"Caught between Recovery and the Coffin"

December 17, 2011 9:06 PM

If I Die Young: Struggling with Addiction and Recovery. "Last year, 249 people died of prescription drug overdoses in Pinellas County, FL. Just about everybody who knew Stacy Nicholson figured she was next. Then an empathetic judge gave her a choice: recovery, or the coffin."

This is an extensive special report by the St. Pete Times. The first link in this post goes to the special report page. The second goes to the primary article.

Additional resources: photo gallery and a related series they did last year on Florida's prescription drug crisis. Also, "Drug court helps people regain lives 'after something has truly taken their soul'"

Video interviews:
Part I: Death and Determination
Part II: Recovery and Relapse.
Part III: Another Chance.

posted by zarq (86 comments total)

From the photo gallery:

Stacy Nicholson, 29, weeps as her mother and public defender ask the judge to let her out of prison to witness the death of her cousin, Francisco Herrera at Northside Hospital in St. Petersburg February 25, 2011. She and her cousin had been living and abusing prescription drugs together. Now he had overdosed, and was going to be taken off life support.

I think treating addiction as a medical epidemic rather than a police/paramilitary "war" would go a long, long way towards easing some of these people back into society.

The more I consider it, the more I think that the current law-enforcement approach is not designed to rehabilitate the addict or even contain the addiction -- but merely to Punish The Sinner. That's really all that matters to us as a society -- we don't care how many lives are destroyed as long as The Bad People get their just desserts.
posted by Avenger at 9:24 PM on December 17, 2011 [56 favorites]

I agree. By the time they are brought before a judge, we've already written them off as unsalvageable.
posted by zarq at 9:27 PM on December 17, 2011 [2 favorites]

Thanks for the reminder. And thanks, Ray Harris.
posted by Devils Rancher at 9:58 PM on December 17, 2011 [1 favorite]

Some of this addiction is because of oxycontin and oxycodone instead of opium from actual poppies. When I had to have oxycodone following dental surgery, the pharmacist warned me he was giving me a drug more dangerous than opium. I used the the absolute minimum dose. Thank God I usually bounce back from things fast.
Oxycontin and the other drugs like it are a product of the war on drugs.
posted by Katjusa Roquette at 10:00 PM on December 17, 2011 [2 favorites]

Of all the oxycodone prescribed in America in the first half of last year, 98 percent was dispensed in Florida.

If that statistic is accurate, it's amazing. When I was last in Florida, around 2008, I do remember seeing all the little doctors offices advertising for pain management. Some areas there was one every block.
posted by sbutler at 11:19 PM on December 17, 2011 [4 favorites]

I'm trying to remember at what point in my life I went from "people have a right to do whatever they want to their bodies" to "you know, we should probably intervene there."
posted by Tell Me No Lies at 11:28 PM on December 17, 2011 [8 favorites]

She has had four chances, a support network, being able to obtain two jobs on short notice in an area with 12 percent unemployment at the time, and she's still playing with fire by drinking. Recovery isn't easy. Taxpayer programs can't provide you a mother who's backing you up the entire time, and not just anyone is going to find employment so easy without tackling the nationwide problem as a whole.

Rehab is certainly preferable to imprisonment, but how do we prevent likely relapses and further harm to society at the same time? It's not an easy answer, I'm sure of that.
posted by Saydur at 11:33 PM on December 17, 2011 [3 favorites]

If this topic interests you, CurrentTV had a great documentary on it... Including the FL oxy industry, which supplies the entire country.
posted by k8t at 11:36 PM on December 17, 2011 [5 favorites]

NPR quotes 90%, but still....
posted by Tell Me No Lies at 11:37 PM on December 17, 2011 [1 favorite]

I'm trying to remember at what point in my life I went from "people have a right to do whatever they want to their bodies" to "you know, we should probably intervene there."

For me, it was when I realized just how skewed I am about most things, and also realized that most people are the same way.
posted by the man of twists and turns at 12:11 AM on December 18, 2011 [1 favorite]

90% or 98%, that is a staggering epidemic of oxy addiction. I applaud the forward thinking of drug court, ladies' day, all the savvy rehab center leaders with their bs detectors, the marathon meetings, second, third and fourth chances with the truth staring the addict in the face more and more closely and nobody enabling. Hurrah for that judge with the coffin in the courtroom.

Most addicts and alcoholics still do die of their addiction or from behaviors or damage connected with it. We used to hear the statistic that something like 10% of alcoholics actually get sober and stay sober. I think it might be a little better now that there is so much information and the addiction is recognized earlier.

We can't prevent likely relapses into drugs either but I think we can reform our system so that addiction is recognized as a medical problem even though it is the crimes the addicts commit which bring them into court. Such arrests should mean the addict automatically requires treatment to achieve and maintain abstinence. Eventually, multiple failures will funnel the addict into a permanent loss of freedom for crimes. Even if an addict does not steal to pay for drugs, it's a crime to kill yourself, I think (I'm not sure about that--saw it on television) and certainly active addiction is slow suicide.

In Louisiana we incarcerate a greater percentage of our population than any place in the history of the world and we are building a new jail right now. This is outrageous. Most people go there for drug-related crimes. New Orleans will doubtless also be the city with the highest murder rate again this year but most of those are also drug related. This war on drugs is absolutely deadly to the bystanders and the community and so far, it hasn't worked.

We need to stop hating, blaming and punishing addicts (while the profitable prison industry continues to privatize and flourish) and start handling the problem with some intelligence.

(Sorry, I got carried away but this is a great post, Zarq; thank you)
posted by Anitanola at 12:27 AM on December 18, 2011 [13 favorites]

recovery, or the coffin."

recovery and immortality!
posted by telstar at 12:28 AM on December 18, 2011 [2 favorites]

Of all the oxycodone prescribed in America in the first half of last year, 98 percent was dispensed in Florida

How could that be possible?

FL oxy industry, which supplies the entire country.

Oh
posted by fullerine at 12:31 AM on December 18, 2011 [1 favorite]

I applaud this judge. It's shocking that this kind of treatment is the exception and not the rule. Making a pragmatic effort to help people recover from addiction shouldn't be noteworthy or unusual in a rational legal system.
posted by knave at 12:34 AM on December 18, 2011 [2 favorites]

A very well written article, thanks for the FPP.

