Is CRACK wack?

April 8, 2003 1:37 PM

The CRACK Program (Children Requiring a Caring Kommunity)The organization's premise is radical, if dizzyingly simple: CRACK gives addicts $200 (they'll throw in an extra $50 if a participant recommends a friend) and sets up the medical procedures at a public hospital or clinic. All Nicole had to do was sign a release form, and two weeks later she had her tubes tied at a local hospital. She received a check the following month.
posted by Espoo2 (78 comments total)

No, posting links to Salon Premium articles is whack.
posted by Pinwheel at 1:51 PM on April 8, 2003

this was covered fairly recently. I searched for crack, fwiw.
posted by jessamyn at 1:54 PM on April 8, 2003

All Salon articles are premium now, dontcha know.

Is this a doublepost, or have I just heard this story before? All I know is, I'm in favor of anything that empowers women not to bring unwanted, drug-addicted babies into the world. I think the woman who runs the program sounds like a saint. And I think anyone who wants to get all bent out of shape over this, can get bent, period.

That would be the mother in me talking.

On preview: Thanks, jessamyn. I thought so.
posted by padraigin at 1:54 PM on April 8, 2003

As for it being Salon premium, you just have to click on the day pass.
As for the doublepost, pardon.
posted by Espoo2 at 1:59 PM on April 8, 2003

It was also covered a long time ago.
posted by signal at 2:01 PM on April 8, 2003

I don't see how this can possibly be bad. The junkies sign up, get either sterilised or committed to long-term birth control, and get money for more crack or heroin. Everybody wins.

Though the medical expenses may rub some people the wrong way, I can just about guarantee that having 3-5 more chronically ill future inmates walking the street would be more expensive.

My only real issue here is a moral one. Is it really fair to allow someone to permanently sterilise him or herself while they are in such a bad place? Long-term birth control is one thing, but a life-altering procedure like a vasectomy or hysterectomy [sp?] isn't really something you want to consider when you're A) a crackhead and B) broke, with someone waving $250 at you. I can't even imagine how horrible it would be to finally come out of a serious addiction, get back into real life, and then have the choice to have a family taken from me.

Then again, the ratio of total crackheads/junkies to those who escape the life and are in a position to start a family is probably such that there would be few (if any) cases like this.
posted by fnord_prefect at 2:01 PM on April 8, 2003

Brilliant.
posted by Witty at 2:01 PM on April 8, 2003

The acronym sickens me, but otherwise it seems pragmatic. How many of the people protesting sponsored sterilization are willing to pony up the dollars to care for a child that for all intents and purposes is motherless? It disgusts me that this is a good idea, but unfortunately it is.
posted by substrate at 2:02 PM on April 8, 2003

All I know is, I'm in favor of anything that empowers women not to bring unwanted, drug-addicted babies into the world. I think the woman who runs the program sounds like a saint. And I think anyone who wants to get all bent out of shape over this, can get bent, period.

Giving crack addicts 200 dollars in exchange for sterilization is tant amount to bribery. No one is for crack-babies, but this isn't the way to go about it.

The root of the problem is drug addiction, which is what needs to be addressed. This only seems to go after a side-effect of addiction, while doing nothing to actually help the addict. What do you think that 200 dollars is going to get spent on?
posted by SweetJesus at 2:03 PM on April 8, 2003

What SweetJesus said.
posted by Slimemonster at 2:07 PM on April 8, 2003

I don't see how this can possibly be bad. The junkies sign up, get either sterilized or committed to long-term birth control, and get money for more crack or heroin. Everybody wins

No one wins. A heroin or crack habit is expensive. For someone who is seriously addicted, 200 bucks is about one day's worth of fix. I don't want to elaborate, but I know a few addicts. My father was also a addictions treatment counselor at a hospital detox ward for years.

This program does nothing to address the root problem of addiction. If the program gave the addicts 200 bucks for attending NA or some other drug treatment program, then I could be for it.
posted by SweetJesus at 2:08 PM on April 8, 2003

No one is for crack-babies, but this isn't the way to go about it.

So you have a better solution? As for helping the addict, that is laudatory-but he or she is the one who started the addiction to begin with. Personal responsibility has to start somewhere.
posted by konolia at 2:09 PM on April 8, 2003

Is it really fair to allow someone to permanently sterilise him or herself while they are in such a bad place?

Is it really fair to let an addict get knocked up over and over and give birth to unwanted and possibly defective (for lack of a better term) babies... which the rest of us will pay for, no doubt. I think the expense now is worth the savings later.

What do you think that 200 dollars is going to get spent on?

MORE CRACK?

This program does nothing to address the root problem of addiction.

That's not the point of the program.

If the program gave the addicts 200 bucks for attending NA or some other drug treatment program, then I could be for it.

...and a hysterectomy. I'd be for that too.

