In a referendum in November, Oregon became the first state to decriminalize the possession of small amounts of heroin, cocaine, methamphetamine and LSD. The move was inspired by a 2001 law in Portugal that removed incarceration as a penalty for drug possession. To judge by "Drug Use for Grown-Ups," Carl Hart welcomed this news, which came too late for him to mention in his provocative and enlightening book. He opens with the announcement: "I am an unapologetic drug user." Mr. Hart, a professor of psychology and a neuroscientist at Columbia University, asserts that "recreational drugs can be used safely to enhance many vital human activities." He bases his claim on decades of research on the behavioral and physiological effects of drugs in humans, coupled with his personal use. Thanks to drugs, he says, "I am a happier and better person." He asks that we think about drugs in a more nuanced way, even at a time when opioid abuse is still headline news. Thus his book represents a calculated risk-namely, that by portraying drug use as so potentially rewarding for responsible users, it may inadvertently seduce non-grown-ups into hazardous use. [continues 808 words]
AT LAST official count, in 2015, over 33,000 people have died from opioid painkillers, heroin, and fentanyl - twice the number killed by guns - and the number of fatalities is rising. Health officials, police chiefs, employers, welfare workers, and politicians at all levels of government are desperately calling for more effective drug treatment, better prevention, smarter opioid prescribing, and improved pain management. Urgent attention is being devoted to every facet of the epidemic except one: how to think about drug addiction itself. As the opioid crisis deepens, it's time to examine whether current thinking about addiction limits our understanding of the epidemic and impedes our efforts to contain it. [continues 268 words]
Addiction isn't an illness like any other. Patients need not just the right medicines but therapy, support and, in some cases, tough supervision The grim faces of the nation's opioid epidemic -- an overdosing parent slumped in the front seat of a car, mouth agape, with a neglected child in the rear seat -- have become too familiar in recent years. More babies are now being born with narcotics in their systems, foster care is strained, and growing numbers of grandparents are raising the children of their own addicted children. [continues 1111 words]
Spurred by an opiate problem that kills three people a day in Massachusetts, Governor Charlie Baker has proposed controversial legislation to give hospitals power to hold addicts against their will if they pose a grave danger to themselves. Intruding on personal freedom is serious business. But in extreme situations it's necessary. I remember the frantic parents of my 23-year-old patient, Susan. They tried to get her committed for "grave disability" due to addiction. Susan had dropped out of college three years earlier, chose to live on the streets of New Haven or crash on her friends' filthy couches. Two months before her parents sought forced treatment, their daughter had overdosed twice, suffered a near-rape, and was hospitalized for abscesses from infected injection sites. [continues 874 words]
We've heard it before. "Drug abuse is an equal opportunity destroyer." "Drug addiction is a bipartisan illness." "Addiction does not discriminate; it doesn't care if you are rich or poor, famous or unknown, a man or woman, or even a child." The phrase "addiction doesn't care" is not meant to remind us that addiction casts a long shadow -- everyone knows that. Rather, it is supposed to suggest that any individual, no matter who, is vulnerable to the ravages of drugs and alcohol. [continues 722 words]
It is a bad time to be in pain. Last week, the maker of OxyContin, a high-strength narcotic analgesic, agreed to pay $635 million to settle charges of "misbranding" brought by the attorney general of West Virginia. "Scores died as a result of OxyContin abuse and an even greater number of people became addicted," said Attorney General John Brownlee. The drug company, Purdue Frederick, admits that its sales force underplayed the abuse potential of OxyContin. And, yes, the company should have acted more quickly to clamp down on overpromotion and to issue strong warnings in the face of overdose deaths. [continues 754 words]
Mel Gibson is the latest reminder of the perils of drunken driving. But in his case it was talking while intoxicated that attracted so much attention. Typically, of course, it is not what someone says under the influence that concerns the public, but what he does. Safety is our main worry. And the goal is to keep the person from driving while intoxicated. That was the aim of the judge who in June handled the case of another high-profile arrestee, Representative Patrick J. Kennedy of Rhode Island. Mr. Kennedy pleaded guilty to driving under the influence after crashing his Ford Mustang on Capitol Hill. [continues 733 words]
Patients arrive broke, busted or abandoned at our methadone clinic in a raw section of Northeast Washington. They are opiate addicts, primarily dependent on heroin, though some take vast doses of street-bought painkillers like OxyContin. Drinking the pink methadone solution every day prevents withdrawal sickness. About half of our patients have also spent years on crack or alcohol. Not all have stopped, but at least they have cut back. We see almost no methamphetamine users, but that is a simple accident of geography - - the corrosive drug hasn't yet reached epidemic proportions in this part of the country. [continues 727 words]
Relief for medical marijuana patients was snatched away last week. In Gonzales v. Raich, the Supreme Court ruled that such patients will be subject to federal prosecution even if their own state's laws permit use of marijuana. Now, short of Congress legalizing medical marijuana, the only way that its users can avoid stiff financial penalties or jail is if it is turned into a prescription medicine approved by the Food and Drug Administration. Justice Stephen G. Breyer said as much during oral arguments last November with his comment that "medicine by regulation is better than medicine by referendum." [continues 549 words]
Washington -- RELIEF for medical marijuana patients was snatched away this week. In Gonzales v. Raich, the Supreme Court ruled that such patients will be subject to federal prosecution even if their own state's laws permit use of marijuana. Now, short of Congress legalizing medical marijuana, the only way that its users can avoid stiff financial penalties or jail is if it is turned into a prescription medicine approved by the Food and Drug Administration. Justice Stephen G. Breyer said as much during oral arguments last November with his comment that "medicine by regulation is better than medicine by referendum." [continues 555 words]
