Nearly 47,000 Americans died from a drug overdose in 2014 — more than from gunshot wounds or car crashes. In Maryland, the governor's office has defined the problem as an "epidemic … destroying lives." Indeed, heroin deaths alone have increased by 186 percent from 2010 to 2015 in the state.
Not only are drug related deaths on the rise, so are the associated harms, including: drug-related crime and violence, the spread of HIV/AIDS and Hepatitis C and the financial burden for taxpayers who shoulder the costs of health care and criminal justice.
The rapid increase of overdoses and addiction has put our nation in crisis mode with everyone from parents to presidential candidates looking for new solutions. To that end, at a press conference in Annapolis tomorrow, state Del. Dan Morhaim, who is also a practicing physician with 30 years of front-line experience in emergency rooms, will introduce a comprehensive legislative package proposing a different approach in Maryland — one that recognizes the epic failures of our current drug war and is based on sound policies being successfully implemented elsewhere in the world.
The first bill would provide treatment on demand in emergency rooms and hospital settings. Estimates show that for every $1 spent on treatment approximately $12 is saved in criminal justice and health care costs. For a wide variety of reasons, hospitals are an excellent location to initiate treatment. (Studies show that addiction is the underlying cause for 60 to 80 percent of patients who present to ERs without insurance.) This legislation requires acute care hospitals to have a counselor available or on-call 24/7 and to have defined arrangements for patient transfer to appropriate rehabilitation services.
The second bill allows individuals to use drugs in approved facilities while supervised by trained staff who also provide sterile equipment, monitor the person for overdose and offer treatment referrals. Similar facilities operate in Europe, Australia and Canada with excellent results, including reducing the spread of diseases and eliminating overdose deaths. These programs also provide a critical access point to drug treatment for the most hard-to-reach users. A study in Canada found that after one such facility opened, there was a 37 percent increase in people entering detoxification programs.
The third bill supports the creation of a four-year "poly-morphone-assisted treatment" pilot project that would allow doctors to use pharmaceutical grade opioids, including heroin, to treat a small group of heroin users under their supervision who have failed all other forms of treatment and who are directly responsible for a significant portion of street crime and uncompensated health care costs borne by taxpayers. Programs of this sort have been established in the United Kingdom and much of Northern Europe with great success. Studies of these programs show they are cost effective, reduce illegal drug use, lead to other treatments and even abstinence, decrease crime, and reduce the black market for heroin.
The final bill decriminalizes the possession and use of very small quantities of drugs. Rather than reducing drug use, criminalizing substance users increases stigma, drives people away from needed treatment and harm reduction services, and amplifies the risk of fatal overdoses and diseases. This bill would keep some drug users — those possessing minimal amounts — out of the criminal justice system, thereby saving critical resources and avoiding the costs of saddling more Maryland citizens with criminal records and their adverse consequences. In 2001, Portugal became the first country to eliminate criminal penalties for low-level possession and use of illicit drugs, and it has not resulted in increased drug use or crime. Rather, it has actually reduced rates of HIV/AIDs and overdose, increased the number of people in treatment, and reduced social costs of drug misuse.
To some, Delegate Morhaim's bills might seem radical. But the legislation simply follows the rest of the world in treating drug use as what it is: a public health issue. And there is nothing radical about wanting to improve health and societal outcomes. Indeed, even the University of Maryland Department of Psychiatry has stated its support for both safe consumption and poly-morphone-assisted treatment programs.
Yes, this is a paradigm shift in how we think about drug use. But if we want to see comprehensive progress on reducing drug use and all of its associated social impacts, we need comprehensive policy change.
Lindsay LaSalle (firstname.lastname@example.org) is a staff attorney for the Drug Policy Alliance (www.drugpolicy.org).