All I know is, I just said "no".
posted by Witty at 2:11 PM on April 8, 2003

Are they getting hysterectomy's or their tubes tied, like I thought the article said - I thought that tubes tied was reversible.
posted by agregoli at 2:14 PM on April 8, 2003

it's immoral to take advantage of drug addicts. however is it unethical? what is the end result for society, and can we attempt to put controls that take advantage of the weakest members of society? no one wants 'crack babies' which is really just shorhand for neglected, abused, and sickly babies (it often comes from drinking or smoking in addition to the crack). you say it's a choice, but if you've ever been an addict you know that 'choice' is a relative word. what is the legal principal for making decisions while intoxicated?

all i know is, i wish i was female. i don't want kids, and that could buy a whole week o'crack!!
posted by chaz at 2:14 PM on April 8, 2003

It's tubal ligations, which are often reversible. Hysterectomies are not performed for birth control purposes.

I stand by my "get bent". You see victims, I see the mothers of victims.
posted by padraigin at 2:17 PM on April 8, 2003

I could see several sides to the argument from both sides. Its social engineering versus cracksploitation (yes, I did just make that one up) versus creating less welfare crack babies. Hmm, tough call, I'll have to go with less welfare crack babies for $200, Alex.

And the question is? Where'd the crack-ho get $200 to buy more rock?
posted by fenriq at 2:17 PM on April 8, 2003

So you have a better solution? As for helping the addict, that is laudatory-but he or she is the one who started the addiction to begin with. Personal responsibility has to start somewhere.

Herion isn't a party drug. It's a drug that people become addicted to because they have severe psychological conditions and they self-medicate. Some people also have a genetic predisposition to addiction, which makes it harder to "keep away". So yeah, personal responsibility has something to do with it, but it's not the whole picture.

And yeah, I do have a better solution. Provide clean needle exchange programs for addicts to cut down on the spread of disease, and instead of shutting addicts away in prison for largely "social annoyance" crimes, spend the money on detox programs and force them to attend NA meeting for the rest of their life (just like AA).
posted by SweetJesus at 2:17 PM on April 8, 2003

I've got to agree with substrate on this one. Unfortunately, there's a lot of people yelling about how evil this program is, yet these are the same people who will complain the loudest when it comes down to actually paying for the care of these unplanned/unwanted children.

Maybe I can pretend to have a drug habit and someone will sterilize me - I can't seem to find anyone willing to tie the tubes of a healthy 26 year old who just doesn't feel like having children.
posted by chickygrrl at 2:18 PM on April 8, 2003

Herion isn't a party drug. It's a drug that people become addicted to because they have severe psychological conditions and they self-medicate.

*bullshit*

That's so naive. I don't mean to be rude, but it really is. The majority of people do drugs because they're fun. If you don't think heroin is fun at first, well, you don't get out enough.

I'm in favor of a variety of programs to help addicts. Including needle exchanges. Including social programs. Including changing legal policy. And including offering them the opportunity to take a smidgen of responsibility about reproduction.
posted by padraigin at 2:24 PM on April 8, 2003

I think it's a brilliant idea. And really, they do enourage the use of the birth control, over the sterilization. To get your tubes tied is a one time cheque, whereas so long as you stay on the b.c. you get a cheque every year. Now, I'm not saying that every crack addict is astute enough to make that observation, but the people who run around saying this program is trying to force people to get sterilized is the one who's whack. If you look at the numbers, the majority go for the birth control.

Honestly, I think society as a whole would be alot better off if everybody had access (and incentive) to use birth control of this type. Unwanted babies don't just happen to drug addicts.
posted by nelleish at 2:25 PM on April 8, 2003

And yeah, I do have a better solution.

That's not a better solution. That's a solution to a different problem.

I mean, I agree with you: What you're saying is good. But it's targeting a different aspect of the drug problem.
posted by claxton6 at 2:28 PM on April 8, 2003

Thought experiment: A new drug control program is started. Anyone who wants $500 turns up at a clinic, and a small implant is placed deep in their skull, near the cerebellum, which contains a tiny but powerful explosive charge. They also receive the money upon completion of the procedure. The implant will detonate in one year's time, causing a shockwave which is entirely contained within the skull, and which destroys the brain. Discuss.
posted by chrid at 2:29 PM on April 8, 2003

the article clearly states "As long as [drug addict] continues to take [Depo-Provera, a bimonthly contraceptive shot], she'll receive $200 a year (as opposed to the one-time payment for sterilization)." So where's the coercion for sterilization?
posted by bokononito at 2:30 PM on April 8, 2003

I'd like to piont out that there is indeed a better term to use than "defective babies".
posted by Space Coyote at 2:30 PM on April 8, 2003

Last year, Patricia McBride, a 41-year-old mother of seven who lost custody of her children because of her drug and alcohol addiction, applied to CRACK to receive Depo-Provera, a bimonthly contraceptive shot. As long as she continues to take it, she'll receive $200 a year (as opposed to the one-time payment for sterilization).

So far, 907 people have signed on with CRACK. Of those, 329 were permanently sterilized and the rest opted for long-term birth control like Norplant or Depo-Provera.