In February 1999, Dr. Frank Fisher, a general practitioner in Shasta County, Calif., was arrested by agents from the California state attorney general's office and charged with drug trafficking and murder. The arrest was based on records indicating that Dr. Fisher had been prescribing high doses of narcotic pain relievers to his patients, five of whom died. He lost his home and his medical practice and served five months in jail before it was discovered that the patients had died from accidents or from medical illnesses, not from the narcotics he prescribed. [continues 1540 words]
Rush Limbaugh's recent admission that he has an addiction to prescription narcotics has thrust OxyContin back into the spotlight. The potent painkiller has been in and out of the headlines for about two years, ever since addicts began injecting it to get a heroin-like high. A Newsweek headline blared, "Rush's World Of Pain: His Path To Pill Addiction . . . The Scourge of OxyContin." Elsewhere, the medication has been demonized as "hillbilly heroin"; Fox's Bill O'Reilly called it "liquid heroin." [continues 591 words]
Limbaugh's recent admission that he has an addiction to prescription narcotics has thrust OxyContin back into the spotlight. The potent painkiller has been in and out of the headlines for about two years, ever since addicts began injecting it to get a heroin-like high. A Newsweek headline blared, "Rush's World Of Pain: His Path To Pill Addiction ... The Scourge of OxyContin." Elsewhere, the medication has been demonized as "hillbilly heroin;" Fox's Bill O'Reilly called it "liquid heroin." [continues 614 words]
Robert Downey Jr. is in trouble again. Los Angeles police took him into custody this week for public intoxication, the latest arrest in a long series of legal problems dating back to 1996 when he was charged with heroin, cocaine and weapons possession. While sympathy for the actor may be wearing thin -- his "Ally McBeal" producer is said to be "furious" -- there remains profound hand-wringing over what to do now. Should he be treated for his addiction? Should he go to jail? Do we hold him accountable? And if so, how? [continues 894 words]
WASHINGTON -- Can people who drink too much be taught to control their alcohol consumption? Unthinkable, say mainstream treatment organizations like the Betty Ford Center and Hazelden, which have long insisted on total abstinence. Now criticism of an approach that allows for some controlled drinking has flared again. In Washington state last week, a leading proponent of this option, Audrey Kishline, pled guilty to killing two people while driving drunk. She is the founder of Moderation Management, set up in 1993 as an alternative to the abstinence-only Alcoholics Anonymous. Then Alex DeLuca, the director of the respected Smithers Addiction Treatment and Research Center in New York City, resigned after failing to persuade his clinic to offer some alternative to total abstinence. [continues 620 words]
THE SWISS HEROIN TRIALS: SCIENTIFICALLY SOUND? Switzerland's heroin maintenance project has made headlines around the world. The dramatic announcement of its success in the summer of 1997 seemed to promise an unconventional but effective way to treat heroin addiction. In this country, the Associated Press reported, Switzerland declared its novel experiment with statedistributed heroin a success, saying the drug giveaway slashed crime, misery and disease associated with hardcore drug addiction (Associated Press, 1997). Favorable commentary in the prestigious oped pages of the New York Times (Lewis, 1998) and the Washington Post (Shenk, 1997), and on the national evening news (ABC World News Tonight, 1997) urged policy makers to consider heroin maintenance here. [continues 3566 words]
New York Mayor Rudolph Giuliani hopes to eliminate methadone treatment in city-run clinics, saying it simply replaces one addiction with another. Meanwhile, the nation's drug czar, Gen. Barry R. McCaffrey, praises methadone as one of the best ways of helping hard-core heroin addicts; he wants to expand its availability. The methadone battles have begun. Again. The history of this and other skirmishes in the war on drugs is recounted in "The Fix" (Simon & Schuster, 335 pages, $25), Michael Massing's tour of the modern era of domestic drug policy. He starts with the 1960s heroin epidemic, takes us through the creation of a national treatment network under Nixon, harsh drug laws in New York state under Rockefeller, softness on marijuana under Carter, "Just Say No" and the crack explosion under Reagan, and ends with the bounce in adolescent use under Clinton. Well-written and lively, "The Fix" features an amazingly long subtitle that says it all: "Under the Nixon Administration, America Had an Effective Drug Policy. We Should Restore It." [continues 641 words]
At the turn of the last century, unrestricted access to morphine, heroin and cocaine led to a great wave of addiction in the U.S. Witnessing this devastation of people's lives, the nation responded with antidrug laws. Somehow the simple lesson here--that drugs are dangerous--has been forgotten by many of our nation's elites. Mike Gray's "Drug Crazy" (Random House, 251 pages, $23.95) is the product of such selective memory. Mr. Gray, a film producer, makes the claim that the harms produced by drug prohibition are worse than the hazards of the drugs themselves. Yet his book is so lopsided that it fails to persuade. This is not to say that the "drug war" is being waged in the best way. Indeed, many drugs today are accessible, cheap and potent, not a good advertisement for current interdiction efforts. But Mr. Gray's angry, anecdote-driven account is hardly the best place to look for reform. [continues 695 words]
Mayor Rudolph Giuliani alarmed drug policy experts on Monday when he said he wanted to abolish all methadone programs for heroin addicts in New York City. Methadone, he said, merely replaces one dependency with another. In fact, he is both right and wrong to take this position. I say this because I work in a methadone clinic and know the drug's considerable benefits and shortcomings. First, the benefits. I have treated many addicts who function perfectly well as long as they take methadone daily. They are at our clinic at 6:30 A.M. so they can get to work by 8 A.M. This is not the way heroin addicts act; it's the way people who need a life-saving, if habit-forming, medicine behave. [continues 389 words]