Back in the early '70's I spent a couple of years working drug wards in the Military. Most of our patients were guys who had been med-evaced from 'Nam and stepped off the helicopter in heavy withdrawal from Heroin.

Observing the impact of this level of addiction was enough to convince me that a glass or two of wine was about all I ever wanted to experience in terms of substance use.
posted by tomswift at 3:45 AM on December 18, 2011 [1 favorite]

I'm trying to remember at what point in my life I went from "people have a right to do whatever they want to their bodies" to "you know, we should probably intervene there."

I'm with you, but I struggle with this question: how do we disentangle the harm directly caused by the drug addiction from the harm caused by our present criminal treatment of those suffering with addiction? These drugs sell at huge markups on the street, which means that buyers are financing drug smuggling rings and engaging in self-destructive behavior to afford their next fix. Maybe some of these patients could be helped far earlier, before their lives were ruined, without the war on drugs?

There are absolutely tons of these stories where drugs have ruined lives and caused deaths, yet alcohol causes enormous suffering and is substantially more available than ibuprofen. Why is it a felony for a housewife to pop a single Xanax without a prescription, but chief of police himself will pour her glass after glass of Merlot? (They don't have much crime in the suburbs, so the Chief moonlights as a bartender, ok?) I think the intervention has to address the problem of drug abuse, rather than the simple existence of drugs. Part of "having a right to do whatever you want to your body" is having the help available to sort out what you actually want to do vs. what your addiction wants to do to your body.
posted by zachlipton at 3:55 AM on December 18, 2011 [10 favorites]

No matter how "empathetic" the judge may be, 95% of this woman's problems are due to her being in court rather than a doctor's office.
posted by aeschenkarnos at 4:12 AM on December 18, 2011 [11 favorites]

Since she's been doctor-shopping for her pills, I'd say a lot of her problems are due to being in a doctor's office. It's probably time to hold bad doctors responsible.
posted by Houstonian at 4:17 AM on December 18, 2011 [9 favorites]

It's probably time to hold bad doctors responsible.

Not so fast.
posted by daksya at 4:39 AM on December 18, 2011 [6 favorites]

No matter how "empathetic" the judge may be, 95% of this woman's problems are due to her being in court rather than a doctor's office.

You know, I'm usually skeptical when law and order types scream "personal responsibility", but if ever there was a case when that maxim applied, it's this one. Sure, she was in a "court", but got sent to a halfway house with an intensive treatment program three times. As others have mentioned, she had a massive support network and the incredible luck to find work, at one point immediately after leaving jail.

And still, she failed, and will almost certainly continue to fail (the end of the piece basically gives it away). Anti-Drug War talk usually focuses on how to redesign incentive and punitive structures for drug use, with the idea that, somehow, this will have an impact on addiction rates (among other things). What radical change to society's approach to drugs would have helped this woman?

At a certain point, you have to just say, this woman's problems are due to her own failings and accumulated poor choices, from the looks of which started at age 12.
posted by downing street memo at 5:36 AM on December 18, 2011 [1 favorite]

A few years ago, drug court Judge Farnell started seeing more and more women charged with prescription drug abuse. By 2009, almost half of her drug court defendants were women.

Women are approximately half of the population.

Instead of punishing the women, the judge offers them a chance to start over.

Excellent. That is great. I'm sure that this program will be extended to young black men from bad neighborhoods any minute now.

I think this program is a great idea. Drug sentencing is out of control in the U.S. and it's good that a Judge is doing something creative about it. More like this please.

But it also kind of rubs me the wrong way that there's a "women's docket" with special lenient sentencing for women.
posted by gauche at 5:59 AM on December 18, 2011 [11 favorites]

At a certain point, you have to just say, this woman's problems are due to her own failings and accumulated poor choices, from the looks of which started at age 12.

This manages to completely deconstruct itself. Generally speaking we don't hold 12-year-olds responsible for their choices. And for good reason!

Attempting to locate "blame" for these situations in "personal responsibility" leads us very quickly to incoherence. No one is an island; none of us spring into existence fully formed at 18, radically free and ready to "choose" the life we will live. The fantasy that we do is just a way for us to look away.
posted by gerryblog at 6:11 AM on December 18, 2011 [13 favorites]

I grew up reading the st. Pete times. She is one of the few last bastions of real journalism. Check their archives for decades of reporting like this on things like the takeover of clearwater by scientology.
posted by dejah420 at 6:26 AM on December 18, 2011 [7 favorites]

This manages to completely deconstruct itself. Generally speaking we don't hold 12-year-olds responsible for their choices. And for good reason!

Attempting to locate "blame" for these situations in "personal responsibility" leads us very quickly to incoherence. No one is an island; none of us spring into existence fully formed at 18, radically free and ready to "choose" the life we will live. The fantasy that we do is just a way for us to look away.

That's why I used "and" there. The two narratives here - a) woman is responsible for her own problems and b) woman was pathed into drug use by Society are not mutually exclusive.

My only point was, this kind of stuff isn't necessarily an artifact of the criminalization of drug abuse; there's no societal reform I could imagine that would help this person. She seems to have two big problems - first, a terrible, enabling mother and a legacy of poor choices dating back almost 20 years, and second, well, she seems like kind of an idiot. So let's have compassion, sure, but let's also not fool ourselves that replacing a drug court with a rehab ward is going to seriously change anything.
posted by downing street memo at 6:33 AM on December 18, 2011 [1 favorite]

I have to wonder whether it would be worse for Stacey if she simply lived in a world where she could have as many little blue pills as she wanted without doctor shopping, paying inflated prices for them, and legal sanctions.
posted by localroger at 6:36 AM on December 18, 2011 [8 favorites]

let's also not fool ourselves that replacing a drug court with a rehab ward is going to seriously change anything.

Right. Wouldn't want to fool ourselves.
posted by gauche at 6:40 AM on December 18, 2011 [4 favorites]

I have to wonder whether it would be worse for Stacey if she simply lived in a world where she could have as many little blue pills as she wanted without doctor shopping, paying inflated prices for them, and legal sanctions.