The better, more profitable option for the crack heads is to choose a non-permanent birth control option. And nearly twice as many people have chosen the non-permanent option. At first glance, I thought 'Eww, offering desperate people cash for sterilization, that's despicable.' But they're offering the desperate people even more cash for simply choosing a reliable birth control method. It's hard for me to see their actions as inherently evil.
posted by jacquilynne at 2:32 PM on April 8, 2003

That's so naive. I don't mean to be rude, but it really is. The majority of people do drugs because they're fun. If you don't think heroin is fun at first, well, you don't get out enough.

I'm willing to bet I get out more than you. Heroin isn't a party drug. Pot, ecstasy, pharmaceutical speed and coke are party drugs. You know why heroin isn't a party drug? Because it causes you to sit in a corner for 10 hours in your own little world. That doesn't jive with the party atmosphere.

Heroin is something you start when the coke gets to be too much, and you need something to take the edge off so you can sleep. That's how most people become heroin addicts. They don't shoot up at a party for the first time and start robbing people the next week. That's bullshit sensationalism.
posted by SweetJesus at 2:32 PM on April 8, 2003

So far, 907 people have signed on with CRACK. Of those, 329 were permanently sterilized and the rest opted for long-term birth control like Norplant or Depo-Provera.

I don't particularly have a problem with the birth control implants, which are not permanent. I do how ever have a problem with a surgical procedure being preformed for a 200 dollar pay off.
posted by SweetJesus at 2:36 PM on April 8, 2003

chrid: I'd be willing to open up that program to ANYONE that is willing... not just addicts.
posted by Witty at 2:36 PM on April 8, 2003

Yeah, but people also start taking heroin because they think it will be pleasurable. How is that different than other drugs?
posted by agregoli at 2:38 PM on April 8, 2003

Heroin is something you start when the coke gets to be too much, and you need something to take the edge off so you can sleep.

Interesting justification. So it's the after-party drug. I see.
posted by Witty at 2:39 PM on April 8, 2003

I'm willing to bet I get out more than you.

Ha. I'd take that bet, but I frown on others turning MeFi threads into personal wars, and I won't do it my own self.

Anyway, you shoot up for your reasons (tummy ache?), and I'll shoot up for mine (the pretty, pretty colors). And to bring it back on topic, I hope when we're both done with our personal idea of partying, there are many resources which we can use to embetter our broken lives.
posted by padraigin at 2:48 PM on April 8, 2003

Interesting justification. So it's the after-party drug. I see.

It's not really an after-party drug either. When I say some coke heads start doing it to take the edge off their coke abuse, I'm talking about serious coke addicts. Not just the bump a hit at a party types.

I don't know anyone who would just try heroin for the hell of it, or to feel good. For the feel-good type of drugs, it's much easier to just buy pot or ecstasy, or if you're a bit heavier, oxycodone. It's pretty hard to come by heroin on the streets, unless you live in a big city and know the right people.

Anyway, most people know how addictive it is, and aren't going to try it. And if you have real friends, they wont let you touch the stuff (We used to tell a good friend of mine who was addicted to prescription speed that if anyone ever offered her coke/heroin to call one of us, and we'd come get her out of the situation). Even most minor addicts know not to touch the stuff. So I don't buy the line that it's party kids getting hooked because they try the stuff to feel good.
posted by SweetJesus at 2:48 PM on April 8, 2003

SweetJesus: Gee, so after I take a healthy dose of morphine, I'm just hallucinating about going out? Woah. My entire circle of peers must be an illusion cast by drug delerium.
posted by bunnytricks at 2:50 PM on April 8, 2003

"I'd like to piont out that there is indeed a better term to use than 'defective babies'"

Noted.

Any chance you're willing to share it?
posted by mr_crash_davis at 2:50 PM on April 8, 2003

Anyway, you shoot up for your reasons (tummy ache?), and I'll shoot up for mine (the pretty, pretty colors). And to bring it back on topic, I hope when we're both done with our personal idea of partying, there are many resources which we can use to embetter our broken lives.

I'm young, and I still get out, but I've seen enough of my friends lives destroyed by drugs and addiction to know better than most. I've got more stories than I can relay here, but what I do know is that addiction isn't as simple as most people here make it.
posted by SweetJesus at 2:51 PM on April 8, 2003

The implant will detonate in one year's time, causing a shockwave which is entirely contained within the skull, and which destroys the brain. Discuss.

are you seriously comparing free, permanent birth control, meaning never having to worry about getting pregnant again, never having to try to feed a baby and an addiction at the same time, never again having to be responsible for some helpless little person's life when you can't even manage your own, with - suicide?

are you missing the point, or just trolling?
posted by Mars Saxman at 2:53 PM on April 8, 2003

What SweetJesus said again.
posted by Slimemonster at 2:55 PM on April 8, 2003

Wait, SweetJesus -- clean needle exchange programs are great, but they don't do anything to "address the root problem of addiction," either. Neither of these programs are designed to do that. Both of them are designed to cope with some of the problems born (ahem) out of of the addiction problem.

