system?

    Personally I believe the best solution would be to legalize all of the crap, treat it like Cigarettes, and Alcohol, even the hardest of the drugs. The we can take a Libertarian approach to dealing with the negative consequences, treatment, education and jailing for inducing addictions in others. Make the Black Market for drugs part of the real economy is key. Take the profit out of the system both the dealing, and for the leaches who are drug war dependent beneficiaries from the war on drugs. It mostly will end the destructive effects on our institutions and freedom. And use the taxes on the recreational drugs to fund a good system of education and treatment to deal with the individual tragedies of the addicted. Then we might have only the issue of personal tragic circumstances from drugs, rather than the looming destruction of our democracy from our political class fixated on keeping us safe. We need politicians to worry about maintaining conditions that keep us mostly safe, mostly free and having an economy where we mostly have equal opportunities to pursue our lives.

  9. Thank you, Dan, for this thoughtful statement.

    I heartily agree with your summary:

    We need politicians to worry about maintaining conditions that keep us mostly safe, mostly free and having an economy where we mostly have equal opportunities to pursue our lives.

    The issues are messy, but I’ll do my best to do exactly that.

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