Remove all the obstacles, and why wouldn't she just be dead sooner?
posted by desjardins at 6:54 AM on December 18, 2011 [3 favorites]

This is another reason I'm a super strong advocate of teaching sociological methods to doctors. Sure, docs know there's a drug epidemic, but they can't tell doctor shoppers from folks in real pain, and sadly those groups form more of a venn diagram than two distinct populations. As such, many people who need medication can't get it. I think a greater understanding of the social implications and/or causes of these problems might go a long way in helping doctors provide better care.

Someone could probably create a survey instrument that helps doctors decide when and what to prescribe. That instrument would probably create a ton of controversy and take 15 years to create.
posted by bilabial at 6:55 AM on December 18, 2011 [3 favorites]

I have to wonder whether it would be worse for Stacey if she simply lived in a world where she could have as many little blue pills as she wanted without doctor shopping, paying inflated prices for them, and legal sanctions.

It would be a better world for actual pain patients, who are being directly harmed by attempts to prevent people like Stacey from the consequences of their own actions.
posted by Ralston McTodd at 6:57 AM on December 18, 2011 [12 favorites]

Fascinating stories, it made me wonder why we don't have a similar epidemic in the UK, and found this:

Doctor shopping is virtually impossible in the UK as most patients visit only one practice, have prescriptions written on official pads, and their doctors have access to full prescription records. Patients do not pay their doctors directly so medical staff are less tempted to prescribe to keep patients happy. In the UK OxyContin is considered similar to morphine and used sparingly. Vicodin isn't licensed. Ibuprofen and paracetamol are available over the counter but pack size is usually restricted.
posted by ellieBOA at 7:00 AM on December 18, 2011 [6 favorites]

Florida is the poster child for misguided drug laws. Possession of a tiny amount of marijuana can get you a year in jail. It's the only state to eliminate mens rea, recently declared unconstitutional. Oh, and another unconstitutional law aimed at the poor. (Aren't Tea Party candidates supposed to be pro-Constitution?)

Doctors need to chill out, too. NSAIDs work just fine for a lot of things.
posted by RobotVoodooPower at 7:00 AM on December 18, 2011 [2 favorites]

Actually, if marijuana had been legalized a long time ago, the super strong varieties might never have been propagated.
Cocaine was made deliberately from a relatively benign leaf. I had tea from this leaves ages ago and it did wonders for altitude sickness I was suffering at the time. I am not sure the little teabags full of leaves were legally present. Someone may have simply brought them in...
Alcohol we all know is damaging stuff, even at low levels. Of something like beer or wine doesn't get you drunk enough, well you go ahead and drink more, or resort to stronger stuff.
posted by Katjusa Roquette at 7:11 AM on December 18, 2011

I cringed to read how this woman eats (cocoa puffs, McDonald's, spaghetti). The article correctly points out that addiction kills brain tissue and alters brain chemicals, but it fails to make the point that rebuilding the brain requires proper nutrition. Without that, the addict is likely to use again to get those feel-good chemicals their brain is starving for. I don't understand why none of these recovery programs seem to place any emphasis at all on proper nutrition.
posted by parrot_person at 7:11 AM on December 18, 2011 [7 favorites]

And still, she failed, and will almost certainly continue to fail (the end of the piece basically gives it away).

Um, what?? The end of the piece very strongly suggests that she has found a new and better way to cope with bad things happening to her. When her boyfriend cheats on her, she allows herself to feel the pain that causes, rather than reaching for pills to numb it. That is a huge positive step.
posted by parrot_person at 7:13 AM on December 18, 2011

a terrible, enabling mother

The mother might be an enabler -- though I'm curious who here magically knows exactly how to deal with addicts in order to help them and would never consider trying to hide a child's crime to prevent their returning to jail -- but I really think calling her a terrible mother isn't fair.

And also, the story seems to be that she was a drug user who had no interest in quitting until she was 28, then decided to try to quit, had a bunch of setbacks (which is normal), and with a lot of help and luck and hard work, managed to make it through her third stint in a halfway house 2 years after first starting to quit. I'm unconvinced that a one or two strikes and you're out of rehab forever is a good way of helping people quit.
posted by jeather at 7:27 AM on December 18, 2011

It appears the state's flailing in an attempt to cut down on medication abuse - there have been reports of pill mill raids, there's a monitoring program, and now every time I go to the doctor and get my Adderall Rx, I have to sign a "behaviour plan" that includes a declaration that I will not give or share my medication with anyone, and - this boggles my mind - will not drink alcohol. I believe this contract doesn't just say I will not mix drinks with my pills, but that I will not drink alcohol at all (I'm not certain because my doctor, being pragmatic, strikes that clause out).
posted by subbes at 7:45 AM on December 18, 2011

downing street memo: "At a certain point, you have to just say, this woman's problems are due to her own failings and accumulated poor choices, from the looks of which started at age 12."

Don't leave out the part about "surplus population," that always tickles me.
posted by Appropriate Username at 8:21 AM on December 18, 2011

What radical change to society's approach to drugs would have helped this woman?

Free drugs, not being criminalised.

Next!
posted by howfar at 8:22 AM on December 18, 2011 [3 favorites]

Follow the money. Florida has made it very easy for a lot of pharma-related concerns to make seriously big bucks, which is at the root of the addiction problem. This August article in the Miami Herald gives an idea just how wild west Florida has been for narco pushers. But the pill mill crackdown will only get rid of the most egregious pushers. A lot of so-called respectable docs play fast and loose with narcotics. See the ProPublica campaign Dollars for Doctors, an ongoing investigation of the financial ties between the medical community and the drug and device industry.

In Florida, things have gotten bad enough that CVS has recently notified some high volume narcotics prescribers it won't fill their prescriptions.
posted by madamjujujive at 8:25 AM on December 18, 2011 [1 favorite]

From Tell Me No Lies' NPR link above:

A major reason pill mills have proliferated in Florida is because, unlike most other states, it lacks a system for monitoring drug prescriptions. [...] In fact, Florida does have a prescription drug database. After years of lobbying by law enforcement, the state Legislature passed a bill last session to create one. It just didn't provide money to pay for it. A private foundation stepped in and began raising funds for the database.

But recently, Gov. Rick Scott has come out foursquare against it. Scott hasn't said much about why he wants to kill it. When pressed at a recent news conference, he said: "I believe it's an invasion of privacy and ... it appears that the money's been wasted."