I suppose you could argue that the sterilization program is taking advantage of addicts, but I think that's kind of patronizing. I think you could make a similar argument that needle exchange programs are pretty damn codependent. Just saying.

Personally, I'm for both programs.
posted by LittleMissCranky at 2:56 PM on April 8, 2003

Gee, so after I take a healthy dose of morphine, I'm just hallucinating about going out? Woah. My entire circle of peers must be an illusion cast by drug delerium.

How much morphine you taking there, bunnytricks? The heroin addicts I know are either confined to their living room floor, or feending for heroin.
posted by SweetJesus at 2:57 PM on April 8, 2003

clean needle exchange programs are great, but they don't do anything to "address the root problem of addiction," either.

The point of that is that addicts are going to be addicts whether you give them clean needles or not. Why not give them clean ones so medicare doesn't have to pay for AIDS treatments.

Besides, if they come to get the needles, they should be almost bullied into getting into a drug treatment program, which of course if I were king, would be free.
posted by SweetJesus at 3:02 PM on April 8, 2003

Well, when I'm queen, there will be, along with free and effective substance abuse programs, the option to voluntarily participate in a contraceptive program as well. Because I believe that while you're treating the root problem--or in the event that you aren't able to treat the root problem--you need to treat the side effects too.
posted by padraigin at 3:11 PM on April 8, 2003

I'm all for contraceptive programs. Give them free birth control pills, condoms, or the implant. But don't pay 'em 200 bucks for a surgical procedure. That's like waving a carrot in front of a donkey.
posted by SweetJesus at 3:15 PM on April 8, 2003

But they get paid $200 bucks for the alternative as well... the shot. Same carrot, two choices.
posted by Witty at 3:17 PM on April 8, 2003

Sweetjesus: Ever hear of Plano, Texas? There was almost an epidemic there a few years ago, as well as other parts of Texas. Heroin was sold in pill form, people would take it AT PARTIES, and eventually would move on to either snorting it or shooting it. Your world and your experience is not the only way things work. I've definitely known people who thought that heroin sounded "fun" and wanted to "try it just one time".
posted by Espoo2 at 3:18 PM on April 8, 2003

Incidentally, and back off track, there was a common (lack of?) wisdom amongst certain of my peers, back in the day, that snorting heroin was not at all like shooting it, and in fact, one could get away with it on a fairly social level much like one could with cocaine (heh). These were people quite sophisticated about their drugs, and yet...there you have it. Many mellow parties were thrown by these lovely folks, and a great deal of Mazzy Star was played.
posted by padraigin at 3:18 PM on April 8, 2003

Sweetjesus: Ever hear of Plano, Texas? There was almost an epidemic there a few years ago, as well as other parts of Texas. Heroin was sold in pill form, people would take it AT PARTIES, and eventually would move on to either snorting it or shooting it. Your world and your experience is not the only way things work. I've definitely known people who thought that heroin sounded "fun" and wanted to "try it just one time".

Yeah, I know. It happened at my old high school. Some kid who was a few years under me ended up over dosing on heroin. But these cases are few and far between, and usually the kids stop using oxycodone before it gets to that point.
posted by SweetJesus at 3:26 PM on April 8, 2003

Will this program pay to reverse the tubal ligation or vasectomy if the addict gets clean? Seems only fair.
posted by joaquim at 3:34 PM on April 8, 2003

joaquim, when all the hordes of cleaned-up former junkies who can't have children become a major social problem, I'll be happy to support such a program...
posted by Mars Saxman at 3:57 PM on April 8, 2003

I'll have to go with less welfare crack babies for $200, Alex.

I would just like to point out that crack babies are a myth.
posted by hob at 3:57 PM on April 8, 2003

The point of that is that addicts are going to be addicts

exactly. and for this reason they shouldn't be having kids. The problem treated in this thread isn't the addicts it's the unwanted children (crack babies) of addicts.
posted by bitdamaged at 3:58 PM on April 8, 2003

Much as I hate the thought of it, I think this is a great idea and I don't much care whether it is fair on the addicts or not. They have made their lifestyle choices and I am getting a bit sick of supporting those choices with my tax dollars.

I would also be happy to support a program that covered reversal of the process for addicts who have broken their habit and have a reasonable chance of staying clean. In the meantime, preventing the abuse of even one baby is worth the $200.
posted by dg at 4:17 PM on April 8, 2003

You know why heroin isn't a party drug? Because it causes you to sit in a corner for 10 hours in your own little world.

Ketamine's hardly the party starter either, yet there was a time you couldn't move at certain clubs for kids exploring their k-hole.

