I believe that there are three major reforms that we need to pursue in Massachusetts drug policy:
(1) Moderation of our sentencing policies. We are incarcerating offenders for drug dealing offenses for too long. Drug dealing is a substantially harmful crime and is often linked to gang activity. But Massachusetts sentences for drug dealing are very long compared to sentences for arguably worse offenses involving violence against persons. For more background, see my publications at this link; scroll down on the same link for detail on my 2007-8 legislation in this area. I expect to file similar, but simplified, legislation in this area in the 2009-10 session.
(2) Improvement of substance abuse treatment quality. Several years ago, I helped develop a national panel report on treatment quality . That experience and my experience representing criminal offenders in drug courts convinced me that treatment quality really is a deep problem.
I believe we need to explore reforming the payment system so that treatment providers are paid by health insurers (including Mass. Health). Currently, residential treatment providers are paid directly based on contracts administered by the state. If reimbursement could be brought within the same structures that pay hospitals and doctors, it might be possible for some of the major health care networks to enter the substance abuse treatment field (which they shun today). Only in a more stable network environment is it likely that we will be able to improve treatment quality — the current system has very high turnover and it is impossible to impose standards.
The parity legislation that both Massachusetts and the federal government passed in 2008 requires coverage of substance abuse treatment. Also, in Massachusetts, we have a health care insurance law that requires universal coverage. Together these two measures create the possibility in Massachusetts of moving reimbursement for residential treatment into an insurance reimbursement framework. I do not have detailed proposals in this area yet.
(3) Expansion of screening and brief intervention and referral (SBIR). Trained screeners operating in the right settings can readily identify people who are using substances in a risky way. Research shows that interviews lasting only a few minutes are almost as reliable as much more thorough assessments. In turn, well-trained motivational interviewers can, in sessions lasting well under an hour, change substance abusing behaviors — and/or persuade people to enter treatment — in a material percentage of cases. A majority of users will be unaffected by the encounter, but the encounters are so inexpensive that their yield is high.
One setting where SBIR has been used effectively is in hospital emergency rooms. A great many of those admitted have substance use issues. A setting where SBIR has been almost absent is in the criminal justice system. There may be some fundamental incompabilities between SBIR and criminal justice settings: Effective SBIR appears to depend heavily on establishing a relationship of trust which is natural in a medical setting, but hard to create any where near a process in which people are facing potential penalties. See this link for more about SBIR in the criminal justice setting. Although progress in the emergency setting seems to be rapid, so far, the only pilot in Massachusetts has been unsuccessful (I ran that pilot in Dorchester Court in 2005).
This is not an area where I have legislative plans, although I believe that a differently run criminal justice pilot might turn out to work: After my election in 2006, I withdrew from leadership of a criminal justice SBIR study at the Boston University School of Public Health, but continue to offer occasional uncompensated advice and assistance to that effort.