Is the concept of monitoring prescriptions being an invasion of privacy as alien to most Americans as it is to me? It seems like making it harder to doctor shop would be a realistic solution to Florida's prescription drug epidemic.
posted by ellieBOA at 8:42 AM on December 18, 2011

You know, the more I read stories of addicts and talk to the ones I've met, it seems that the underlying thread is an overwhelming difficulty dealing with the daily ups and downs. So many seem to have minimal or malfunctioning coping skills and I wonder if some sort of comprehensive program in early childhood could help address these issues.

It seems so haphazard how people learn to cope. If you are fortunate your parents have good coping skills and don't seek out numbness as a way of dealing with the good and bad. If you are less fortunate, they teach you to drown your pain in work, school or something productive. But even then the lesson is ignore and hide from the pain rather than dealing with it.

I just wonder if teaching emotional skills could help those that would become addicts to find a way of living before they feel the seduction of numbness.
posted by teleri025 at 8:52 AM on December 18, 2011 [6 favorites]

In Louisiana we incarcerate a greater percentage of our population than any place in the history of the world and we are building a new jail right now. This is outrageous. Most people go there for drug-related crimes.

This sure does solve the problem of what to do with the scores left unemployable due to the of outsourcing of unskilled labor in recent decades. It's the one tax you'll NEVER hear the rich complain about paying.
posted by any major dude at 8:53 AM on December 18, 2011 [1 favorite]

I honestly don't understand how legalization is supposed to help the addict. They obviously don't care about the effects on their bodies, and/or are powerless to stop. Without legal consequences, what incentive do they have to quit? They will still need to get money to feed their habit; you're delusional if you think taxpayers will pay to hand out drugs like candy. If they can't get jobs, they will steal.

I am in favor of legalizing pot because of its relative harmlessness and low potential for addiction, but I have a problem justifying legalization of the harder stuff. It's not just about the individual person's body - drug abuse has clearly led in many cases to (non-trafficking related) violence, child neglect, theft, driving accidents, suicides, etc etc. I don't know how this would be any different if it was legalized.
posted by desjardins at 8:58 AM on December 18, 2011

desjardins, much of what's in this article, Heroin on the NHS, applies to oxycodone as well.
posted by daksya at 9:05 AM on December 18, 2011

At a certain point, you have to just say, this woman's problems are due to her own failings and accumulated poor choices, from the looks of which started at age 12.

I'd modify this as follows: "At a certain point you have to admit that the grip of addiction on a person is so strong and deep, that recovery becomes unlikely."

We admit that certain diseases are chronic or perhaps deadly - why don't we admit the same about addiction? Not in the "you can be a dry alcoholic but you will always be an alcoholic" sense, but in the "you will never be able to function without these drugs unless restrained" sense.

I don't blame the person for this - I think addiction will eventually permanently rob a person of all agency. I'm not really sure what to do with this... I'm not in favor of locking these people up, but they're guaranteed to become dangerous to others or even criminals in the outside world, probably even if we legalize the drugs.

I would endorse "wet houses" but only hesitantly. They solve some problems, but are also basically spaces for people to drink/snort/shoot themselves to death without causing much collateral damage.
posted by tempythethird at 9:14 AM on December 18, 2011

Again, we can't even get decent basic healthcare in this country. You're delusional if you think taxpayers will pay for addict's drugs, and insurance has no incentive to do so.
posted by desjardins at 9:14 AM on December 18, 2011

I honestly don't understand how legalization is supposed to help the addict

By providing them with clean, cheap (or free) drugs. By preventing their lives from turning into a desperate chase for the next hit. By avoiding those euphemistic "legal consequences" that make them unemployable.

And the price? Do you know how much it costs to try someone? How much it costs to incarcerate someone? Do you know how much drug related crime costs to the economy?

I am a traditinonalist about this question. Drug prohibition is a largely 20th century experiment, a novel approach without a scintilla of evidence to support its efficacy.

If you want to give people a motivation to get off drugs, give them a reason to live. It is a sad society that deals with misery by criminalising its consequences.
posted by howfar at 9:24 AM on December 18, 2011 [12 favorites]

There are many strong arguments for legalizing drugs; however, I don't think helping the individual addicts is one of them. I don't think that cheap, clean drugs are helpful for an addict anymore than a bottle of Thuderbird is for an alcoholic.
posted by wobumingbai at 9:43 AM on December 18, 2011

Read gauche's links, or this from the New Yorker if you're a subscriber. This isn't just some airy, hypothetical question; Portugal has already had success with decriminalization.

The paper, published by Cato in April, found that in the five years after personal possession was decriminalized, illegal drug use among teens in Portugal declined and rates of new HIV infections caused by sharing of dirty needles dropped, while the number of people seeking treatment for drug addiction more than doubled.

"Judging by every metric, decriminalization in Portugal has been a resounding success," says Glenn Greenwald, an attorney, author and fluent Portuguese speaker, who conducted the research. "It has enabled the Portuguese government to manage and control the drug problem far better than virtually every other Western country does."

Compared to the European Union and the U.S., Portugal's drug use numbers are impressive. Following decriminalization, Portugal had the lowest rate of lifetime marijuana use in people over 15 in the E.U.: 10%. The most comparable figure in America is in people over 12: 39.8%. Proportionally, more Americans have used cocaine than Portuguese have used marijuana.

The Cato paper reports that between 2001 and 2006 in Portugal, rates of lifetime use of any illegal drug among seventh through ninth graders fell from 14.1% to 10.6%; drug use in older teens also declined. Lifetime heroin use among 16-to-18-year-olds fell from 2.5% to 1.8% (although there was a slight increase in marijuana use in that age group). New HIV infections in drug users fell by 17% between 1999 and 2003, and deaths related to heroin and similar drugs were cut by more than half. In addition, the number of people on methadone and buprenorphine treatment for drug addiction rose to 14,877 from 6,040, after decriminalization, and money saved on enforcement allowed for increased funding of drug-free treatment as well.

posted by gerryblog at 9:50 AM on December 18, 2011 [6 favorites]

I don't think that cheap, clean drugs are helpful for an addict anymore than a bottle of Thuderbird is for an alcoholic.