I say was, because I don't go to that sort of club anymore, and thus don't know if it's gone out of style yet.
posted by inpHilltr8r at 4:37 PM on April 8, 2003

By the way- those who responded to my post: It was a theoretical (and, hey! satirical) expansion of the CRACK program, intended as a discussion catalyst. I posted in the full knowledge that you couldn't see the grin on my face - I guess, looking back on it, that it was a troll post. My first ever! Sorry, I won't do it again.
posted by chrid at 4:42 PM on April 8, 2003

(More a question than an opinion) At least two years ago, I heard of a technique to make a heroin addict clean in four days: they would be given a drug that would make them unconscious for four days, a second drug to help clean the drug from their system, and a third drug that would block their receptors for a month, so that heroin would be of no use even if they used it. The follow-up was after a month or two, another shot of the blocker drug.
Recently, I asked a friend about why a program like this wasn't in use *anywhere* in the US. He replied that, although it was highly effective and only a few in ten thousand would die from the induced coma, the enormously profitable methadone industry in the US had stopped it cold. They opposed even testing it, and lobbied successfully to completely bar it from the country.

Does anyone know if this is true?
posted by kablam at 7:35 PM on April 8, 2003

kablam: The program, or something similar, does exist. I've heard of people visiting Canada for it.

However, there are similar options in the US. If you check into, say, a hospital's detox wing, they will basically drug you into oblivion for a week or so, until the withdrawals are over. You can then get a prescription for an opiate blocker Nalexatrone, or something similar, I can't recall the exact name offhand. Works just as you describe... take as much heroin as you want, and you won't feel a thing. usually done in conjunction with a mood stabilizer or antidepressant.
It is possible to quit heroin, even working within the established medical system here, without methadone. I have never heard of anyone being pressured into using methadone. It's an option, sure, but people who want to go it alone are given just as much support (perhaps more).

Granted, this is simply what I know secondhand from people in the system, and it may vary by area, so take it with a grain of salt.
posted by Kellydamnit at 8:03 PM on April 8, 2003

Or you could always join...
...Narnocon.

That'd be the Scientologee "drug rehab" program, in which they attempt to kill you through sauna sweats, Vitamin C megadoses, and general incompetency.
posted by five fresh fish at 8:58 PM on April 8, 2003

One of the slogans used by CRACK: "Don't let getting pregnant get in the way of your drug habit."

This is obviously an organization brimming with compassion for drug-addicted women.

Paying people--especially hard-core drug addicts who almost certainly cannot give meaningful informed consent--to undergo a major, effectively irreversible medical procedure is wrong. Period. I'm shocked and appalled that doctors are actually agreeing to perform these operations, assuming they are aware of the financial incentives that are involved. IMO, they should be sued for malpractice and sanctioned by their state medical boards for unprofessional conduct.

I'm kind of surprised too that supposedly liberal Salon would print such an uncritical piece on an organization that clearly has nothing but contempt for drug-addicted women. The AMA's (!) article about the organization is decided more pointed.
posted by boltman at 9:29 PM on April 8, 2003

From the AMA article above:

Paid clients: 302 women, 2 men
Methods used: 148 tubal ligations, 98 Depo-Provera, 32 Norplant, 25 intrauterine devices, 2 vasectomies

So, can I get paid to have a vasectomy too?
posted by dg at 10:40 PM on April 8, 2003

Rather than writing these people off I think I prefer the more radical solution of providing the choice of (a) providing assistance to all those wishing to try to escape their addictions and (b) prescribing medical heroin to addicts so that they can live productive and not unreasonably healthy lives and don't cause huge costs to society through criminal activity, something which seems toproduce decent results where it has been tried, in for example, Switzerland,(plus official report here) Holland and the UK. Whilst in the UK one experiment was ended despite strong results, further experimentation has been advocated by no less than the Association of Chief Police Officers
posted by biffa at 3:42 AM on April 9, 2003

SweetJesus: I hate to disillusion you but the majority of heroin users are not confined to their living room floor, or feending for heroin.

Two groups that show the most dramatic increases in heroin use over the last decade are suburban kids and young professionals. In many bedroom communities heroin is exactly what you say it isn't, ie., a party drug. It is readily available, inexpensive and you'd be surprised how many kids are pooling their resources to pick up a bundle on the weekend.

Granted, the majority of these people do not become addicted, but if the genetic, environmental and physiological components of addiction are combined with availability it is far from uncommon. Rehabs are filled with college students detoxing from opiates.

I think you would also be surprised at the dealers lurking about financial centers and the suits copping on their lunch hours. Its' quite amazing the amount of chemical abuse an expert can subject his body to and make it to work every day... after all (if your one of those unfortunate enough to graduate from recreational use to abuse), you gotta find a way to buy more and not all of us are cut out for a life of crime. Dope in jail/prison is quite expensive and the payment arrangements can be very disagreeable.

Because of increased supply and the potency of the dope on the street, folks have discovered that snorting it works just fine while avoiding the stigma and discomfort of shooting it. Some will move on for the IV rush trying to recapture that elusive first blast-- most won't, but enough do that this is not a problem that is going away anytime soon.

BTW, if you really believe it doesn't feel good you do need to get out more. Of course the problem is it feels really, really good exactly once and you can waste quite a few years of your life trying to find it again. I'm not going to Google up a slew up a slew of stats to prove this to anyone; it's easy enough to find out for yourself and you can get started for the price of a decent bottle of wine.
posted by cedar at 4:51 AM on April 9, 2003

So I don't buy the line that it's party kids getting hooked because they try the stuff to feel good.


