Harm Reduction Round-Up

First, the Baltimore Sun apparently ran a column a while ago advocating the legalization of drugs. The author reports on the feedback he received from ex-users:

Drugs are part of a way of life - robbery, gangs, prostitution - that would persist even if the delivery method changed, the women said. "Addiction is not just getting high," said Felicia, who like the other addicts isn't especially proud of her past and didn't want her last name used. "It's the whole thing - copping [buying on the street], stealing, whatever you do."

Alcohol is legal, but "people out there will rob for a fifth of liquor because they can't get a dollar and 50 cents," she said. "They steal, they trick. They do the same thing. I've got friends that will go out there and hustle harder than me for a drink." Methadone also is legal, but plenty of methadone patients who are clean of heroin still break the law, she said.

Second, Addiction Inbox explores naloxone distribution.

Finally, Health Beat does a great job pointing out the increases in spending on incarceration at the same time as decreases in real health care spending:

Just take a look at history. According to a Health Affairs article from earlier this year, since 1987 public and private investment in substance abuse (SA) treatment has not kept pace with other health spending. From 1987 to 2003, the average annual total growth rate for SA treatment was 4.8 percent, while U.S. health care spending grew by 8.0 percent each year. Because of this mismatched growth rate, SA spending fell as a share of all health spending from 2.1 percent in 1986 to 1.3 percent in 2003.

Compare this drop in treatment spending to the increase in drug arrests: according to the Bureau of Justice Statistics, in 1987 drug arrests were 7.4 percent of all arrests reported to the FBI; by 2005, drug arrests had risen to 13.1 percent of all arrests. Our spending on SA treatment and the volume of drug arrests are moving in opposite directions. And for all the political pageantry surrounding yesterday’s report, President Bush’s FY 2008 budget calls for cutting $158.7 million from the Substance Abuse and Mental Health Services Administration (SAMHSA) budget and $278.9 million from the Safe and Drug-Free Schools and Communities (SDFS) program.

If you take a look at the President’s 2008 drug control budget, it may look as if it emphasizes treatment over enforcement, since it claims a 3.4 percent increase (the most of any other sector of drug control) from 2007. But take this number with a grain of salt—there are a lot of questions marks beneath the surface. In 2001 The Boston Globe reported that drug officials had no methodology to formulating the drug control budget, admitting that “we made it up” and that budget reports did not reflect how money was actually being spent through drug policy. Since 2003, there have been worries that the Office of National Drug Control Policy (ONDCP) budget inflates its commitment to treatment by including alcohol and tobacco in its numbers for SAMHSA, even though by statute ONDCP is excluded from dealing with those substances. Worse, since 2003 the ONDCP drug budget hasn’t reported incarceration costs and costs related to the prosecution of drug cases, resulting in an artificial parity between enforcement and treatment.

Health Beat goes on to discuss Insite in a way that frames arguments against it as pro-enforcement. She offers an explanation of why enforcement approaches seem to always win in political discourse:

More often than not, treatment is going to lose out because it lacks the populist, kick-you-in-the-gut political salaciousness of punishment.

To me it seems that the debate is actually between enforcement, treatment and HR. Unfortunately HR and enforcement seem to be the squeaky wheels and treatment loses out. These debates don't have to be framed as enforcement OR treatment OR HR. We could do all three. Couldn't we?