They are helpful because they're not dirty, expensive drugs.
posted by howfar at 9:53 AM on December 18, 2011 [1 favorite]

wobumingbai: I don't think that cheap, clean drugs are helpful for an addict anymore than a bottle of Thuderbird is for an alcoholic.

Are you sure?
posted by daksya at 10:01 AM on December 18, 2011 [3 favorites]

By providing them with clean, cheap (or free) drugs. By preventing their lives from turning into a desperate chase for the next hit. By avoiding those euphemistic "legal consequences" that make them unemployable.

I drug addict that not in recovery probably isn't employable, in this scenario they would just get high, all the time, they just wouldn't have to steal to get money.

And the price? Do you know how much it costs to try someone? How much it costs to incarcerate someone? Do you know how much drug related crime costs to the economy?

How much does rehab cost, the first, second, third of fourth time? I'm still for it but I'm not sure the savings offset prison costs. And how are unemployed addicts who are getting cheap or free drugs supposed to support themselves? What about the costs to support their children? What about the cost to support their hospitalization, like the cousin that died in this article?

If you want to give people a motivation to get off drugs, give them a reason to live. It is a sad society that deals with misery by criminalizing its consequences.

This is a self-made misery and as mentioned upthread, these are people with poor coping skills. A reason to live comes largely from within, from people valuing their families, their children, themselves. And while I think rehab and recovery programs can help with this, it can be an incredibly tremendous hurdle to jump.

I'm OK with the consequences being prison or rehab and being in prison should include mandatory drug treatment. I see people passed out and sleeping in their own filth or so drunk or high they can barely stand.

The Cato paper is interesting but I'm not sure where the woman in this article would fall. The lower HIV rates are not surprising, numerous studies had shown that and even some US communities have tried to provide free needles (which is often met with community resistance) but the benefit is obvious. I mean best case scenario for this woman would be methadone, if she had the wherewithal to do so on her own.
posted by shoesietart at 10:01 AM on December 18, 2011

What radical change to society's approach to drugs would have helped this woman?

I don't know if it would have helped Stacy in particular, but making cannabis more widely available to pain patients as an alternative to narcotics would be an excellent start (beginning with lifting the restrictions on its use in clinical trials). Lots of people with prescription drug problems were introduced to their drugs of choice by their well-meaning doctors. Surely it makes both clinical and societal sense to start with the less addictive agent, and introduce opioids only if treatment fails.
posted by Wordwoman at 10:02 AM on December 18, 2011 [1 favorite]

I think that many people have a stereotype of what it means to be an addict, perpetuated by articles like this one and by years of anti-drug propaganda, that does not cohere with reality. The overwhelming majority of drug users (of all drugs, not just pot), even those whom medical science would categorize as addicts, are functional, contributing members of society. According to the National Household Survey on Drug Abuse, 70 percent of regular drug users (of all drugs) have full time jobs. Most people buy their drugs with money they earn or come into legitimately. Please don't use outlier cases like this one as an excuse to turn thousands or millions of otherwise law-abiding people into criminals, and please don't use these edge cases in an attempt to prove that removing criminal sanctions won't help anyone.
posted by decathecting at 10:04 AM on December 18, 2011 [18 favorites]

drug addict that not in recovery probably isn't employable

Who what the where now?

(preview)

Oh, thanks decathecting. That saved me a bunch of words.
posted by howfar at 10:06 AM on December 18, 2011 [2 favorites]

I drug addict that not in recovery probably isn't employable

I think this is debatable.

If clean drugs were provided legally and cheaply, some addicts would certainly take small "maintenance" doses to forestall withdrawal but not get high, and go on with functional lives. For these people, surviving withdrawal and getting rid of dependence is an impossible task, but they can live without getting high.

Other addicts need not only to forestall withdrawal but actually to get high, and while they would be helped somewhat by legal drugs, they might OD and die at worst and at best become burdens on society or criminals, legal cheap drugs or not.

I don't know if any research has been done to generally determine what percentage of addicts fall into which group, I think it would be a great thing to look into.
posted by tempythethird at 10:07 AM on December 18, 2011

I think that many people have a stereotype of what it means to be an addict

I also think this is a terminology problem. My previous post is not about drug users many of whom are certainly out there.

Addicts, to me, are not the same as users. Addicts are those people whose drug use is damaging their lives - their health, careers, relationships, whatever - and yet they go on using. Some users may slip into addiction easily, some only slowly, and many never.

But IMO there isn't much of an ethical grey-zone regarding users - if there were no addicts but only users, then complete legalization would be a no-brainer. Unfortunately some users will always become addicts.
posted by tempythethird at 10:14 AM on December 18, 2011

Oxycodone is the deadliest drug of all.

Just calling this out as purple prose. The article is laced with this treacly stuff. It's in service of a good cause, but these rhetorical flourishes persuade by means of the same unreasoning instincts that started the drug war. There's good information in here, too ... but the quality of the prose is distracting.
posted by doteatop at 10:15 AM on December 18, 2011

Other addicts need not only to forestall withdrawal but actually to get high

This group will itself have functioning and non-functioning members. Some people can use maintenance doses through the week and binge on weekends, for example.

Further to what you go on to say, I think some of the divide in this debate is over what one regards as being the addict's primary problem.

If you believe that the majority of problems of the majority of addicts stem from their addiction, you are more likely to see drug prohibition as a viable strategy.

If you believe in diverse causes of problems you are likely to believe in diverse solutions, and also more likely to believe that the good that prohibition can do is minimal in comparison to its detrimental effects.
posted by howfar at 10:23 AM on December 18, 2011 [1 favorite]

tempythethird, I worry that you're engaged in a sort of "True Scotsman" definition there, where you can say that addiction always ruins lives because if your life isn't ruined, you must not really be an addict. Addiction is just a physical or psychological dependence on a substance. So, if a person gets ill when he can't get access to heroin, but is able to hold down a job and raise a family while regularly using heroin, he is an addict, just as someone who can't quit smoking but is otherwise functional is addicted to nicotine. If you want to say that he's not an addict, I think you're using the term very differently than the way most medical professionals would use it. And if you want to count physical withdrawal as a "health" effect that would make someone an addict, then we're back to my original point, which is that the overwhelming majority of addicts are functional, productive, and commit few or no crimes other than their drug use.
posted by decathecting at 10:31 AM on December 18, 2011 [3 favorites]

But IMO there isn't much of an ethical grey-zone regarding users - if there were no addicts but only users, then complete legalization would be a no-brainer. Unfortunately some users will always become addicts.