No one said it was "party kids" although some of them do it, yes. Drugs are drugs, that's what they're for, or they wouldn't exist to the extent they do.

Everyone tries the stuff to feel good. Even if you're taking it, as you say, to come down off of another high, that's making you feel better, isn't it?
posted by agregoli at 6:49 AM on April 9, 2003

hob: I would just like to point out that crack babies are a myth.

In a strict sense, yes: the original worry that babies exposed to cocaine in the womb would have permanent brain damage solely becuase of the cocaine is apparently not true.

But cocaine exposure during pregnancy (and exposure to other recreational drugs of abuse) still causes all sorts of problems such as major birth defects and prematurity. Low birth weight, usually because of prematurity, is the major risk factor for infant mortality, and prematurity causes other disasters such as brain hemorrhage and cerebral palsy.

Recreational drugs during pregnancy == BAD, 'crack babies' or not.
posted by Slithy_Tove at 7:14 AM on April 9, 2003

I think they should pay everyone who gets sterilized $200, not just drug addicts.
posted by moonbiter at 7:25 AM on April 9, 2003

"Birth control is available to these women and it's free, but they're not interested in being responsible. Money motivates people of all walks of life," explained Barbara Harris, who launched C.R.A.C.K. in 1997.

Interesting, yet one aspect that the neither the salon (I didn't press on to the premium part) nor the AMA article touched on is the lack of impetus these folks will now have towards using birth control post-C.R.A.C.K. - remember, birth control does more than just throwing a wrench into the baby making process.

It could be argued that this population was not on birth control in the first place, yet that is an untested observation specific to this population.

I really hope that they follow this group and track them post-C.R.A.C.K. Again, regardless of the babies that could be born to these addicts, the main issue revolves around the addicts themselves. What will they do with their now sterilized bodies? Will this group be more prone to risky behavior that might give rise to higher instances of AIDS than even their non-sterilized counterparts? Without follow-up studies, we might never know.

Yet, unfortunately, this program is a salve that attempts to quick-remedy and patch a much larger problem. Until we can live in a country that can decriminalize the disease of addiction, and provide more holistic and effective solutions for addicts than merely a jail cell, we will have to contend with debating the merits of these programs while ignoring the much larger issues.
posted by jazzkat11 at 9:40 AM on April 9, 2003

Kellydamnit: thanks for the info. I think my point for the rest of the discussion is that a system exists to get people off heroin *for good* in FOUR DAYS. Now, sterilization of addicts is one thing, and stringing them out on methadone is a second, and putting them in prison for years is a third.

So why in pluperfect hell are we *not* offering to STOP their addiction COLD in FOUR DAYS! All the other alternatives seem INSANE by comparison. Except for a TINY minority of addicts who can't use this technique, who in their right mind, or even drug addled mind would refuse it if offered in exchange of prison?
posted by kablam at 10:22 AM on April 9, 2003

..a system exists to get people off heroin *for good* in FOUR DAYS.

I sincerely doubt the permanence of such a program as much as the many snake-oil remedies that have gone before it. Unfortunately there is a much larger component than merely that of the physiological or physical realm to addiction. An example would be asking the simple question of what factors lead to drug use for the addict in the first place.

Unfortunately there are many issues a pill can not address.
posted by jazzkat11 at 10:44 AM on April 9, 2003

Paying people--especially hard-core drug addicts who almost certainly cannot give meaningful informed consent--to undergo a major, effectively irreversible medical procedure is wrong. Period. posted by boltman at 9:29 PM PST on April 8

Are these people adults or not? If one of these addicts steals a stereo or engages in car jacking do we give them a get out of gaol free card because they didn't know what they are doing? I'm of the opionion that if you can't make an informed decision about birth control you shouldn't be having kids.

Note also that this isn't a women's right issue. Men are also qualify for the program and they don't have non-sterilization options.

How much does a uninsured tubal ligation cost in the US? A program such as this may be the only way that the typical dirt poor addict can afford the procedure. Would those who are outraged feel the same way if the only incentive was the free medical procedure?
posted by Mitheral at 11:11 AM on April 9, 2003

mars saxman: when all the hordes of cleaned-up former junkies who can't have children become a major social problem, I'll be happy to support such a program...

Fair enough. If you let us know your threshold values of "hordes" and "major", we'll be happy to notify your sense of outrage at the appropriate time.
posted by joaquim at 12:33 PM on April 9, 2003

I can't believe that this is even a serious proposition. $200 to get surgically sterilized?! WTF?

So many people here seem to be discussing this as acceptable without any hint of irony.

(All of what SweetJesus said.)
posted by Lleyam at 12:57 PM on April 9, 2003

ahh, touché, joaquim. but it is clear that there are very few places on earth where reduced birth rates pose a problem, regardless of the mother's health socioeconomic status. I'd be in favour of paying anyone to get sterilized, if they want it. With six billion people and counting, sucking up an increasing fraction of the planet's fresh water, we have far bigger problems to worry about than people who decide they don't want children and later change their minds.