All of which is equally true of alcohol, and yet we manage to make that drug available in a controlled form to adults -- many of whom are alcoholics -- without the sky falling in.
posted by PeterMcDermott at 10:44 AM on December 18, 2011 [4 favorites]

decathecting I'm really not trying to split hairs here, just to get a decent grip on the problem, which is really subtle. And you're right, I'm probably improperly expanding the scope of the word "addiction". Certainly the "functional-addict" that you describe would benefit greatly from legalization.

I suppose that there is no single term for what I'm trying to describe - someone who is both addicted and whose addiction demands a damaging level of use.

I've partaken in various things on and off for years, and know plenty of others who have as well. In my own circle, just a small handful of people have descended into the addiction+damage downward spiral. My anecdata would lead me to say that something like 5-10% percent of recreational users will ever get there.

But still, I think this sub-group represents the greatest ethical and policy challenge, because though casual users and "functional addicts" (not to mention our personal liberties, budgets, legal systems, and so on) would greatly benefit from full legalization, I think its much murkier for that last group.
posted by tempythethird at 10:48 AM on December 18, 2011

There is plenty of damage done by alcohol. I suspect the cost to society is higher than it is with hard drugs. However, that ship has sailed. There is no functional way to criminalize it now. "Alcohol is legal, therefore heroin should be too!" is a specious argument. In some perfect world, mind-altering substances wouldn't have any adverse consequences, but it's not the world we live in, and I don't see the point in increasing the number of people who face those consequences. I don't feel that Europe is a fair comparison because of cultural differences.
posted by desjardins at 10:57 AM on December 18, 2011 [1 favorite]

Addicts, to me, are not the same as users. Addicts are those people whose drug use is damaging their lives - their health, careers, relationships, whatever - and yet they go on using.

This strikes me as a semantic thing -- it's awfully hard to define "damage".

I know more than a few alcoholics and addicts (they are one and the same) who maintain perfectly sound careers, relationships and are relatively healthy. Sure, they may take some extra sick days and have a few more arguments with a partner than they would minus the substance abuse issues, but do not necessarily have any more problems than a non-addict with poor coping skills, a sub-standard education or a variety of other health issues.

I would be very hesitant about making generalizations about drug addicts. My grandmother spent the last twenty years of her life addicted to opiates. Yet, died as a beloved member of her community, church and family. She was a truly kind woman who never hurt a soul. But, and let there be no doubt, she was as much an addict as the guy lying in his feces on your local skid row.
posted by cedar at 11:03 AM on December 18, 2011

desjardins, I don't disagree with you that drug addiction is damaging to some addicts. I agree that drug use, including alcohol use, has adverse consequences for some people and sometimes for society as a whole. However, I do think that the burden of proof should fall on those who wish to prosecute and imprison people to show the benefits of that action. I don't think that the burden of proof should ever fall on people to show why they should not be imprisoned. Can you point to any good, reliable evidence that prosecuting and imprisoning drug addicts and other users of currently illegal drugs is beneficial to them or to society as a whole, when compared with the alternative of not imprisoning them?
posted by decathecting at 11:18 AM on December 18, 2011

I think we may be having a problem with the term "addiction" here for philosophical as much as for practical or political reasons. "Addiction" is at least as problematic as any other term that is conceptually dependent on the notion of free-will. This doesn't make it meaningless (necessarily) but, like other notions tied to free will, like culpability and retribution, it might be better set aside in the public policy context.

We can probably describe the set of behaviours we are trying to prevent, without having to go to the mat over their philosophical underpinnings.
posted by howfar at 11:19 AM on December 18, 2011

I would endorse "wet houses" but only hesitantly. They solve some problems, but are also basically spaces for people to drink/snort/shoot themselves to death without causing much collateral damage.

If these sort of things would make it so those who truly need the narcotics for pain relief were more able to get them, without medical personnel looking sideways at you, I would be all for this. Chronic pain is still under treated in many people in the USA do to doctors worrying about being arrested. Chronic pain patients will suffer and stretch out their medication to not have to deal with a doctor who will tell them they cannot prescribe anything else due to the same issues.

I have mentioned this on MeFi before. I abused NSAIDs for years due to being unable to get proper pain relief. I took enough ibuprofen that my doctors belief that is part of the reason I was diagnosed with renal cell carcinoma. The only reason I took all the ibuprofen was due to doctors refusing to treat my chronic pain. The NSAIDs kept me able to semifunction, yet, in the long run they are liable to cost me years off my life. People who abuse narcotics are a large part of the reason for this.
posted by SuzySmith at 11:29 AM on December 18, 2011 [1 favorite]

I don't feel that Europe is a fair comparison because of cultural differences.
That's a real easy way to write off a big mountain worth of evidence. And as an American who lives in Europe, I wouldn't say that the cultural gap is quite that big.

And the alcohol argument is a fair one. A huge amount of people indulge harmlessly without turning themselves into criminals, and alcoholics don't have to worry about being criminalized for the primary manifestation of their disease. I don't see why we shouldn't extend the same benefits to those who responsibly enjoy currently illegal substances, or to those addicted to them.

I guess you would say that criminalization keeps some people from becoming addicted, but its far from obvious to me how many people are truly dissuaded (certainly I'm not, nor do I know many people that ever thought - "I'd love to smoke some weed, but I won't because it's illegal and I'm scared of the legal consequences") or that this is worth the cost of loss of freedoms, drug wars, incarceration-culture, racism, and a drug trade that's currently destabilizing chunks of Mexico.
posted by tempythethird at 11:39 AM on December 18, 2011

This strikes me as a semantic thing -- it's awfully hard to define "damage".

Well I'm groping for a definition here for a reason - because although I'm an advocate of legalization, there is going to be a certain kind of addict/abuser that has to be accounted for in any legalization/decriminalization scenario.

This is the person who will use to the point of becoming unemployable and possibly having serious physical and mental health problems. Unemployability leads to criminality, even when drugs are legal. In addition, legal/cheap/clean drugs could just exacerbate the problem for this kind of user. Currently this user is taken care of (abused, swept under the rug) by the criminal justice system - and I'd like to know what a good alternative would be.
posted by tempythethird at 12:07 PM on December 18, 2011

It's not clear to me that the price or quality of oxycodone has much to do with this story. The drug is coming straight from the manufacturer and the glut appears to be keeping prices low -- reference is made in the story to her being able to attain it for $1 or $2 dollars a pill.

All of which makes Florida a sort of perverse lab experiment that allows these factors to be ruled out.

One of the things that is thrown into sharp relief is that addicts have to eat. You could put free oxycodone dispensers on every corner and it wouldn't affect this woman's story -- having gotten to the point where she was unable to work, she would still end up having to steal (the offense that landed her in the court system to begin with) to feed herself.

One wonders then if an integral part of Europe's success is the accompanying social infrastructure that allows non-functional addicts to sleep and eat effectively for free. After all it's hard to face the world clean when you don't know where your next meal is coming from.
posted by Tell Me No Lies at 12:10 PM on December 18, 2011 [3 favorites]

desjardins, I'm sorry, but I don't really get your approach to the Portuguese data on criminalisation. Surely it must be relevant to some aspects of your argument, even if not all aspects? For example, you believe that addicts require legal consequences in order to have an incentive to quit. Do you think that this doesn't apply to Portuguese addicts in the same way it does to American ones? If not, what cultural differences to you think compensate for this in the Portuguese case that would be relevant in the American case?

Cultural differences do exist, but we're going to need to get a bit more specific if we're going to get an idea of whether they invalidate the data in a US setting.
posted by howfar at 12:14 PM on December 18, 2011

One wonders then if an integral part of Europe's success is the accompanying social infrastructure that allows non-functional addicts to sleep and eat effectively for free. After all it's hard to face the world clean when you don't know where your next meal is coming from.

I think this is an excellent point. Decriminalisation or legalisation of drugs is not an answer to the problems created by drugs, only those problems created by their prohibition (which are many and serious). If you want to help a drug addict you have to help them with their life, not just their addiction.
posted by howfar at 12:20 PM on December 18, 2011

I would benefit from cheap, clean and legal drugs.

I am a well paid engineer working on products that most of you use everyday. I volunteer all the time, I help out my mother and sister when they are not doing well.

I'd rather be able to get and use the drugs I like without having to deal with sketchy duded carrying knives and guns, and I could do without the constant worry of going to jail (I like me drugs mostly because they let me relax and unwind and stop worrying, if they were legal maybe I wouldn't need as much).

The legality of tobacco has nothing to do with my decision to quit, and I cut my hard alcohol because of horrible hangovers and GI tract bleeding.

Maybe if all of us highly functional drug abusers came out of the closet people's outlook may change.
posted by Ayn Rand and God at 12:51 PM on December 18, 2011 [7 favorites]

teleri025overwhelming difficulty dealing with the daily ups and downs. Which would be a dandy explanation if many addicts weren't saddled with a greater than average proportion of downs prior to their drug use. A teacher of mine in high school was quite disdainful of the US War on Drugs and he said, of impoverished crack addicts, "this is likely the best feeling they're going to have all week. You want to send people to jail for the only thing that's ever reliably felt good to them?" And I agree, because I grew up in a home where my pleasures outside of books were few. And my other pleasures were awash in shame and anxiety (mooching food off the neighbors - delicious food, but so embarrassing). I didn't learn healthy coping skills until I was into my 20s, and I had thought I was fine on that front. I mean, seriously, I didn't learn to identify anger within myself until I was 26 or so.

howfar And the price? Do you know how much it costs to try someone? How much it costs to incarcerate someone? Do you know how much drug related crime costs to the economy? These costs are tied up in the prison industrial complex, which has an enormous lobbying power. They will fight tooth and nail to keep arrest and conviction rates high, to maintain absurd mandatory minimum sentencing policies, and to keep poor treatment of inmates out of the spotlight. Yes, this is very expensive, but they are able to run effective campaigns based on fear.

shoesietart This is a self-made misery and as mentioned upthread, these are people with poor coping skills. A reason to live comes largely from within, from people valuing their families, their children, themselves. And while I think rehab and recovery programs can help with this, it can be an incredibly tremendous hurdle to jump. The didn't decide to cope poorly. They likely did not feel valued as children (for any number of reasons), and they are not necessarily even aware that they lack appropriate coping mechanisms. Many many people think that screaming because you are angry is normal, or that they are in some way bad for feeling some unpleasant emotion. Combine this with a distinctly US problem, the "southern culture of honor" which has been shown to result in fewer subtle and early clues of distress...leading to a "sudden" leap into violent words or actions...and you have a burbling pot of mess.


Wordwoman I don't know if it would have helped Stacy in particular, but making cannabis more widely available to pain patients as an alternative to narcotics would be an excellent start (beginning with lifting the restrictions on its use in clinical trials). Lots of people with prescription drug problems were introduced to their drugs of choice by their well-meaning doctors. Surely it makes both clinical and societal sense to start with the less addictive agent, and introduce opioids only if treatment fails. I'll admit I'm cynical about this, but the enormous lobbying capacity of Big Pharma has a hand in preventing the further research of marijuana for pain relief. Also, regulating strength is a noted difficulty among the scientists who approach this work, and Big Pharma deftly exploits that challenge.


tempythethird I've partaken in various things on and off for years, and know plenty of others who have as well. In my own circle, just a small handful of people have descended into the addiction+damage downward spiral. My anecdata would lead me to say that something like 5-10% percent of recreational users will ever get there. Please don't do this. Scientists and Sociologists alike have a hard enough time getting folks to respect the percentages that are arrived at via years of review of quantitative and/or qualitative data. If you're pulling a number out of your ass, please call it a guess. But further than that, be aware that you are likely hanging out with a "self selected" subset of the population, and I'd guess not a representative sample - racially, educationally, financially, or geographically. I'll take pains to point out that rates of addiction and damage caused by addiction both vary across the population.