Hell yes I think this is acceptable, Lleyam. The volunteer benefits, because they don't have to worry about pregnancy anymore - ever. Think of the $200 as compensation for missed work, if you want - there are a lot of people who really are so close to the bottom that they couldn't afford time off to get the operation even if it were free. And society in general benefits, because we don't have to pay for the hypothetical children this person might have had, and we don't have to deal with the consequences of yet more unwanted children growing up poor and probably neglected.

And besides, they CLEARLY HAVE A CHOICE, since half of the program's applicants have opted for temporary birth control! You simply can't argue that they are being coerced into sterilisation when they can get the same amount of money (or more, since the program renews every year) if they opt for depo, norplant, or an IUD instead.
posted by Mars Saxman at 1:41 PM on April 9, 2003

Mitheral: I think its important to see this program not just through the lens of social policy but through medical ethics as well. It's true that the government (and non-profits) require low-income people to do all sorts of stuff in order to get certain benefits (e.g. cash welfare, food stamps, a spot in a homeless shelter, etc). One can argue about whether it's good social policy or not, whether it protects the rights of low-income people and all of that good stuff. But there's nothing wrong with it in theory.

However, when you start talking about social policies that basically bribe people to undergo major, life-altering medical procedures you've left the realm of general social policy and entered a very different realm of medical ethics and patient rights. Whether or not they are "adults" or whether or not they've made some extremely poor choices in their lives is simply beside the point. Doctors' professional responsibilities do not allow them to make those sorts of judgments about the lives of their patients.

You have the legal doctrine of informed consent to deal with. How can a drug addict jonsing for their next fix possibly be expected to make a rational decision about whether they ever want to have children again when $200 is shoved in their face? More importantly, how can a medical doctor--who has a fiduciary duty to his patients, I might add--possibly agree to perform an irreversible medical procedure knowing the perverse incentives involved? This type of program would be absolutely unthinkable if it involved paying drug addicts to donate their kidneys or undergo medical or psychological experimentation.

The informed consent problem is made even more poignant when one considers the long and sordid history of doctors misleading, manipulating and lying to their patients in order to produce what they considered to be the best outcome for the patient. (for example, doctors used to not tell patients they were dying or had a high likelihood of dying because of cancer, or some other serious disease, in order to avoid unnecessarily upsetting them). Only recently has the medical profession decisively rejected this model of patient care. Doctors' complicity in this CRACK scheme strikes me as a step back toward the bad old days.

You have the extremely unpleasant history of eugenics to deal with. The fact that the program appears to target mothers addicted to crack-cocaine, usually thought of as the drug of choice for poor blacks, ought to at least raise some eyebrows.

Finally, you also have the strong moral and constitutional value of reproductive freedom to contend with. No, this practice is probably not unconstitutional (although it is at least possibly unconstitutional for state agencies to participate in the program depending on how coercive a court would view it as applied to drug-addicts), but it certainly goes against the spirit of the Constitution to the extent that it is about manipulating extremely vulnerable women to rob them of the ability to have children.

Barbara Harris can do what she wants with her money, but like I said, I think any doctor that participates in her little scheme ought to be sued for malpractice, which is a distinct possibility once some women that participated in the program get clean and then realize that they want to have kids.
posted by boltman at 8:21 PM on April 9, 2003

On the other hand, this program eliminates abortions, and unwanted and abused children.

Please, think of the children!
posted by five fresh fish at 9:35 PM on April 9, 2003

so would forced sterilization or, better yet, we could do a Clockwork Orange sort of thing where we'd condition them to never want to have sex again. It might even be cheaper too because you'd save the $200.

It's funny how these social problems become so easy to solve if you just don't let those pesky means get in the way of your ends. Reminds me of a certain war that I keep hearing about.
posted by boltman at 12:53 AM on April 10, 2003

Boltman: I concede the shadow of eugenics this program may cast on Americans. I tend to not see those kinds of possibilities; drug abuse in up here in Canada is racially more of an equal opportunity problem.

However the ethics of the situation on the medical side should, IMO, come down to two choices. Either a person requesting an elective procedure is compenant to make an informed decision, or they aren't. If they aren't society should be attempting to heal that person until they achieve competence. I realize that isn't how it works in the US and that if one isn't employed or independently wealthy access to non-life threatening health care is limited.

I also believe that a doctor refusing elective treatment because the patient may have ulterior motives (the $200) that she disagrees with is just as wrong as the doctor who doesn't tell someone they are going to die. A professional's job is to give me the options and consequences and then let me, even though I may be an addict or Jehovah's Witness, make an informed decision.

Whether or not they are "adults" or whether or not they've made some extremely poor choices in their lives is simply beside the point. Doctors' professional responsibilities do not allow them to make those sorts of judgments about the lives of their patients.

This basically sums up my position. A doctor shouldn't be considering outside history (drug abuse) when deciding whether to preform an elective procedure. Whether I'm a asian addict, black CEO, or white yuppie should not determine whether they will preform a sterilization. A doctor should either preform sterilization for all her patients or none.
posted by Mitheral at 8:28 AM on April 10, 2003

You have the extremely unpleasant history of eugenics to deal with.