Also, my panties are in a twist over the idea that the level of damage caused by drug use can be some litmus test for whether one is addicted. It would be absurd to say that the person who uses a drug one time and on that first event wraps their car around a tree is "an addict" because of the amount of damage. Equally absurd, the guy who shows up for work on time, turns in stellar reports and closes awesome sales while doing two rails of coke in the bathroom at lunch every day. When he dies at 53 when his commercial flight goes down, he will probably be medically definable as an addict.
posted by bilabial at 1:22 PM on December 18, 2011 [4 favorites]

Drug addiction is a disease with a volitional component. We shouldn't send drug addicts to jail any more than we should send alcoholics to jail, or diabetics who won't stop eating candy, or smokers with emphysema, or morbidly obese people at McDonald's. Seriously, its not complicated. You don't send sick people to jail because they are sick.
posted by yarly at 7:26 PM on December 18, 2011

You send sick people to rehab and then jail if they don't comply. Sounds fair to me. The person in the article got repeated chances at rehab specifically because she feared jail. In the end it seems to have made a difference. All carrots and no sticks is just another form of enabling. We do need something that weeds out the self-destructive hardcore addicts from the casual user, though.

As for Europe, what I was getting at was the social safety net mentioned above. We simply do not have that here in the requisite amounts. We absolutely need to tackle that as well.
posted by desjardins at 7:02 AM on December 19, 2011

Speaking only for myself and my experiences with my own addictions, a fear of jail really did nothing. Toward the end, I used to hope I would get arrested. I used to pray for an end in whatever form that was. Thankfully, there was a county run rehab facility I went to that saved my life when I was ready to give up. I hear with the cutbacks they are taking less and less people. I have also spoken to people that feel that going to jail was the best thing that happened to them. Everyone is different, but until I was done, really done and had gone through it all my way, I wasn't stopping. I am thankful every day that I made it through alive.
posted by heatherly at 7:54 AM on December 19, 2011 [1 favorite]

Addiction is sad. There's no way around it. In the 70's, when I was a wee sprout, my folks ran a methadone clinic, and for the next 20 years were involved in addiction, recovery and counseling programs (before my Dad went and did therapy for the military for another 20 years. Good man, my Dad.)

I have known recovering addicts who were able to get straight and become productive members of society. I have known addicts who were so messed up, with pain and grief, that they had to go into intensive, in-patient programs for years, just to get to the point where they could begin to put their patchwork lives together in some way.

What we know is that jail isn't the answer. Trying to stem the supply isn't the answer.

Also, is it me, or is everything stronger and MORE addictive now? Meth, Crack, Weed, it's all benefitted from genetic engineering and advanced chemistry. Drugs can now mess you up more permanantly and more quickly than in the past. It's an industry that canibalizes its customers. The better the drugs, the faster they die.

Sure, there are genetic issues at work. Some folks are hard-wired to be addicted to something. There are poverty issues, coping skills issues, addiction is a multi-faceted demon and one-sided approaches won't work.

The more we learn, the more successful we'll be in curing addiction, in getting folks into successful recovery.

In the mean-time, try everything. If one thing won't work, maybe something else will. What will work from one person, may not work for another. It's a problem worth solving.
posted by Ruthless Bunny at 1:25 PM on December 19, 2011

Please don't do this. Scientists and Sociologists alike have a hard enough time getting folks to respect the percentages that are arrived at via years of review of quantitative and/or qualitative data.

Actually, tempythethird's figures coincide almost exactly with those that the scientists propose -- ie, approximately 10% of regular drug or alcohol users are likely to experience some degree of problem drug use/drinking during their lifetime drug using career.

Drugs can now mess you up more permanantly and more quickly than in the past. It's an industry that canibalizes its customers. The better the drugs, the faster they die.

I might not know very much about anything, but the one thing I do know something about is drugs and addiction. And the one thing that I'm most certain of in that regard is that the substance is incidental to addiction and dependence. The problem invariably lies with the addict rather than the substance that they're addicted to.

I'm not telling you anything you don't know here, Ruthless Bunny. Your post identifies the various contributory factors, but then goes and ignores them all in favour of more War On Drugs propaganda. Whiskey is stronger than beer, but we don't go around wringing our hands about the new genetically modified form of alcohol that messes people up faster and more permanently than in the past.

Why?

Because it's complete bollocks is why.
posted by PeterMcDermott at 9:52 PM on December 19, 2011 [2 favorites]

You send sick people to rehab and then jail if they don't comply. Sounds fair to me.

I look forward to seeing the imprisonment of all of the other sick people who aren't compliant with their treatment regimes.

Diabetics? The obese? Smokers with heart disease?

Lock 'em all up, amirite?
posted by PeterMcDermott at 9:56 PM on December 19, 2011 [2 favorites]

Is there evidence that diabetics or smokers tend to neglect their children or become violent because they're in an altered state? Do obese people get into car accidents because they're fat?
posted by desjardins at 8:01 AM on December 20, 2011

desjardins, again, can you point to specific statistics about the percentage of drug users who are violent or neglect their children, versus those who use drugs without harming other people? Do you have specific data showing that putting drug users in jail lowers the number of people who cause harm to others or the amount of harm they cause? You seem to be relying on opinion and anecdote quite a bit to support your assertions, but if you have good information that shows that putting drugs users in jail lessens the harm of drug use and abuse, I would like to see that data.
posted by decathecting at 9:05 AM on December 20, 2011 [1 favorite]

News from the opposite end of the spectrum: Accused of misconduct, judge Amanda Williams resigns. This on the heels of a full episode of This American Life devoted to the accusations and complaints around Williams' "tyrannical" behavior.
posted by knave at 5:18 AM on December 21, 2011 [1 favorite]

decathecting, sorry I haven't gotten back to you yet. Didn't feel like searching "violent drug users" at work. :)
posted by desjardins at 11:56 AM on December 21, 2011

desjardins, I really don't want to be a jerk about this, but I'd really encourage you not to advocate in favor of putting people in jail if you're not in a position to do the research that will allow you to determine whether there's any chance that doing so might improve conditions for anyone. You've made some pretty bold statements in this thread, including accusations that many or most drug users abuse their children, and when I asked you to back them up, your response was a joke about how you can't be expected to do research because you're at work. I think that's pretty irresponsible, and I hope that next time you're going to make accusations about large groups of people you don't know, you'll refrain from posting them to the internet until you're able to produce some facts about the people you're discussing.
posted by decathecting at 4:44 PM on December 22, 2011

Richard Branson: Time to end the war on drugs.
posted by knave at 12:52 PM on December 26, 2011