Boltman: You can make historical references to eugenic initiatives in the past, in addition to the populations you suggest this program is targeting; however, they have posted the racial breakdown for the program recipients so far. It's a very fair balance to date.

No, this practice is probably not unconstitutional

It isn't, and as the AMA article points out, this is a private organization. Thus, it is free of the operating constraints of a federal or state funded agency.

A doctor shouldn't be considering outside history (drug abuse) when deciding whether to preform an elective procedure

Mitheral: Drug abuse is not an 'outside history' when it comes to medical practice and procedure. Even before you reach the realm of medical ethics, any doctor will consider a patient's medical history before performing even a regular checkup. In regards to their socioeconomic or class status, you are entirely right. But that is not to be confused with a medical history, even in the slightest. I would hope that you would want your own doctor to review your full medical history before any procedures are performed.

Minnesota, one of the leading states in proactive healthcare initiatives, has what is termed as a 'vulnerable adult law'. The basic premise is that certain individuals are not deemed to be entirely cognizant and able to make informed decisions. Initially targeted towards the elderly folks, it also covers drug addicts and dependents. Essentially, once classed as a 'vulnerable adult', an individual becomes a ward of the state, and has a more thorough and protective cloak of rights suited to them.

Although this could be a medical practitioner's worst nightmare in regards to governmental bureaucracy, if a similar law were to be adopted by the states and then followed up with a progressive network of treatment, therapy, and vocational training for individuals, it would be an immense start towards solving the root issues that the C.R.A.C.K. program is attempted to address.
posted by jazzkat11 at 10:54 AM on April 10, 2003

Mars Saxman, I think you're being disingenuous. Yes, the world has an over-population problem but the number of births prevented would be insignificant. To my mind this scheme preys on the unfortunate and lures them into sterilization with the promise of (not very much) money. I don't have a problem with the provision of reversible contraceptive drugs, but to permanently take away someone's ability to have children when they're in the head state of a drug addict is reprehensible. I'd almost go so far as to compare this scheme with that of the stereotypical predatory drug "pusher" luring people into their addiction in the first place.
posted by Lleyam at 11:09 AM on April 10, 2003

A professional's job is to give me the options and consequences and then let me, even though I may be an addict or Jehovah's Witness, make an informed decision.

Well, I guess in the area of doctor/patient relationships I'd have to slightly disagree with you. I think that the doctor's duty is to assist the patient in reaching the best decision for them given their particular circumstances. That involves a much more in-depth relationship with the patient than just simply providing some facts and then obeying their orders. Prescription drugs is probably the best example of this--patients hear all sorts of advertisements in the US for the latest miracle drugs and then march over to their doctor and demand that the doctor prescribe the drug for them, even when the drug might be very risky given their circumstances. The doctor's role it these situation is most certainly not just to provide information and then prescribe the drug. The doctor's role is to attempt to reach consensus with the patient about the best course of treatment, and that might include flatly refusing the prescribe certain medications in the face of patient demands for them. (note these types of situations are far different than your Jehovah's Witness example, where the question is about the right to refuse treatment rather than the right to receive inappropriate treatment).

Now, take away the $200, and I would have no problem with a doctor performing, or even, given the right circumstances, recommending sterilization to a drug-addict who has indicated concerns about getting pregnant and seems resolved not to have children. I quite agree with you that drug addicts should have the same degree of access to medical treatment as anyone else.

The problem here is the $200. Offering a serious drug addict money to get sterilized is little different than just offering them drugs. CRACK's advertisements ("don't let pregnancy get in the way of your drug habit") admit as much. If these women are physically addicted to drugs, they feel a need for the drugs not unlike the need a starving person feels for food. I presume you wouldn't condone offering food to a starving person in exchange for sterilization, even if they are adults that are starving due to bad choices or a character failing. The situation that CRACK addresses is little different in terms of the level of coercion involved.

As a doctor, when you know your patient is seriously physically addicted to drugs (which is a medical condition, I might add, not just an element of the patient's "background"), and--here's the key--you know that she is being given the opportunity to purchase drugs by a third party in exchange for undergoing the procedure she is asking you to perform, there's just no way that you can accept her consent to the procedure as valid, no more than her consent to have her kidney removed for $200 would be valid. The coercive power of the money is just too high given the circumstances. The ethical thing for the doctor to do is to simply refuse to perform the operation.

on preview: jazzk, I brought up the constitutional argument because I think it is illustrative of the extremely high value that our society places on the right to bodily autonomy and reproductive freedom. The fact that this program flies in the face of those values casts significant doubt on its appropriateness, and the propriety of doctors' involvment in it. Same goes for the eugencics point. It's not unconstituional, just extremely ugly given our history and values.

And I do think that state agencies participating in the program would be vulnerable to legal attack, at least in theory.
posted by boltman at 12:09 PM on April 10, 2003